Hospital Uses Lean to Speed Stroke Care

Targeted News Service

October 19, 2012

A hospital stroke team used lean manufacturing principles—most frequently employed in the automotive industry—to accelerate treatment times, according to new research in the American Heart Association’s journal Stroke.

In a prospective observational study, the average time between patients arriving at Barnes-Jewish Hospital in St. Louis, MO, and receiving the clot-busting agent tissue plasminogen activator (tPA) decreased 21 minutes using the process improvement technique. Data from more than 200 patients ranging over three years were included in the study analysis.

The shorter the time between patients arriving at the hospital and receiving tPA, the greater the chance to reduce brain injury after stroke, researchers said.

Using lean techniques, the hospital’s stroke team identified unnecessary or inefficient steps, such as inefficient patient transportation, tasks performed one at a time rather than simultaneously and time-consuming traditional lab-based tests.

Protocols were formulated to eliminate wasteful steps, keeping only crucial steps that added value to patient care, in keeping with auto manufacturers’ lean methods, which eliminate inefficiencies in automobile production.

The team streamlined the process by having emergency medical services route patients directly to the CT scanner for immediate brain imaging, enlisted the help of more team members who each had fewer tasks to complete and instituted bedside tests that provide laboratory results within minutes.

These modifications ensured rapid diagnosis and treatment would be available for patients as soon as they arrived at the emergency department. As a result, 78% of stroke patients received tPA within one hour of arrival.

The “Get with the Guidelines” national database indicates that currently only about 30% of patients in the United States are treated within one hour. The overall treatment time was reduced from 60 minutes to 39 minutes, an improvement sustained for a year after implementation.

The protocol changes didn’t alter patient safety or clinical outcomes, researchers said, adding that a larger study is needed to validate results

“There is growing awareness that fast and efficient treatment is important for improving the effectiveness of tPA,” said Jin-Moo Lee, M.D., lead author of the study and director of the cerebrovascular disease section in the department of neurology at Washington University School of Medicine in St. Louis.

“National guidelines suggest that door-to-needles times should be under 60 minutes, yet these guidelines do not state how this can be achieved. Lean process improvements methodology can be effectively applied towards achieving this and other process improvement goals.”