Updating old protocols helped a team of specialists improve the quality of care they provide for atrial fibrillation (AFib) patients. The group shared its story in a new analysis for JACC: Clinical Electrophysiology.
“The steep rise in the prevalence of AFib is a global health problem,” wrote lead author Benjamin Berte, MD, PhD, a cardiology professor at Luzerner Kantonsspital in Switzerland, and colleagues. “It has a clear impact on the quality of life of affected patients and on the health care budget.”
Berte et al. aimed to boost care by standardizing the pulmonary vein isolation (PVI) procedure at a single medium-sized hospital. Prior studies had concluded that the quality of PVI could be inconsistent, so the authors thought this would be an effective way to bring about change and help specialists deliver high-quality patient care.
The team turned to lean management techniques—which focus on organization, a consistent workflow and continuous improvement—to assist with its mission.
“Value can be defined as delivered care divided by cost,” they wrote. “Ideally, each patient receives the same good quality of care in an equitable, timely way.”
Berte and colleagues began by simplifying the procedure and standardizing the necessary materials, technique and workflow. The next step was eliminating waste—and the No. 1 thing they saw being wasted during PVI procedures was time. Changes were made to make things move in a faster, more efficient manner. Patient preparation was moved to a large preparation room outside of the lab, for example, and an updated closure suture technique was implemented that reduced post-procedure compression time.
The third and final step involved improving standardization by “agreeing on which value-added steps were used in which specific order.” A data-tracking device monitored specialists in advance, recording just how long it took to complete each step of the process. The PVI procedure was broken down into a series of steps, and those steps were arranged in a way that was intended to improve care across the board.
The final result was a new-look protocol that saved time while still achieving strong patient outcomes. Consistent reductions were seen in procedural length, skin-to-skin-time and setup time. Overall efficiency improved by more than 41 minutes.
“After two decades of understanding of pathophysiology, determination of the ideal treatment strategy, guideline implementation, and confirmation of an acceptable effectiveness and safety profile, the last step should be the analysis and improvement of AFib ablation efficiency,” the authors concluded. “To evaluate efficiency, both reduction in time and variance need to be investigated. The incorporation of lean management could potentially lead to improved efficiency with an additional beneficial effect on safety and effectiveness.”
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.