Using Lean to Improve Patient Safety and Resource Utilization After Pediatric Adenotonsillectomy

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Mingyang L Gray1, Sida Chen, Eliezer Kinberg

  • 1From the Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.

Journal of Patient Safety
|March 26, 2019
PubMed

Insights

This quality improvement project successfully reduced emergency department (ED) visits for children after adenotonsillectomy by over 50%. Lean principles were applied to streamline care and decrease nonemergent ED resource utilization.

Area of Science:

  • Quality Improvement
  • Pediatric Surgery
  • Healthcare Management

Background:

  • Postadenotonsillectomy patients frequently utilize emergency department (ED) resources for nonemergent issues.
  • This nonemergent use strains healthcare resources and impacts patient care.
  • Standardizing care pathways is crucial for optimizing outcomes.

Purpose of the Study:

  • To decrease nonemergent emergency department (ED) visits in pediatric adenotonsillectomy patients by 50%.
  • To achieve a future state of 5% or less overall ED visits for all postoperative patients within one year.
  • To standardize preoperative, intraoperative, and postoperative management protocols.

Main Methods:

  • A quality improvement project utilizing Lean methodologies.
  • Retrospective review of adenotonsillectomy cases over a 12-month baseline period.
  • Application of Lean tools like A3 Thinking, Ishikawa diagrams, and value stream mapping for analysis and intervention development.

Main Results:

  • The overall ED visit rate post-adenotonsillectomy decreased significantly from 36.2% to 15.5% (P = 0.0095).
  • ED visits for nonbleeding complaints saw a significant reduction from 30.4% to 12.1% (P = 0.01748).
  • No significant change was observed in ED visits for bleeding or the use of intraoperative dexamethasone and acetaminophen.

Conclusions:

  • Implementing Lean principles effectively reduced postoperative ED visit rates by over 50%.
  • This approach successfully addressed the nonemergent utilization of emergency resources.
  • Lean principles offer a valuable framework for waste reduction and value enhancement in surgical care.
Abstract

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