Souza Davenilcio Luiz, Korzenowski André Luis, Alvarado Michelle McGaha, Sperafico João Henrique, Ackermann Andres Eberhard Friedl, Mareth Taciana, Scavarda Annibal José
Industrial & Systems Engineering Department, Polytechnic School, University of Vale do Rio dos Sinos, São Leopoldo 93022-750, RS, Brazil.
Accounting Department, School of Management and Business, University of Vale do Rio dos Sinos, Porto Alegre 91330-002, RS, Brazil.
Healthcare (Basel). 2021 Jun 19;9(6):763. doi: 10.3390/healthcare9060763.
This article presents the state of the art of Lean principles applied in Emergency Departments through a systematic literature review. Our article extends previous work found in the literature to respond to the following questions: (i) What research problems in emergency departments can Lean principles help overcome? (ii) What Lean approaches and tools are used most often in this environment? (iii) What are the results and benefits obtained by these practices? and (iv) What research opportunities appear as gaps in the current state of the art on the subject? A six-step systematic review was performed following the guidance of the PRISMA method. The review analysis identified six main research problems where Lean was applied in Emergency Departments: (i) High Waiting Time and High Length of Hospital Stay; (ii) Health Safety; (iii) Process redesign; (iv) Management and Lessons Learned; (v) High Patient Flow; (vi) Cost Analysis. The six research problems' main approaches identified were Lean Thinking, Multidisciplinary, Statistics, and Six Sigma. The leading Lean tools and methodologies were VSM, Teamwork, DMAIC, and Kaizen. The main benefits of applying Lean Principles were (a) reductions in waiting time, costs, length of hospital stay, patient flow, and procedure times; and (b) improvements in patient satisfaction, efficiency, productivity, standardization, relationships, safety, quality, and cost savings. Multidisciplinary integration of managers and work teams often yields good results. Finally, this study identifies knowledge gaps and new opportunities to study Lean best practices in healthcare organizations.
本文通过系统的文献综述介绍了精益原则在急诊科的应用现状。我们的文章扩展了文献中先前的研究成果，以回答以下问题：（i）精益原则可以帮助克服急诊科的哪些研究问题？（ii）在这种环境中最常使用哪些精益方法和工具？（iii）这些实践取得了哪些结果和效益？以及（iv）作为该主题当前技术水平的差距出现了哪些研究机会？按照PRISMA方法的指导进行了六步系统综述。综述分析确定了精益原则在急诊科应用的六个主要研究问题：（i）高等待时间和高住院时间；（ii）健康安全；（iii）流程重新设计；（iv）管理与经验教训；（v）高患者流量；（vi）成本分析。确定的六个研究问题的主要方法是精益思维、多学科、统计学和六西格玛。主要的精益工具和方法是价值流映射（VSM）、团队合作、DMAIC（定义、测量、分析、改进、控制）和持续改善（Kaizen）。应用精益原则的主要好处是：（a）减少等待时间、成本、住院时间、患者流量和手术时间；以及（b）提高患者满意度、效率、生产力、标准化、关系、安全性、质量和成本节约。管理者和工作团队的多学科整合往往会产生良好的效果。最后，本研究确定了医疗保健组织中研究精益最佳实践的知识差距和新机会。
