Cegłowska Urszula, Zawada Anna, Zielińska Magdalena, Hermanowski Tomasz, Buczacki Aleksander
Department of Applied Pharmacy, Faculty of Pharmacy, Medical University of Warsaw, Poland.
Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy, Medical University of Warsaw, Poland.
Postep Psychiatr Neurol. 2024 Jun;33(2):67-79. doi: 10.5114/ppn.2024.141056. Epub 2024 Jul 24.
Stroke is the second leading cause of death worldwide with an annual mortality rate of 6.55 million, which accounts for 11.6% of the total number of deaths. Early diagnosis is crucial for improving treatment outcomes. Lean management is an approach originating in the car manufacturing process derived from the Toyota Production System, which healthcare providers have recently adapted. The objective is to examine the use of lean practices in managing AIS in hospital settings.
A systematic literature search was performed using MEDLINE and SCOPUS databases, including publications from 1st January 2000 to 20th September 2022.
A total of 13 studies fulfilled the predefined inclusion criteria. The recombinant tissue plasminogen activator (rtPA) was used in 11 studies, in 2 studies in combination with mechanical thrombectomy (MT). MT alone was used in the other 2 studies. The value stream mapping was used in all included studies to analyze workflow in acute ischemic stroke (AIS) treatment. Outcome measures include mostly door-to-needle (DTN) time for rtPA treatment and door-to-puncture (DTP) time for mechanical thrombectomy. DTN time was assessed in nine studies and reached statistically significant results in five. DTP was examined in three studies; in two, statistically significant decreases in DTP were observed.
Lean management can be a useful method for achieving key performance indicators in AIS, consistent with current guidelines. The results of this systematic literature review show that value stream mapping may improve the process of AIS treatment by reducing in-hospital delays. The field of research that focuses on implementing lean management tools in healthcare is increasing, with more publications appearing in recent years.
中风是全球第二大致死原因，年死亡率达655万，占总死亡人数的11.6%。早期诊断对改善治疗结果至关重要。精益管理是一种起源于丰田生产系统的汽车制造流程的方法，医疗保健提供者最近已采用该方法。目的是研究精益实践在医院环境中管理急性缺血性中风（AIS）的应用。
使用MEDLINE和SCOPUS数据库进行系统的文献检索，包括2000年1月1日至2022年9月20日的出版物。
共有13项研究符合预先定义的纳入标准。11项研究使用了重组组织型纤溶酶原激活剂（rtPA），2项研究将其与机械取栓术（MT）联合使用。另外2项研究单独使用了MT。所有纳入研究均使用价值流图来分析急性缺血性中风（AIS）治疗的工作流程。结果指标主要包括rtPA治疗的门到针（DTN）时间和机械取栓术的门到穿刺（DTP）时间。9项研究评估了DTN时间，其中5项达到了统计学显著结果。3项研究检查了DTP；在2项研究中，观察到DTP有统计学显著下降。
精益管理可能是实现AIS关键绩效指标的有用方法，与当前指南一致。该系统文献综述的结果表明，价值流图可能通过减少住院延迟来改善AIS治疗过程。近年来，专注于在医疗保健中实施精益管理工具的研究领域不断扩大，出现了更多的出版物。
