Reducing door-to-needle times using Toyota's lean manufacturing principles and value stream analysis

Area of Science:

• Neurology
• Healthcare Management
• Process Improvement

Background:

• Timely administration of tissue-type plasminogen activator (tPA) is crucial for acute ischemic stroke treatment efficacy.
• National initiatives aim to shorten door-to-needle times for tPA delivery.
• Lean process improvement methodology offers a framework for optimizing clinical workflows.

Purpose of the Study:

• To develop and implement a streamlined intravenous tPA protocol for acute ischemic stroke.
• To reduce door-to-needle times by analyzing and improving the existing treatment pathway.
• To evaluate the impact of lean process improvement on stroke care efficiency and safety.

Main Methods:

• Value stream analysis (VSA) was employed by a multidisciplinary team to identify inefficiencies in the tPA protocol.
• A pre-VSA and post-VSA epoch comparison was conducted to assess changes in protocol metrics and clinical outcomes.
• Protocol modifications included direct patient routing to CT, parallel workflow processing, and point-of-care laboratories.

Main Results:

• VSA identified key inefficiencies such as patient re-routing, serial processing, and laboratory delays.
• The revised protocol significantly decreased mean door-to-needle time from 60 minutes to 39 minutes (P<0.0001).
• The percentage of patients treated within 60 minutes increased from 52% to 78% (P<0.0001) with no increase in symptomatic hemorrhage.

Conclusions:

• Lean process improvement is an effective strategy for expediting time-dependent stroke care.
• Streamlined protocols can significantly reduce treatment delays for acute ischemic stroke.
• Implementing lean methodology enhances efficiency without compromising patient safety in tPA administration.