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Weigel WA et al, 2018: Process improvement for a complex dual medical procedure.

Weigel WA, Gluck M, Ross AS, Lin OS, Williams BL, Blackmore CC.
Department of Anesthesiology, Department of Radiology, Department of Gastroenterology, Virginia Mason Medical Center, Seattle, Washington, USA.
Center for Healthcare Improvement Science, Virginia Mason Medical Center, Seattle, Washington, USA.

Abstract

Pancreatic extracorporeal shock wave lithotripsy followed by endoscopic retrograde cholangiopancreatography is accepted worldwide as a treatment for a large, symptomatic, obstructing pancreatic stones. However, timely completion of the combined process requires coordination of equipment and personnel from two different complex procedures. We used Lean management tools in a week-long event to redesign the process around the patient. Using idea-generated Plan Do Study Act cycles to refine the process, from scheduling to postprocedure recovery, equipment and personnel were aligned to allow these two procedures to occur in immediate succession. The redesigned process resulted in all patients receiving both procedures without delay. This eliminated over 8 hours of wait time. Standard work and a newly created complex scheduler improved flow. We reduced the number of anaesthetics for patients without prolonging the procedure length.

BMJ Open Qual. 2018 Aug 21;7(3):e000273. doi: 10.1136/bmjoq-2017-000273. eCollection 2018.

 

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Comments 1

Peter Alken on Tuesday, 27 November 2018 14:37

The article does not focus on ESWL but describes an organizational and procedural rearrangement of the combined therapy of pancreatic duct stones by ESWL followed by endoscopic retrograde stone removal.
An interesting note by the authors is that with the type of lithotripter used initially a patient orientated procedure was not possible: “Only a few medical centres in the USA have the capability of combining ESWL and ERCP. Originally, the process at our hospital was designed around the equipment. Lithotripsy, before 2008, was performed with a stationary lithotripter in a designated OR (Dornier HM3 Lithotripter, Donier, Dornier Medtech, Munich, Germany). Using this lithotripter unit in combination with the need for high-quality imaging for ERCP (located in the Gastrointestinal procedural rooms) necessitated different sites for the two phases ESWL/ERCP procedure. The stationary lithotripter unit was replaced by a mobile unit in 2008 (Storz Medical Modulith SLX-F2, Karl Storz Lithotripsy America, Kennesaw, Georgia, USA). ... With the mobile lithotripter came the opportunity to design this process around the patient, a philosophy embraced by our institution.”
To those interested in how to improve a workflow I strongly recommend to get familiar with “Kaizen”, a philosophy of continuous improvement made popular in the 60’s by a Japanese management consultant Masaaki Imai https://en.wikipedia.org/wiki/Masaaki_Imai .

The article does not focus on ESWL but describes an organizational and procedural rearrangement of the combined therapy of pancreatic duct stones by ESWL followed by endoscopic retrograde stone removal. An interesting note by the authors is that with the type of lithotripter used initially a patient orientated procedure was not possible: “Only a few medical centres in the USA have the capability of combining ESWL and ERCP. Originally, the process at our hospital was designed around the equipment. Lithotripsy, before 2008, was performed with a stationary lithotripter in a designated OR (Dornier HM3 Lithotripter, Donier, Dornier Medtech, Munich, Germany). Using this lithotripter unit in combination with the need for high-quality imaging for ERCP (located in the Gastrointestinal procedural rooms) necessitated different sites for the two phases ESWL/ERCP procedure. The stationary lithotripter unit was replaced by a mobile unit in 2008 (Storz Medical Modulith SLX-F2, Karl Storz Lithotripsy America, Kennesaw, Georgia, USA). ... With the mobile lithotripter came the opportunity to design this process around the patient, a philosophy embraced by our institution.” To those interested in how to improve a workflow I strongly recommend to get familiar with “Kaizen”, a philosophy of continuous improvement made popular in the 60’s by a Japanese management consultant Masaaki Imai https://en.wikipedia.org/wiki/Masaaki_Imai .
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