Lean approach applied to the blood gas system in point-of-care testing (POCT): The IRCCS San Gerardo dei Tintori experience

Abstract

ABSTRACT Costs of medical care have increased worldwide, which may be due to unnecessary operational inefficiency. Different approaches exist to enhance procedural processes, and the Lean concept is used to improve quality and performance by systematically eliminating waste. In this study, Lean methodology with the four-stage Deming cycle (Plan, Do, Check, and Act) was applied to the point-of-care testing (POCT) system of the IRCCS San Gerardo dei Tintori. Starting from the evaluation of the current strategies used in the clinical laboratory, our goal was to facilitate workflow standardization, increase the efficiency, appropriateness, and quality standards in the execution of blood gas analysis in POCT, and to plan improvements, staff satisfaction, and safety. Six qualitative key process indicators, such as workflow, work area management, visual checks, reagents and supplies inventory, sample traceability, and work standardization, were used to investigate problems and identify solutions. The adoption of cutting-edge technologies, the training of personnel on the best pre-analytical practices, the standardization of cleaning procedures, the distribution of easy check workflow charts, and standardized material request documents reduced manual operations from 70 to 40% and patient identification errors of 10x. This approach created a diffuse collaborative culture and improved standardization of processes and safety.