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

Laser device placed on the heart identifies insufficient oxygenation better than other measures

September 20, 2017
A new device can assess in real time whether the body's tissues are receiving enough oxygen and, placed on the heart, can predict cardiac arrest in critically ill heart patients, report researchers at Boston Children's Hospital ...

Metabolism switch signals end for healing hearts

September 19, 2017
Researchers have identified the process that shuts down the human heart's ability to heal itself, and are now searching for a drug to reverse it.

Beta blockers not needed after heart attack if other medications taken

September 18, 2017
A new study from the University of North Carolina at Chapel Hill finds beta blockers are not needed after a heart attack if heart-attack survivors are taking ACE inhibitors and statins. The study is the first to challenge ...

Which single behavior best prevents high blood pressure?

September 15, 2017
(HealthDay)—You probably already know that certain healthy lifestyle behaviors can reduce your risk of developing high blood pressure, but is any one behavior more important than the others?

RESPECT trial shows closing a small hole in heart may protect against recurrent stroke

September 13, 2017
A device used to close a small hole in the heart may benefit certain stroke patients by providing an extra layer of protection for those facing years of ongoing stroke risk, according to the results of a large clinical trial ...

Study shows so-called 'healthy obesity' is harmful to cardiovascular health

September 11, 2017
Clinicians are being warned not to ignore the increased cardiovascular health risks of those who are classed as either 'healthy obese' or deemed to be 'normal weight' but have metabolic abnormalities such as diabetes.

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.