National guidelines recommend treatment time for stroke patients be under 60 minutes, yet the guidelines fail to suggest how to lower door-to-needle times. So Barnes-Jewish Hospital in St. Louis found a solution in Lean manufacturing techniques, according to new research in the American Heart Association journal Stroke.
Using the auto industry' approach to eliminate inefficiencies, the hospital reduced the average time between patient arrival and treatment. The door-to-needle time dropped from 58 to 37 minutes. Hospitals need quick treatment because the sooner a stroke is treated, the less damage the brain suffers.
To accelerate the treatment time, the hospital's stroke team evaluated each step in the door-to-needle process to identify and remove the inefficient steps.
"We sought suggestions from everyone involved, from the paramedics who bring in patients, to admitting clerks, radiology technologists, nurses and physicians," senior author Jin-Moo Lee, associate professor of neurology at Washington University School of Medicine, said yesterday in a statement.
The streamlined stroke treatment process involved paramedics bringing patients directly to the emergency department's CT scanner for evaluation for immediate brain imaging rather than to a patient examination room. It also added staff to carry out some tasks simultaneously, such as having two treatment nurses per patient so one nurse can put in an IV, while the other gets medications, noted the Washington University announcement.
The Lean strategy also has been found to speed the delivery of care to heart attack patients. After one hospital conducted rapid process improvements, its door-to-balloon time dropped from 89 minutes to 77, FierceHealthcare previously reported.
But Lean initiatives don't mean automatic process improvements, as 50 percent or more of healthcare Lean Six Sigma initiatives fail, Anthony Cirillo, president of Fast Forward Consulting, wrote last week in Hospital Impact. Highlighting the need for staff buy-in, he noted such efforts fall short "because organizations can't align their people around them."
For more:
- here's the announcement
- read the Washington University announcement
- here's the Hospital Impact blog post