In many trauma hospitals, especially Level I and II centers, there tends to be a tendency toward complex, high volume care. As any trauma professional knows, this is a setup for system inefficiencies. Lean principles were derived from Japanese manufacturing practices in the 1980’s, and includes a toolset that helps companies eliminate waste. Any use of resources for anything but creating end value for the customer is considered waste and must be eliminated.
The discharge planning process for trauma inpatients is one of many parts of the care spectrum that contains waste, and researchers at Grant Medical Center in Columbus looked at the result of applying lean principles to it.
A lean mapping event was held, which is one of the tools promoted by the lean process. This identified areas for immediate evaluation and intervention. This, in turn, resulted in new workflows, which were then evaluated for their effect.
The primary area of concern indentified was inter-service communication. This included getting reliable information from consult services and providing pertinent information to physical therapy. They also discovered that trauma patient admissions to units not designated for the trauma service resulted in lengths of stay 1.6 times the average.
Three areas for improvement were identified:
- Off-unit trauma admissions
- Patients with length of stay > 15 days
- Miscommunication regarding patient education at discharge
Bottom line: This abstract is heavy on theory and very light on practice. There is no statement or analysis of results. However, it does seem like there may be some use for Lean methodology in analyzing trauma care. The trick will be to develop interventions that actually remove some of the inefficiencies in our care processes. I will definitely sit in on this presentation!
Reference: Lean methodology for performance improvement in the trauma discharge process. EAST 2014, oral paper #31.