Universidad Autónoma de Baja California, Ensenada, Baja California, Mexico.
Universidad Autónoma de Baja California, Ensenada, Baja California, Mexico.
Value Health. 2020 Feb;23(2):260-273. doi: 10.1016/j.jval.2019.11.002. Epub 2020 Jan 23.
To assess the effects of lean healthcare (LH) on patient flow in ambulatory care and determine whether waiting time and length of stay (LOS) decrease after LH interventions.
A systematic review was performed with close adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched for studies of healthcare organizations applying LH interventions within ambulatory care published between 2002 and 2018. Six databases and grey literature sources were used. Two reviewers independently screened and assessed each study. When consensus was difficult to reach, a third reviewer intervened. Finally, a summary of findings was generated.
Out of 5627 studies, 40 were included. Regarding LOS for all patients, 19 out of 22 studies reported a decrease. LOS for discharged patients decreased in 11 out of 13 studies, whereas LOS for admitted patients was reduced in 6 out of 7 studies. Waiting time for patients before seeing a healthcare professional decreased in 24 out of 26 studies. Waiting time to treatment and waiting time for appointments were minimized in 4 and 2 studies, respectively. Patients who left without being seen by a doctor decreased in 9 out of 12 studies. Finally, patient and staff satisfaction were measured in 8 and 2 studies, respectively, with each reporting improvements.
According to our findings, LH helped to reduce waiting time and LOS in ambulatory care, mainly owing to its focus on identifying and minimizing non-value added (NVA) activities. Nevertheless, evidence of the impact of LH on patient/staff satisfaction and the translation of the obtained benefits into savings is scarce among studies.
评估精益医疗（Lean Healthcare，LH）对门诊患者流程的影响，并确定 LH 干预后等待时间和住院时间（Length of Stay，LOS）是否缩短。
本系统评价严格遵循系统评价和荟萃分析的首选报告项目（Preferred Reporting Items for Systematic Reviews and Meta-Analyses，PRISMA）进行。我们检索了 2002 年至 2018 年期间在门诊护理中应用 LH 干预的医疗机构的研究。使用了 6 个数据库和灰色文献来源。两名评审员独立筛选和评估了每一项研究。当难以达成共识时，第三名评审员介入。最后，生成了研究结果总结。
在 5627 项研究中，有 40 项符合纳入标准。对于所有患者的 LOS，22 项研究中有 19 项报告了缩短。13 项出院患者的 LOS 研究中有 11 项报告了缩短，而 7 项入院患者的 LOS 研究中有 6 项报告了缩短。26 项研究中有 24 项报告了患者在见医护人员之前的等待时间缩短。4 项研究分别使治疗前等待时间和预约等待时间最小化，2 项研究分别使这两项等待时间最小化。12 项研究中有 9 项报告了未就诊就离开的患者减少。最后，8 项研究测量了患者和员工的满意度，2 项研究分别报告了满意度提高。
根据我们的研究结果，LH 有助于缩短门诊护理的等待时间和 LOS，主要原因是它专注于识别和最小化非增值（Non-Value Added，NVA）活动。然而，研究中关于 LH 对患者/员工满意度的影响以及所获得的收益转化为节省的证据很少。
