Abstract
Background:
During the past 20 years, because of respiratory care policies in Taiwan, delivering high-quality services in a cost-effective and efficient manner has been a challenge. Although hospitals are all different, this study discovered common problems with respect to respiratory care, namely interrupted patient care, lengthy wait times, excess motion, and diminished intellectual performance by respiratory therapists. To resolve these complex problems, we undertook this project to identify process components, increase efficiency and standardization, and encourage a teamwork approach in implementing solutions. Lean thinking combined with mobile medical cart (MMC) use was demonstrated to effectively improve the intensive care unit (ICU) respiratory care process.
Methods:
From January to December 2018, data were collected concerning 23 respiratory therapists in the respiratory care division of a 162-bed hospital, and observations were made across 6 ICUs. We adopted lean thinking (understanding user value, mapping value-streams, creating flow and continuous improvement) and quality improvement tools (Kanban) to simplify numerous processes. The MMC is a reliable wireless system that contains all the information required for delivering effective care. It provides storage space for essential supplies, making them easily accessible. Because of the success of the 1-year trial, we evaluated the time wasted in daily activities, common variation, and process components and used the Taiwan Clinical Performance Indicator (TCPI) parameter to assess outcomes.
Results:
Through the streamlined process enabled by using the MMC, the time wasted was reduced to 45 minutes during respiratory therapist treatment. To assess the common variation and process in daily work, the rate of improvement in the performance of various tasks was determined; these tasks and their improvement rate are outlined as follows (Table 1). These results indicate improvement in respiratory care accreditation.
Conclusions:
By applying lean thinking combined with MMC use, a respiratory therapist can have a positive effect in the ICU because that combination entails investigating and optimizing processes and ensuring the proper skill set is utilized in performing necessary daily tasks. It can effectively decrease time wasted, facilitate the provision of patient-centered care, improve workflow, and reduce staff workload and delay times, all of which can create a culture that emphasizes patient safety.
The outcomes with respect to the TCPI parameter are outlined as follows: (1) ventilator-associated pneumonia rate, 0.92‰; (2) ventilator weaning rate, 74.14%; and (3) 24-hour to 72-hour reintubation rate, 2.95% to 4.81%. View all access options for this article.Table.1 The rate of improvement in the performance of various tasks
Easily perform various tasks for critically ill patients
100%
Simultaneously perform multiple tasks and device replacement
75%
Multidisciplinary team communication
75%
Electronic medical record recordkeeping
87.5%
Correct administration of inhaled drug
95.8%
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