Hospital uses 'lean' manufacturing techniques to speed stroke care

October 18, 2012

A hospital stroke team used auto industry "lean" manufacturing principles 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 (tPA), decreased 21 minutes using process improvement techniques adapted from auto manufacturing. Data from more than 200 patients was included in the study analysis, ranging over 3 years.

The shorter the time between patients arriving at the hospital and receiving tPA, the greater the chance to reduce 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 eliminates inefficiencies in .

The team streamlined the process by having EMS route patients directly to the for immediate brain imaging, enlisted the help of more team members each with fewer tasks to complete, and instituted bedside tests which provide laboratory results within minutes. These modifications ensured that rapid diagnosis and treatment would be available for patients as soon as they arrived at the Emergency Department.

As a result, 78 percent of received tPA within one hour of arrival. The "Get with the Guidelines" national database indicates that currently only about 30 percent of patients in the United States are treated within one hour. The overall treatment time was reduced from 60 minutes to 39 minutes—sustained for a year after implementation.

The protocol changes didn't alter patient safety or clinical outcomes, researchers said.

"There is growing awareness that fast and efficient treatment is important for improving the effectiveness of tPA. 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," said Jin-Moo Lee, M.D., Ph.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.

A larger study is needed to validate results, researchers said.

Explore further: Despite benefit, hospitals not always alerted of incoming stroke patients

Related Stories

Despite benefit, hospitals not always alerted of incoming stroke patients

July 10, 2012
Treatment is delivered faster when emergency medical services (EMS) personnel notify hospitals a possible stroke patient is en route, yet pre-notification doesn't occur nearly one-third of the time. That's according to two ...

Clot-busting drug safe for stroke patients taking blood thinner

May 10, 2012
Acute ischemic stroke patients taking the blood thinner warfarin can be treated safely with the clot-busting drug tissue plasminogen activator (tPA), according to research presented at the American Heart Association's Quality ...

Study: Stroke victims not receiving timely diagnosis, care

May 2, 2012
The mantra in stroke care is "time is brain." With each passing minute more brain cells are irretrievably lost and, because of this, timely diagnosis and treatment is essential to increase the chances for recovery. While ...

Recommended for you

Could this protein protect people against coronary artery disease?

November 17, 2017
The buildup of plaque in the heart's arteries is an unfortunate part of aging. But by studying the genetic makeup of people who maintain clear arteries into old age, researchers led by UNC's Jonathan Schisler, PhD, have identified ...

Raising 'good' cholesterol fails to protect against heart disease

November 16, 2017
Raising so-called 'good' cholesterol by blocking a key protein involved in its metabolism does not protect against heart disease or stroke, according to a large genetic study of 150,000 Chinese adults published in the journal ...

New model estimates odds of events that trigger sudden cardiac death

November 16, 2017
A new computational model of heart tissue allows researchers to estimate the probability of rare heartbeat irregularities that can cause sudden cardiac death. The model, developed by Mark Walker and colleagues from Johns ...

Popular e-cigarette liquid flavorings may change, damage heart muscle cells

November 16, 2017
Chemicals used to make some popular e-cigarette liquid flavorings—including cinnamon, clove, citrus and floral—may cause changes or damage to heart muscle cells, new research indicates.

Possible use for botulinum toxin to treat atrial fibrillation

November 16, 2017
From temporarily softening wrinkles to easing migraines, botulinum toxin has become a versatile medical remedy because of its ability to block nerve signals that can become bothersome or risky.

Proteome of the human heart mapped for the first time

November 15, 2017
A healthy heart beats about two billion times during a lifetime, thanks to the interplay of more than 10,000 proteins. Researchers from the Max Planck Institute of Biochemistry (MPIB) and the German Heart Centre at the Technical ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.