Process Improvement Strategies Research Articles

Maximization of Resources in Health Care Facilities: Simple Review Article

Internationally, public health systems are under pressure to fulfill rising healthcare demand while facing increasing financial constraints. The amount of health outcomes that can be obtained with public healthcare spending must consequently be maximized. The debate of resource allocation in medical systems is crucial because, in systems with various financing sources, resources used to treat one sickness or person cannot be used to treat another condition or person. Initiatives to improve quality and safety are essential throughout the health care system. It is crucial to use a variety of process improvement strategies to spot inefficiencies and provide patients with unnecessary, yet preventable, carousing various techniques and tools for quality improvement, including as Plan-Do-Study-Act (PDSA), Six Sigma, and others. Several of the Global Sustainable Development Goals have included the idea of fairness in the delivery of health services, particularly the goal of universal health coverage. The efficiency of healthcare delivery at both the operational and system levels continue to be a topic of study as a result of rising healthcare expenditures and limited resources. Therefore, given little resources and complex population health needs, health planners and managers have had to struggle with striking a balance between the two.

Observational process data analytics using causal inference

AbstractVoluminous process data are available with the paradigm shift toward smart manufacturing. However, most historical data are observational, containing noncausal correlations due to confounders and mediators. Estimating causal effects from observational data remains a bottleneck in leveraging them for active applications such as optimization and control. This work aims to introduce a causal modeling framework for analyzing observational process data and extracting quantitative causal information. We demonstrate a real‐world application in steel manufacturing where causal inference is used to analyze observational production data and improve the steelmaking process. Additionally, we propose a novel formulation for identifying critical process parameters from observational data, where causal inference is combined with variance‐based methods to estimate corresponding risks of interventions to the manufacturing system. The proposed methods are compared with statistical ones to illustrate that causally interpreting statistical correlation leads to problematic results, while the provided workflow generates satisfactory strategies for process improvement.

Integrating 1G with 2G Bioethanol Production by Using Distillers’ Dried Grains with Solubles (DDGS) as the Feedstock for Lignocellulolytic Enzyme Production

First-generation (1G) bioethanol is one of the most used liquid biofuels in the transport industry. It is generated by using sugar- or starch-based feedstocks, while second-generation (2G) bioethanol is generated by using lignocellulosic feedstocks. Distillers’ dried grains with solubles (DDGS) is a byproduct of first-generation bioethanol production with a current annual production of 22.6 million tons in the USA. DDGS is rich in fiber and valuable nutrients contents, which can be used to produce lignocellulolytic enzymes such as cellulases and hemicellulases for 2G bioethanol production. However, DDGS needs a pretreatment method such as dilute acid, ammonia soaking, or steam hydrolysis to release monosaccharides and short-length oligosaccharides as fermentable sugars for use in microbial media. These fermentable sugars can then induce microbial growth and enzyme production compared to only glucose or xylose in the media. In addition, selection of one or more suitable microbial strains, which work best with the DDGS for enzyme production, is also needed. Media optimization and fermentation process optimization strategies can then be applied to find the optimum conditions for the production of cellulases and hemicellulases needed for 2G bioethanol production. Therefore, in this review, a summary of all such techniques is compiled with a special focus on recent findings obtained in previous pieces of research conducted by the authors and by others in the literature. Furthermore, a comparison of such techniques applied to other feedstocks and process improvement strategies is also provided. Overall, dilute acid pretreatment is proven to be better than other pretreatment methods, and fermentation optimization strategies can enhance enzyme production by considerable folds with a suitable feedstock such as DDGS. Future studies can be further enhanced by the technoeconomic viability of DDGS as the on-site enzyme feedstock for the manufacture of second-generation bioethanol (2G) in first-generation (1G) ethanol plants, thus bridging the two processes for the efficient production of bioethanol using corn or other starch-based lignocellulosic plants.

A Systematic Review of Nursing Practice Workarounds.

Nursing practice workarounds (NPWs) are a significant problem for health care organizations. Identified NPWs serve as a catalyst for innovation to improve efficiency, patient safety, and system design. To date, a systematic review of NPW literature has not been performed. The aim of this systematic review was to synthesize evidence of NPW definitions, context, and prevention strategies, utilizing previous research to develop a framework that examines the current state of this phenomenon and implications for clinical practice, while highlighting the need for future research. A systematic review of the literature was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Academic Search, Ovid MEDLINE, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Google Scholar databases were reviewed for eligible studies from 2013 to 2020. Results were further screened and sorted by relevance and scored for quality. Thirteen studies were included. Studies lacked the use of theory, and NPW definitions were varied. Nursing workarounds occurred most frequently when implementing new technology (46%) and when administering medications (31%). Contributing factors were workplace stressors and obstructions in workflow environment. Workaround prevention strategies include open communication and a proactive approach addressing conditions, situations, and processes. Overall study quality was low. This systematic review provides valuable information for critical care nurses and administrators regarding NPW. Implications for practice include the need for proactive and open communication between nurses and administrators when new technology and/or patient care processes require NPW. Administrative considerations include process and environmental improvement strategies to remove perceived workflow barriers. Future research to examine causes and consequences of NPW is needed to identify interventions for NPW prevention. Specific nursing considerations include workload, staffing and time constraints, and impacts of work-related stress levels. Critical care nursing processes should be examined for common NPW challenges. Interventions developed to address these challenges should then be tested to further advance evidence-based critical care nursing care.

Stakeholders' perceptions of barriers and facilitators for dental and mental health referrals of HIV/AIDS clinic patients.

Persons living with HIV/AIDS (PLWHA) are understudied and underserved with respect to both dental and mental health services. The coexistence of psychiatric and dental problems in PLWHA leads to more complex diagnostic assessments and treatments compared to the general population. The aim of the present study was to identify relevant themes from the perspectives of important stakeholders regarding the barriers to and facilitators of patient referral to these services. Semi-structured Key Informant Interviews (KIIs) were conducted with nine program directors and other key staff from New York State HIV clinics to examine barriers to and facilitators of successful dental and mental health referrals and factors that affect patient motivation. Primary themes crystalized around dental and mental health referral, subject knowledge and perspective, patient barriers, and strategies to overcome barriers. Identified barriers included mental health and HIV status stigma, social determinants of health, fear, disconnectedness, and inconsistent access for dental care. Facilitators identified included case management, integrated one-stop-shop care, and interprofessional awareness and collaboration. Potential patient motivators included process improvement strategies such as transportation support, case management, incentives, and building trust. Specific strategies to facilitate patient motivation such as care coordination and interprofessional collaboration is useful for improving dental and mental health referrals.

Perceptions and barriers of adverse drug reaction reporting within inpatient state psychiatric facilities.

IntroductionAdverse drug reactions (ADRs) are a leading cause of morbidity and mortality for hospitalized patients. Health care organizations track ADRs to reduce patient mortality, reduce hospital readmissions, decrease costs, and improve patient care. Differing definitions of ADRs cause confusion among providers, leading to hesitation with ADR reporting. The objective of this study was to understand health care professionals' perspectives of ADR reporting within inpatient state psychiatric facilities.MethodsA survey was sent to 143 health care professionals throughout 25 inpatient state psychiatric facilities within 1 state. The survey assessed the definition of an ADR, confidence in reporting, barriers to reporting, the role of reporting, who should report and review ADRs, and strategies for process improvement.ResultsThe survey had a 75.5% response rate with 108 respondents. Most respondents could identify the definition of an ADR, were moderately confident in reporting ADRs, and understood the importance of ADR reporting. Barriers to ADR reporting included the reaction not being serious, a lack of information about the ADR, or not enough clarity on how to report an ADR. Fear of retaliation was an additional barrier to ADR reporting. Training and direction on ADR reporting, education on real versus perceived consequences, a designated point person to aid in reporting, and better access to reporting technology were suggested improvements for ADR reporting.DiscussionFrom this survey, it is evident that respondents believe improved education and training, improved communication regarding reporting consequences, and consensus on the definition of an ADR would encourage reporting.

High-reliability organisation principles implemented in dentistry.

Introduction/objectives Successful dentistry inherently requires high-reliability and situational awareness to provide consistent high-quality care. However, treatment errors still occur in dentistry as they do in medicine. The importance of avoiding error is elevated for dentistry due to the increased frequency of irreversible procedures in each patient interaction compared to non-surgical specialties in medicine. Although a universal protocol for time-out exists, wrong-site procedures are a persistent healthcare issue in dentistry.Data By implementing high-reliability organisations (HROs) principles to dentistry, improved safety and quality can be achieved.Sources There are five essential principles that HROs have been observed to adhere to: preoccupation with failure; situational awareness/sensitivity to operations; a reluctance to simplify; deference to expertise; and commitment to resilience. Deep examination of the potential vulnerabilities in dentistry, using HRO ideology will create effective process improvement strategies. It fosters a culture of accountability using systematic problem-solving as opposed to condemnation.Study selection Implementation of HRO principles will improve the existing universal time-out process, while placing quality and performance at the central focus of strategic success.Conclusions Dentists can adopt these HRO principles into their practices to create effective process improvement strategies.

Reduction of CAUTI Events in an ICU During the COVID-19 Pandemic Through Shared Governance and Using Process Improvement Strategies

BackgroundCatheter Associated Urinary Tract Infections (CAUTIs) are associated with an increase in mortality, morbidity, length of stay, and hospital costs. Intensive Care Units (ICUs) have higher rates of CAUTIs than other hospital units. During the Coronavirus (COVID-19) pandemic, Hospital Associated Infections (HAIs) have increased, including a 30% increase in CAUTI events within ICUs nationwide. The aim of this project was to engage the frontline staff in reducing CAUTI rates in the ICU.MethodsThis project occurred on a 40 bed Intensive Care Unit (ICU) in a 350+ bed community hospital. The patient population included patients positive for COVID-19. The Shared Leadership Council (SLC), which comprised of both unit leadership and frontline staff, utilized Plan-Do-Check-Act (PDCA) framework to reduce the incidence of CAUTIs on the unit. Peri-care and catheter care was identified as a gap in recent CAUTI events. The SLC developed a 4-pronged approach to include: hand hygiene cues, peri-care and catheter care training, CAUTI prevention bundle and external device review, and Patient Care Assistants (PtCA) to champion and standardize catheter and peri-care in daily unit workflow.ResultsThe result was a reduction in the number of CAUTI events in the ICU during 2021 from 3 in Quarter 1, to 2 in Quarter 2, to 0 in Quarter 3.ConclusionsThese results support success in engaging front line staff in Process Improvement Projects aimed at reducing HAIs. The SLC identified opportunities to close CAUTI prevention bundle element gaps, developed a set of interventions, and executed the interventions in the ICU.

Establishing a Reference Procedure Length for Anterior Cervical Fusions: The Role for Standards in Surgical Process Improvement.

Surgical process improvement strategies are increasingly being applied to specific procedures to improve value. A critical step in any process improvement strategy is the identification of performance benchmarks. Procedure length is a performance benchmark for anterior cervical discectomy and fusion (ACDF) procedures; therefore, we sought to establish reference procedure lengths for 1-level, 2-level, and 3-level ACDFs at both teaching and non-teaching institutions and to describe methods for using this information to advance surgical process improvement initiatives. We performed a retrospective analysis of consecutive ACDFs performed at a resident teaching institution (RT) and a non-teaching institution (NT) for all 1-level, 2-level, and 3-level ACDFs. Mean case lengths and patient outcomes were calculated for individual surgeons and institutions. After limiting cases to 1-level, 2-level, and 3-level ACDFs and applying all exclusion criteria, 991 cases at the RT institution and 131 cases at the NT institution (a total of 1122 cases) were available for analysis. The mean (SD) procedure length for 1-level, 2-level, and 3-level ACDFs at the RT versus NT institutions were 121.9 min (36.3 min) and 73.6 min (29.7 min) (p<0.001), 172.7 min (44.8 min) and 112.0 min (43.0 min) (p<0.001), and 218.3 min (54.9 min) and 167.6 min (54.2 min) (p<0.001), respectively. Thirty-day outcomes were the same between institutions, except that the RT institution had a shorter mean hospital length of stay for 2-level ACDFs (1.6 days versus 2.9 days, p=0.001). This study is the first to attempt to establish a standard reference procedure length for 1-level, 2-level, and 3-level ACDFs. These data can guide efforts in surgical process improvement.

Multivariate Six Sigma: A case study in an outpatient pharmaceutical care unit

KEY POINT Six Sigma strategies for process improvement are widely used in industry and manufacturing. The spreading tendency to gather process data about hospital activity is leading to an increase of process improvement projects in the healthcare context. The complexity of these databases requires upgrading the classical statistical Six Sigma toolkit. In this paper we present a Six Sigma project carried out in an Outpatient Pharmaceutical Care Unit at Hospital Universitario Doctor Peset in Valencia (Spain), where we illustrate the benefits of using latent variables-based models, specifically Partial Least Squares Regression (PLS), integrating them into the DMAIC phases of the project.

Implementation of Process Improvements to Facilitate Cardiac CT Re-Credentialing in a Rural Healthcare System.

Background: Because rural providers may experience barriers in achieving the necessary components to successfully re-credential in cardiac computed tomography (Cardiac CT), we evaluated the current system for re-credentialing at our organization and implemented processes to facilitate Cardiac CT re-credentialing for our providers.Methods: Institutional opportunities for Cardiac CT quality assurance (QA) conference attendance, Cardiac CT imaging evaluation, and Cardiac CT continuing medical education (CME) acquisition were assessed in 2009 and 2013. Process improvement strategies were implemented in 2014 including adding electronic media hosting sites, a "hands-on" image interpretation course, and more options for CME acquisition. Pre- and post-educational improvements were evaluated over a 10-year period. The number and type of events hosted, attendees, image review opportunities, and CME credits awarded were assessed and compared at the provider level.Results: Attendance at Cardiac CT QA conferences increased substantially following implemented changes despite fewer certified Cardiac CT providers. Electronic attendance accounted for 26% of this increased attendance, while the "hands on" course provided 43 images for review per year. The number of Cardiac CT CME credits awarded increased substantially, paralleling increased QA and "hands-on" attendance.Conclusion: In rural healthcare systems, institutional strategies can increase provider access to components necessary for Cardiac CT level II re-credentialing. In the COVID-19 era, rural and urban health organizations may find considerable provider benefit and engagement by using similar process improvement methods to help providers meet local and national requirements for certification.

The role of equipment flexibility in Overall Equipment Effectiveness (OEE)-driven process improvement

In manufacturing and assembly operations, Overall Equipment Effectiveness (OEE) is a frequently used quantitative metric for measuring the overall productivity of a single machine, cell or an integrated manufacturing system. However, it does neglect and typically even penalizes flexibility capabilities. Today’s customer needs for highly customized products put these productivity-based measurements more and more under pressure. Frequent product changes on assembly workstations typically result in lower availability through more set-up, more performance losses due to slower cycles and the learning-forgetting effect of operators, and start-up defects resulting in more frequent quality issues. A contradiction arises: in modern production and assembly this flexibility becomes more and more important as an enabler for the mass customization paradigm, but is difficult to incorporate in (or put in relation to) an OEE figure or trend and conflicts with the OEE-driven process improvement strategies. Consequently, it can be argued that flexibility capabilities should be embedded in the equipment effectiveness calculation. Modern manufacturing and assembly cells should have a high equipment effectiveness through a high product mobility with a stable and uniform productivity across the complete range of products. This paper first highlights the importance of flexibility in the measurement of equipment effectiveness to facilitate the mass customization paradigm and to try to continuously improve towards a resilient manufacturing system. Next, the heuristic measurement framework for the Flexibility-included Overall Equipment Effectiveness (OEEFlex) metric is introduced, based on three core indicators: mobility, uniformity and range. The three factors are introduced and described. Links to current OEE measurement frameworks are made. The approach towards the new metric starts from a long list of losses and variables and possible calculation methods for the indicator values. Future research describes illustrative simulation scenarios to filter towards a short list of relevant and valuable calculation options for the overall metric. Followed by an expert based approach towards final selection of the metric and a case based in-company validation of the result.

S3389 Identifying Barriers to Vaccination in Veteran Patients With Advanced Liver Disease

Introduction: Patients with advanced fibrosis and cirrhosis are at high risk for vaccine-preventable conditions such as Hepatitis A/B. Despite Center for Disease Control (CDC) recommendations, many patients with liver disease remain unvaccinated. The goal of our project was twofold: (1) to identify barriers to vaccination at a Veterans Affairs Medical Center (VAMC), and (2) to formulate process improvement strategies to improve vaccination rates among our veterans. Methods: An ad-hoc multidisciplinary quality improvement team was assembled to evaluate and improve upon vaccination efforts in the VAMC Gastroenterology (GI) and Liver clinics. Data was collected through a 10-item questionnaire consisting of multiple choice, free response, and Likert scale questions that was distributed electronically to clinic providers. Results: Twenty providers participated in the survey: 8 attendings (40%), 9 GI fellows (45%), 1 nurse practitioner (5%), 1 physician assistant (5%), and 1 pharmacist (5%). Six providers (30%) reported almost always addressing vaccination status with patients during an encounter in clinic. Data also revealed that 50% of providers rarely or never undergo post vaccination serological testing (Figure 1). Thirteen (65%) providers currently have a note template related to vaccinations, but 19 providers (95%) reported an interest in implementing a standardized template. A majority of providers believed that the most effective and opportune time to address vaccinations during an encounter was during patient intake with the clinic nurse (13, 65%) as opposed to during the encounter with the provider (4, 20%) or during check-in with the medical support assistant (3, 15%). Moreover, there was variability amongst providers in prioritizing vaccinations during patient encounters (Table). Qualitative data was obtained regarding perceived barriers to vaccination. Common themes elicited were lack of time (65%), patients declining vaccinations (55%), and overlap of responsibility with primary care providers (35%). Providers also expressed difficulty determining vaccination history for patients. Conclusion: Significant room for improvement remains in vaccination rates of VAMC patients. Addressing opportunities and barriers such as provider education, standardizing a template for vaccination status and immunity in provider documentation, and engaging veterans during clinic intake could prove to be beneficial interventions improving the rates of vaccination in the future.Figure 1.: Addressing Vaccination Status and Post-Vaccination Serological Testing During Patient Encounters.Table 1.: Priority of Addressing Vaccinations During Clinic Encounters.

Lipid reduction to improve clarification and filterability during primary recovery of intracellular products in yeast lysates using exogenous lipase

AbstractBACKGROUNDThe yeast Pichia pastoris is a popular host organism for production of a range of biological products, several of which are intracellular. The disruption of yeast cells by homogenization also releases large quantities of lipids, which can foul the downstream membranes and chromatography matrices used for purification. This work examines lipid removal from yeast cells following homogenization by enzymatic degradation and its impact on the performance of the subsequent centrifugation and filtration.RESULTSLipase treatment of cell homogenate at 37 °C for 2 h, followed by clarification using a scaled‐down mimic of disc stack centrifugation, resulted in a 6.5‐fold improvement in solids removal when compared to untreated feed material. The lipase‐treated and untreated materials that had undergone initial centrifugation were then tested for filtration performance by passing the material through a 0.45 μm polyethylene sulfone membrane under constant flux. A 50% increase in throughput was observed in comparison to the untreated material.CONCLUSIONThese proof‐of‐concept data suggest enzymatic digestion of lipids, analogous to the widely performed DNA reduction using nucleases, could be a valuable process improvement strategy. © 2021 The Authors. Journal of Chemical Technology and Biotechnology published by John Wiley &amp; Sons Ltd on behalf of Society of Chemical Industry (SCI).

Electrochemical vanillin reduction in a plane parallel flow reactor: Characterization, modeling and process improvement

The application of electrochemical flow reactors for electrosynthetic processes on a laboratory or pilot scale has recently gained increased attention as they provide reliable and improved performance and facilitate a further scale-up. We investigated in this study the electrochemical reduction of vanillin (4-hydroxy-3-methoxybenzaldehyde) to its pinacolization product hydrovanilloin, a building block in the synthesis of biobased polymers, in a divided plane parallel flow reactor in batch recycle operation mode. First, the mass transport of the flow reactor was characterized with dimensionless groups using the ferricyanide ion / ferrocyanide ion system as model reaction. The mass transport was further improved by 3D-printed turbulence promoters. We then studied the electrochemical vanillin reduction monitored by an online UV-cell setup at various electrolyte flow rates up to 20 cm s−1 and current densities up to 50 mA cm−2 with total conversions of 95%. Key figures of merit such as Faradaic efficiencies, space-time-yields and specific energy consumptions were calculated and a simple model was used to describe vanillin concentration decays and courses of these key figures of merit. The model distinguishes between a kinetic and mass transport-controlled zone, which transition point was predicted based on the mass transport characterization results. Lastly, we developed based on the model an operational process improvement strategy for fast and energy efficient production of hydrovanilloin and validated it experimentally. This study reports a first engineering approach for the production of vanillin-based polymer building blocks in an electrochemical flow reactor highlighting the ability of simple prediction models.

Peningkatan Kinerja Operations Pada Perusahaan E-Commerce Enabler Indonesia PT XYZ

This study aims to explain the increase in operating performance at the E-Commerce Enabler PT. XYZ. The current condition of PT. XYZ into several parts such as operationally. The business process carried out by PT XYZ is still manual, one of which is using google docs. The biggest problem with this company is the high number of canceled orders, this is because many processes are not going well. The consultation project aims to provide recommendations for business process improvement strategies from the operational management side of PT XYZ in order to increase client satisfaction. The analysis of this research is divided into two parts, the first theory analysis and validation analysis which includes data and interviews. The results showed 1) The main mistakes that occurred in the company PT. XYZ is the delivery of Service Level Agreement (SLA) that is not as expected. 2) Not achieving the Service Level Agreement (SLA) causes the canceled order value to increase. 3) To find out the root cause of the non-conformity of the Service Level Agreement (SLA) is to use the theory of Business Process Management (BPM).

Peningkatan Kinerja Operations Pada Perusahaan E-Commerce Enabler Indonesia PT XYZ

This study aims to explain the increase in operating performance at the E-Commerce Enabler PT. XYZ. The current condition of PT. XYZ into several parts such as operationally. The business process carried out by PT XYZ is still manual, one of which is using google docs. The biggest problem with this company is the high number of canceled orders, this is because many processes are not going well. The consultation project aims to provide recommendations for business process improvement strategies from the operational management side of PT XYZ in order to increase client satisfaction. The analysis of this research is divided into two parts, the first theory analysis and validation analysis which includes data and interviews. The results showed 1) The main mistakes that occurred in the company PT. XYZ is the delivery of Service Level Agreement (SLA) that is not as expected. 2) Not achieving the Service Level Agreement (SLA) causes the canceled order value to increase. 3) To find out the root cause of the non-conformity of the Service Level Agreement (SLA) is to use the theory of Business Process Management (BPM).

Utilizing process improvement strategies to generate clinic templates and improve patient flow in pediatric otolaryngology

ObjectivesTo examine outcomes from process improvement strategies aimed to: 1) develop computer generated physician clinic templates using captured and historic clinical data, and, 2) introduce said new template designs while maintaining historic daily patient volumes. MethodsAn Institutional Review Board approved retrospective review of time stamped data collection in a tertiary facility pediatric otolaryngology clinic. ResultsA discrete-event simulation was built from timestamps associated with clinic interaction milestones. The data were analyzed to develop standard clinic templates with the goal to reduce patient overall visit length by 10%. A total of 12,052 clinic visits were analyzed, 8,045 before (avg. of 62.9 visits/day) and 4,007 after (avg. of 65.7 visits/day) template standardization. The change led to a 10.5% (5.5 min, p < 0.001) decrease in total clinic visit time from 52.3 ± 25.9 min to 46.8 ± 25.0 min. This data extrapolated over a year is estimated to save 1,567 clinic hours. Secondarily, it was found that patient experience was not affected as a result of this change. ConclusionDiscrete-event simulation, using the principles of process improvement, is effective in guiding clinic operational redesign. This quality improvement project decreased the average length of clinic visit by 10% with no impact on historic high clinic volumes. Patient flow can improve in high volume pediatric otolaryngology practices by using process improvement strategies and discrete-event simulations to create standardized provider templates. Theoretically, this strategy can lead to improved patient and physician experiences along with an increase in patient visits over time.

Using Lean Six Sigma to Decrease Delivery Time of Blood Products to the Operating Room

Lean Six Sigma (LSS) is a process improvement strategy used in many industries. Its goal is to improve performance and quality by eliminating waste, optimizing flow, and reducing variability. This article describes LSS methods and their application in health care. We detail a successful quality improvement (QI) initiative in which we tested LSS tools to evaluate and enhance our institution's blood product delivery to the operating room (OR). Incorporating LSS-driven changes resulted in a revised workflow, which decreased personnel workload and significantly reduced delivery time. We hope this article will encourage other health care institutions to integrate LSS strategies into their workflows.

Experimental study on oxygen concentrator with wide product flow rate range: individual parametric effect and process improvement strategy

Improvement on oxygen (O2) concentrator using pressure swing adsorption (PSA) technology according to variable product demands is of great significance, which, for instance, provides the key step for success in practical O2 therapy for COVID-19 patients who need to be delivered with a wide product flow rate range (1–15 standard liter per minute (SLPM)) of medical O2 (purity > 82%). This work studied the individual effects of major PSA process parameters on O2 production performance at the product flow rate of 3.46–19.88 SLPM (0.64–3.68 SLPM per kilogram of adsorbent (SLPM/kg)), based on a self-designed two-bed PSA unit with a modified Skarstom cycle using Li-LSX zeolite adsorbents. The improvement strategies were accordingly proposed based upon influential mechanisms of each parameter: 1) at lower product flow rates (≤2.00 SLPM/kg), increasing the purge flow rate and decreasing the adsorption pressure to suppress excess O2 adsorption, and decreasing the feed flow rate to ensure low energy consumption; 2) at higher product flow rates (≥2.00 SLPM/kg), decreasing the purge flow rate and increasing the adsorption pressure to eliminate N2 breakthrough and O2-rich product waste, and appropriately increasing the feed flow rate to enhance cost-effectiveness. An improved set of parameters rendered O2 purity (95.67–74.86%), recovery (11.28–49.05%), productivity (0.47–2.04 mmol/kg/s) increased by up to 3.52–20.08%, 0.36–20.47%, 6.82–19.61%, and energy consumption (4.07–0.95 kWh/kgO2) decreased by up to 10.56–18.10%, in comparison to two conventional sets, respectively. The results are beneficial for developing intellectualized and flexibly-controlled O2 concentrators for practical applications.