BACKGROUND The goal of Lean Thinking in Healthcare is to reorganize the healthcare settings to deliver care more efficiently, minimizing wastes and transforming them into value. A systematic review conducted between May and September 2019 showed how a structured and scheduled application of Lean management in Emergency Departments leads to a reduction of non-value-added activities, waste, and - mainly - time. The COVID-19 pandemic required a quick organization of the logistics of Hospital structures, providing fast and constantly evolving changes to manage the high turnout of Sars-Cov-2 positive patients. AIM This study aims to analyze the organizational structure put in place at the Emergency Department of a II Level DEA Hospital in Central Italy in the COVID Era, with the aim, from Lean perspective, to evaluate the change and the repercussion on the assistance activity, and to analyze the evolution of the concept of non-value-added activity compared to the pre-COVID Era, comparing it with the data available from the Lean literature. MATERIALS AND METHODS A descriptive observational study was conducted looking at the Operating Unit and the designated pathways for patients arrived by ambulance or their own means, suspected of possible Sars-Cov-2 infection or not; for each pathway the Value Stream Map (VSM) was constructed. OUTCOMES A plan for new hires and the reorganization of spaces has made it possible to distinguish treatment areas for positive/suspicious and negative/non-suspicious patients; at both the Operating Unit and the Hospital level, "clean" and "dirty" pathways were created, toward which the patient in the ED was directed right from the access to the pre-Triage, where it was mandatory to exclude fever, cough, dyspnea and contact with cases of proven positivity. DISCUSSION/CONCLUSION From the mapping of flows, "wastes" that overlap with those described in the Lean literature have specifically emerged. Overall, the reorganization of spaces and activities of the ED has, on the one hand, allowed safe COVID emergency management for patients and caregivers; on the other hand, however, new steps, procedures and obligatory routes, although necessary and value-added, have contributed to increase waiting and transport times, multiple and repetitive handling, and therefore, globally, prolongation of management times. Keywords: COVID-19, Lean Thinking, Emergency, value-added activities, non-value-added activities, waste.
BACKGROUND L’obiettivo del Lean Thinking in Healthcare è di riorganizzare i setting sanitari per erogare le cure in modo efficiente, minimizzando gli sprechi e trasformandoli in valore. Una revisione sistematica condotta tra maggio e settembre 2019 ha mostrato come una strutturata e pianificata applicazione della gestione snella nei dipartimenti di emergenza porti ad una riduzione delle attività non-a-valore e degli sprechi, principalmente di tempo. La pandemia da COVID-19 ha reso tuttavia necessarie rapide riorganizzazioni delle strutture logistiche e aziendali, cambiamenti tempestivi e in continua evoluzione per rispondere all’afflusso di pazienti positivi al Sars-CoV-2. OBIETTIVO Lo studio si propone di analizzare l’assetto organizzativo messo in atto nel Pronto Soccorso di un ospedale DEA di II livello del Centro Italia in epoca COVID, con lo scopo, in ottica Lean, di valutare il cambiamento e la ripercussione sull’attività assistenziale, e di analizzare l’evoluzione del concetto di attività non-a-valore rispetto all’epoca pre-COVID, confrontandolo con i dati disponibili dalla letteratura Lean. MATERIALI E METODI E’ stato condotto uno studio osservazionale descrittivo prendendo visione della riorganizzazione dell’U.O. e dei percorsi designati per i pazienti afferenti con 118 o mezzi propri, sospetti per possibile infezione da Sars-Cov-2 e non; per ogni percorso è stata costruita la relativa Value Stream Map (VSM). RISULTATI Un piano di nuove assunzioni e la riorganizzazione degli spazi hanno permesso di distinguere le aree di trattamento dedicate a pazienti positivi/sospetti e negativi/non sospetti; sia a livello di U.O. che aziendale, sono stati creati degli appositi percorsi “puliti” e “sporchi”, verso cui il paziente afferente al Pronto Soccorso veniva indirizzato fin dall’accesso al pre-Triage, dove era necessario e fondamentale escludere febbre, tosse, dispnea e contatti con casi di positività accertata. DISCUSSIONE/CONCLUSIONE Dalla mappatura dei flussi sono nello specifico emersi “sprechi” sovrapponibili a quelli descritti dalla letteratura Lean. Complessivamente, la riorganizzazione degli spazi e dell’attività del Pronto Soccorso ha sì da un lato consentito una gestione dell’emergenza COVID sicura per pazienti e operatori; dall’altro, però, nuovi step, procedure e percorsi obbligati, se pur necessari e a valore, hanno contribuito a determinare aumento dei tempi di attesa e di trasporto, spostamenti multipli e ripetitivi, e dunque, globalmente, prolungamento dei tempi di gestione. Parole chiave: COVID-19, Lean Thinking, emergenza, attività a valore, attività non a valore, sprechi.
Pensare snello in emergenza. Lean Healthcare e riduzione degli sprechi: implicazioni e applicazioni in emergenza COVID-19.
TOMBESI, CHIARA
2019/2020
Abstract
BACKGROUND The goal of Lean Thinking in Healthcare is to reorganize the healthcare settings to deliver care more efficiently, minimizing wastes and transforming them into value. A systematic review conducted between May and September 2019 showed how a structured and scheduled application of Lean management in Emergency Departments leads to a reduction of non-value-added activities, waste, and - mainly - time. The COVID-19 pandemic required a quick organization of the logistics of Hospital structures, providing fast and constantly evolving changes to manage the high turnout of Sars-Cov-2 positive patients. AIM This study aims to analyze the organizational structure put in place at the Emergency Department of a II Level DEA Hospital in Central Italy in the COVID Era, with the aim, from Lean perspective, to evaluate the change and the repercussion on the assistance activity, and to analyze the evolution of the concept of non-value-added activity compared to the pre-COVID Era, comparing it with the data available from the Lean literature. MATERIALS AND METHODS A descriptive observational study was conducted looking at the Operating Unit and the designated pathways for patients arrived by ambulance or their own means, suspected of possible Sars-Cov-2 infection or not; for each pathway the Value Stream Map (VSM) was constructed. OUTCOMES A plan for new hires and the reorganization of spaces has made it possible to distinguish treatment areas for positive/suspicious and negative/non-suspicious patients; at both the Operating Unit and the Hospital level, "clean" and "dirty" pathways were created, toward which the patient in the ED was directed right from the access to the pre-Triage, where it was mandatory to exclude fever, cough, dyspnea and contact with cases of proven positivity. DISCUSSION/CONCLUSION From the mapping of flows, "wastes" that overlap with those described in the Lean literature have specifically emerged. Overall, the reorganization of spaces and activities of the ED has, on the one hand, allowed safe COVID emergency management for patients and caregivers; on the other hand, however, new steps, procedures and obligatory routes, although necessary and value-added, have contributed to increase waiting and transport times, multiple and repetitive handling, and therefore, globally, prolongation of management times. Keywords: COVID-19, Lean Thinking, Emergency, value-added activities, non-value-added activities, waste.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12075/4449