Newswise A process developed to increase efficiency and productivity in Japanese car factories has helped improve stroke treatment at Barnes-Jewish Hospital, report researchers at Washington University School of Medicine in St. Louis.
By applying the principles of Toyotas lean manufacturing process, doctors sharply reduced the average time between patient arrival and treatment, known as door-to-needle time, from 58 to 37 minutes.
The findings are reported Oct. 18 in the journal Stroke. In an average year, the medical schools physicians treat 1,300 stroke patients at Barnes-Jewish.
Beginning stroke treatment earlier can help prevent the brain damage that causes paralysis and loss of speech after a stroke. The researchers say the drop in treatment time results from applying a key component of lean manufacturing to patient care: getting input from all members of the team to identify inefficient steps involved in the process.
We sought suggestions from everyone involved, from the paramedics who bring in patients, to admitting clerks, radiology technologists, nurses and physicians, says senior author Jin-Moo Lee, MD, PhD, associate professor of neurology at Washington University School of Medicine in St. Louis and director of the cerebrovascular disease section in the Department of Neurology. Once the inefficient steps were identified, we developed a completely new protocol that eliminated them. This new treatment protocol helped us achieve one of the fastest door-to-needle times in the country.
Barnes-Jewish has a dedicated stroke team capable of quickly evaluating and treating patients with tPA, which breaks up blood clots in the brain that cause strokes. The earlier it is given, the more effective tPA is at preventing permanent brain damage caused by stroke.
Because tPA can cause dangerous bleeding in the brain and throughout the body, the drug can no longer be given if too much time elapses after a stroke begins. At that point, its risk outweighs the potential benefit. Ideally, the drug must be given within 60 minutes after a stroke begins, a period known as the golden hour.
We already had very good door-to-needle times, but we thought that we could do better, Lee says. So we put all of our team members in a room for two days and asked them to evaluate each step in the door-to-needle process.
Experts at Barnes-Jewish with experience using the principles of lean manufacturing in a healthcare setting helped facilitate the discussion.
Identifying steps that are wasteful and do not add value is a primary goal of lean manufacturing, says David Jaques, MD, vice president of Surgical Services at Barnes-Jewish Hospital and a professor at the School of Medicine. Lean has made it possible to speed the delivery of medication or blood, improve teamwork and communication and ensure that those caring for patients always have easy access to supplies and equipment.
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