Using a lean management approach in acute ischemic stroke management: a systematic review

Area of Science:

• Healthcare Management
• Process Improvement
• Stroke Care

Background:

• Stroke is a leading global cause of death, necessitating efficient treatment protocols.
• Early diagnosis and intervention are critical for improving patient outcomes in acute ischemic stroke (AIS).
• Lean management, adapted from manufacturing, offers a framework for optimizing healthcare processes.

Purpose of the Study:

• To examine the application and effectiveness of lean management practices in hospital settings for managing acute ischemic stroke (AIS).
• To assess the impact of lean tools on key performance indicators in AIS treatment.

Main Methods:

• A systematic literature search was conducted across MEDLINE and SCOPUS databases for studies published between 2000 and 2022.
• Included studies focused on lean practices in AIS treatment, analyzing workflow using value stream mapping.
• Outcome measures primarily included door-to-needle (DTN) time for rtPA and door-to-puncture (DTP) time for mechanical thrombectomy.

Main Results:

• Thirteen studies met the inclusion criteria, evaluating treatments like recombinant tissue plasminogen activator (rtPA) and mechanical thrombectomy (MT).
• Value stream mapping was universally applied to analyze AIS treatment workflows.
• Statistically significant reductions in DTN time were observed in five studies, and in DTP time in two studies.

Conclusions:

• Lean management principles and tools, particularly value stream mapping, can effectively reduce in-hospital delays in AIS treatment.
• Implementing lean practices supports achieving key performance indicators and aligns with current stroke treatment guidelines.
• The growing body of research indicates increasing adoption of lean management in healthcare for process optimization.