Washington, Oct 19: A process to boost efficiency and productivity in Japanese car factories is helping slash treatment time for stroke patients and boosting recovery.
Applying the principles of Toyota’s lean manufacturing process, doctors sharply cut down the average time between patient arrival and treatment from 58 to 37 minutes, at the Washington University School of Medicine’s (St. Louis) Barnes-Jewish Hospital.
Timely treatment can help prevent brain damage that triggers paralysis and loss of speech, post-stroke. In an average year, the medical school treats 1,300 stroke patients at Barnes-Jewish, the journal Stroke reports.
The shortened treatment time results from applying a key component of lean manufacturing to patient care: getting input from all members of the team to identify inefficient steps involved in the process, according to a Washington statement.
“We sought suggestions from everyone involved, from the paramedics who bring in patients, to admitting clerks, radiology technologists, nurses and physicians,” says senior study author Jin-Moo Lee, associate professor of neurology at Washington.
“Once the inefficient steps were identified, we developed a completely new protocol that eliminated them. This new treatment protocol helped us achieve one of the fastest door-to-needle times in the country,” adds Lee.
Barnes-Jewish has a dedicated stroke team capable of quickly evaluating and treating patients with tPA (Tissue plasminogen activator), which breaks up blood clots in the brain that cause strokes. The earlier it is given, the more effective tPA is at preventing permanent brain damage caused by stroke.
Because tPA can cause dangerous bleeding in the brain and throughout the body, the drug can no longer be given if too much time elapses after a stroke begins. At that point, its risk outweighs the potential benefit. Ideally, the drug must be given within 60 minutes after a stroke begins, a period known as the “golden hour”.
The new treatment procedures were implemented in February 2011. The changes not only lowered average treatment times by nearly 40 percent, but they also increased the percentage of patients treated within “the golden hour” from 52 to 78 percent.