Lean techniques to improve flow of critically ill patients in a health region with its epicenter in the intensive care unit of a reference hospital

Abstract

ObjectiveTo analyze whether the application of Lean techniques to improve the flow of critically ill patients in a health region with its epicenter in the intensive care unit (ICU) of a reference hospital. DesignObservational study with pre and post intervention analysis. SettingICU of a reference hospital. PatientsWe design projects and a value stream map of flow and compared pre and post intervention. InterventionsWe recorded demographic data, patient transfers by EMS for lack of beds and delay times in the discharge from ICU to ward. Multidisciplinary meetings and perform daily visual panel, with high priority ICU discharge. We promote temporary relocation of critically ill patients in other special areas of the hospital. We performed a professional satisfaction questionnaire with pre and post implementation of process. We make a statistical analysis of pre and post-intervention comparisons. ResultsWe planned for 2013 and progressively implemented in 2014. Analysis of patients entering the critical process flow (1) evaluate patients who must transfer for lack of beds, focusing on a diagnosis: pre 10/22 vs. 3/21 post (p=.045); (2) analysis of time delay in the discharge from the ICU to ward: 360.8±163.9min in the first period vs. 276.7±149.5 in the second (p=.036); and (3) personal professional satisfaction questionnaire, with 6.6±1.5 points pre vs. 7.5±1.1 in post (p=.001). Analysis of indicators such as the ICU acquired infections, length of ICU stay, the rate of re-admissions and mortality, with no significant differences between the two periods. ConclusionsThe application of Lean techniques in the critically ill process had a positive impact on improving patient flow within the health region, noting a decrease of transfers outside the region due to lack of beds, reduced delayed discharge from ICU to conventional ward and increased satisfaction of ICU professionals.