Abstract 3670: Lean Manufacturing Process Improvement Methods Accelerate and Simplify Transfer of Patients to a Comprehensive Stroke Center

Abstract

Background and Purpose: Acute therapies offered at comprehensive stroke centers require the rapid transfer of stroke patients from outlying hospitals. Here, we describe the application of Lean manufacturing process improvement methods to stroke care in order to accelerate the transfer of patients from outlying hospitals. Methods: A multidisciplinary team of Stroke Neurologists, Vascular Neurosurgeons, ED Physician, Call Center staff and Lean Performance Management Engineers critically evaluated the chain of events required to accept a patient for transfer from outlying hospitals. Barriers and inefficiencies were identified in a “current state” Value Stream Map (VSM). A “future state” VSM created a new process for stroke patient transfer by overcoming the identified barriers and was implemented in March, 2011. Metrics were prospectively collected for a 4-month period prior to (7/1/10-10/30/10) and after implementation of the “future state” VSM (3/1/11-6/30/11), and included: mean time from call start to physician acceptance, percent of calls resulting in acceptance of patients within 15 minutes, total number of patients accepted within 15 minutes over 4 months, and total number of calls. Student’s T-test was used to compare means, while Chi-square test was used to compare ratios. Results: Identified barriers to rapid acceptance of patients included: 1) inefficient distribution of cases between services (neurology vs. neurosurgery); 2) calls frequently transferred from one physician to another on other services; and 3) lack of available beds resulting in acceptance delays. To overcome these inefficiencies, a new process was created with the following changes: 1) alternating call coverage shared between neurology and neurosurgery; 2) immediate acceptance of the patient with behind the scenes patient allocation to appropriate service; 3) direct involvement of patient placement services in transfer process. Mean time to acceptance decreased significantly from 14 min prior to new protocol implementation to 9 minutes (p< 0.03). The total number patients accepted within 15 minutes increased from 186 to 307 during this 4-month period. Percent accepted within 15 minutes also increased from 73% to 92% (p<0.0002). In addition, the rate of patient calls (#calls/month) increased after new protocol implementation (see table ). Conclusions: Lean manufacturing process improvement tools are effective in designing hospital and physician work flow to help improve stroke care. Such practices require a collaborative approach including all parties involved in the process.