Reengineering the Cardiac Catheterization Lab Processes: A Lean Approach
This paper presents a cross-functional effort in a US community hospital for an overall process improvement in its Cardiac Catheterization Lab (CCL). One of the key system performance metrics identified was the patient turnaround time. The objective of this study was to identify the sources of delays in the system that lead to prolonged patient turnaround time using a structured lean approach. A set of qualitative recommendations were proposed and implemented. Quantification of some of these recommendations and certain additional ‘what-if’ scenarios were evaluated using Discrete Event Simulation (DES). The simulation results showed that significant reduction in patient turnaround time could be achieved if the proposed recommendations were implemented. This study demonstrated the benefits of adopting the lean philosophy in the continuous process improvement journey in the healthcare delivery arena.
National Heart Lung and Blood Institute, “Cardiac Catheterization,” http://www.nhlbi.nih.gov/health/dci/Diseases/cath/cath_what.html, 2009, Accessed July 2009.View at: Google Scholar
Heart Rhythm Society, “EP Study,” http://www.hrspatients.org/patients/heart_tests/electrophysiology_study.asp, 2009, Accessed July 2009.View at: Google Scholar
Donald E. Lighter, Advanced Performance Improvement in Health Care: Principles and Methods, Jones & Bartlett Publishers, Massachusetts, USA, 2009.
R. W. Chalice, Stop Rising Healthcare Costs Using Toyota Lean Production Methods, ASQ Quality Press, Milwaukee, Wisconsin, USA, 2005.
A. Kumar and S. J. Shim, “Eliminating Emergency Department Wait by BPR Implementation,” in Industrial Engineering and Engineering Management: IEEE International Conference, pp. 1679–1683, 2007.View at: Google Scholar
D. L. King, D. I. Ben-Tovim, and J. Bassham, “Redesigning emergency department patient flows: Application of Lean Thinking to health care,” Emergency Medicine Australasia, vol. 18, no. 4, pp. 391–397, 2006.View at: Google Scholar
L. G. Connelly and A. E. Bair, “Discrete Event Simulation of Emergency Department Activity: A Platform for System-level Operations Research,” Acad Emerg Med., vol. 11, no. 11, pp. 1177–1185, 2004.View at: Google Scholar
D. R. Eitel, S. E. Rudkin, M. A. Malvehy, J. P. Killeen, and J. M. Pines, “Improving Service Quality by Understanding Emergency Department Flow: A White Paper and Position Statement Prepared For The American Academy Of Emergency Medicine,” Journal of Emergency Medicine, In Press, Corrected Proof, Available online 2 June 2008.View at: Google Scholar
R. Davies and H. Davies, “Modeling patient flows and resource provision in health systems,” Omega, vol. 22, no. 2, pp. 123–131, 1994.View at: Google Scholar
A. K. Hutzschenreuteryz, P. A. N. Bosmanz, and I. Blonk-Altenax, “Agent-based Patient Admission Scheduling in Hospitals,” in Proceedings of the 7th international joint conference on Autonomous agents and multiagent systems: industrial track, pp. 45–52, Estoril, Portugal, 2008.View at: Google Scholar
S. Ramakrishnan, K. Nagarkar, M. DeGennaro, A. K. Courtney, F. Emick, and K. Srihari, “A Study of the CT Scan Area of a Healthcare Provider,” in Proceedings of the 2004 Winter Simulation Conference, R. G. Ingalls, M. D. Rossetti, J. S. Smith, B. A. Peters, and R. G. Ingalls, Eds., pp. 2025–2031, Washington DC, USA, 2004.View at: Google Scholar
J. Workman-Germann and H. Woodward-Hagg, Implementing Lean Six Sigma Methodologies in the Radiology Department of a Hospital Healthcare System, http://docs.lib.purdue.edu/cgi/viewcontent.cgi?article=1037&context=rche_rp, RCHE Publications, 2007 (accessed 5 July 2009).
J. Bosire, T. Gandhi, S. Wang, and K. Srihari, “Comparing Simulation Alternatives Based on Quality Expectations,” in Proceedings of the 2007 Winter Simulation Conference, S. G. Henderson, B. Biller, M. H. Hsieh, J. Shortle, J. D. Tew, and R. R. Barton, Eds., pp. 1579–1585, Washington DC, USA, 2007.View at: Google Scholar
J. Abraham and M. C. Reddy, “Moving Patients Around: A Field Study of Coordination between Clinical and Non-Clinical Staff in Hospitals,” in Proceedings of the ACM 2008 conference on Computer supported cooperative work, pp. 225–228, San Diego, USA, 2008.View at: Google Scholar
K. Jensen and J. Crane, “Improving Patient Flow in the Emergency Department,” Healthcare Financial Management, vol. 62, no. 11, pp. 104–108, 2008.View at: Google Scholar
B. Egolf, G. Nail, M. Donoghue, C. Pexton, and Waukesha, “Working to Eliminate Bottlenecks: Florida Hospital's Cardiac Cath Lab Achieves Greater Efficiency and Higher Satisfaction,” Cath Lab Digest - ISSN: 1073-2667, vol. 15, no. 11, pp. 54–56, November 2007.View at: Google Scholar
R. Siegrist, M. Gutkin, O. Levtzion-Korach, and S. Madden, “Improving Patient Flow in the Cath Lab,” Healthcare Financial Management, vol. 63, no. 4, pp. 92–98, 2009.View at: Google Scholar
G. J. Dehmer, J. W. Hirshfeld, W. J. Oetgen et al., “CathKIT: Improving Quality in the Cardiac Catheterization Laboratory,” J Am Coll Cardiol, vol. 43, pp. 893–899, 2004.View at: Google Scholar
M. Moscucci, E. K. Rogers, C. Montoye et al., “For the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2), Association of a Continuous Quality Improvement Initiative with Practice and Outcomes Variations of Contemporary Percutaneous Coronary Interventions,” Circulation, vol. 113, pp. 814–822, 2006.View at: Google Scholar
S. Konopka, M. Millar, B. O'Brien, and M. Weissman, Reducing Delays in the Cardiac Cath Lab with Six Sigma, Isixsigma Healthcare online, 2006, available at http://healthcare.isixsigma.com, (accessed 3 May 2009).
M. Moscucci and K. A. Eagle, “Door-to-Balloon Time in Primary Percutaneous Coronary Intervention: Is the 90-Minute Gold Standard an Unreachable Chimera?” Circulation, vol. 113, pp. 1048–1050, 2006.View at: Google Scholar