Going lean trims D2B time by facilitating teamwork

Initiating a lean approach into its PCI program allowed a hospital to knock 12 minutes off its average door-to-balloon time, according to a case study prepared for the Agency for Healthcare Research and Quality (AHRQ).

AHRQ contracted with the American Institutes of Research to evaluate the use of lean production in the healthcare setting. The manufacturing sector implements these approaches as a way to eliminate the use of resources that don’t provide value to the system. The concept has been applied to healthcare to reduce waste and improve care.

The report’s authors provided six cases studies from five diverse types of hospitals that had taken on a lean project. One Midwest urban facility with a heart center, defined as Central Hospital, had introduced a lean quality improvement initiative into its care process in 2007 at the behest of a newly hired president with experience in lean design.  

The project teams formed to shepherd the lean project selected door-to-balloon time as prime target because the hospital’s average 89-minute time flirted too closely with the maximum standard of 90 minutes. They used a rapid cycle improvement tool to work with the cardiac catheterization laboratory and the emergency department to study the door-to-balloon process, identify possible improvements and conduct trial runs.

To improve workflow and efficiency, they developed a check list that allowed cath lab personnel to see what emergency department staff had done before handing off the patient. Emergency staff began alerting the cath lab immediately in the case of a STEMI patient and the cath lab staff began to help emergency room prioritize steps for the transfer. All cardiologists, and not just the cath lab group, received a weekly update on the door-to-balloon project’s progress at staff meetings.

Based on their new protocols, they reduced the average door-to-balloon time from 89 to 77 minutes. According to staff interviewed for the case study, the process improved communication between the two hospital units, boosted morale, created a sense of serving patients well and even changed their perceptions of the rapid cycle improvement tool.

The report, “Improving Care Delivery Through Lean: Implementation Case Studies,” was completed in late 2014 and is now available online.