Rra safety net Masimo : An help for Lean Healthcare


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Apport du RRA / Safety Net Masimo dans la méthodologie Lean Healthcare : Augmenter la sécurité tout en améliorant la productivité

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Rra safety net Masimo : An help for Lean Healthcare

  1. 1. RRA - Safety NetLean Healthcare : A new vision in hospital managementDr Arnaud Depil DuvalChief of Emergency Department Evreux France
  2. 2. Lean Management andHealthcare System
  3. 3. Lean Concept Industrial method, Created by Toyota, Player centered, Lean Healthcare : application to health system.
  4. 4. Lean ManagementImprove productivityStaffrestrictionRéduction ofmaterialcostsOptimizationof flows
  5. 5. Lean ManagementCost reduction : Increase productivity : War on waste (muda) : Equipment Staff Optimization of flow, Just in time,Simplify : Standards developement, Implication of teamwork (Kaizen)
  6. 6. MUDATreatmentMovementWaitingStocksTransfersOver-productionCorrectionQuality
  7. 7. Muda : people Treatment : Activity linked to quality criteria wich arenot adapted to patients needs (unused data, etc.), Movements : Waisted time, searching or movingunvaluable materials, Waiting : Patient waiting for medical support.
  8. 8. Muda : quantity Stocks : expired drugs, obsolete stocks, inadaptedequipments, etc. Transfers : Unnecessary mouvment of patient,equipment or personnal, Over-production : Redundant or too earlywork, cheksand recheks.
  9. 9. Muda : Quality Correction : Time spent to do, to verify or correcterrors.
  10. 10. When to measure respiratoryrate
  11. 11. When to measure respiratory rate Post opérative, Intensive Care Unit, Continuous Medical Care, Emergency Room, Post Emergency Hopitalization Unit (UHCD)
  12. 12. When to measure respiratory rate Post extubation, Medical intoxications, Opioids treatment (Patient Controlled Analgesia), Mild sedation, Acute intoxications (alcohol, drugs…) Palliative care…
  13. 13. Use of PCA in post emergencyunitApplication of Lean Healthcare
  14. 14. Utilisation of PCA in post emergencyunitMorphinetitration• 1 injection each10 minutesPrescription ofper ostreatment• No conversiontableOutcome ofpatient• H1 if not alone• H2 if aloneTime consuming UnefficientNon satisfactionOverdoseComplications
  15. 15. Utilisation of PCA in post emergencyunitMorphin titration• 1injection each 10 minutesPCA implementation• Multiples equipment• Cost suppliesPatient monitoring• Each 15 minutes during 1st hour• Each 2 hoursPer os prescription• Conversion table
  16. 16. Nurse charges and PCA 1 mesure each15 minutes 1st hour, Then each 2 hours, So 10 mesures per12 hours.
  17. 17. Nurse charges Mean cost of nurse is about 18€/hour, Measure of respiratory rate needs 3 minutes bypatient.
  18. 18. Nurse charges and PCA 1 mesure each15 minutes 1st hour, Then each 2 hours, So 10 mesures per12 hours, 30 minutes of nurse working, Cost of 9€ by patient for12 hours, 10 à 30 meters round-trip.
  19. 19. Nurse flow
  20. 20. Nurse charges and flow 5 patients = 2h30 working time / 12 hours.Limitationof patientnumberPoormonitoring
  21. 21. RRA / Safety Net and LeanManagement
  22. 22. Advantages of RRA Non invasive, Confortable for patient (and staff), Reliability, Continuous monitoring, Monitoring both respiratory rateand oxymetry.
  23. 23. Safety net The Safety net allows increasing number of patientwith monitoring, Safety Net allows « nurse ubiquity » by « continuousmonitoring in pocket »
  24. 24. RRA / Safety Net and LeanRRA Safety Net Reduce unnecessarysteps Reduce time needed tomeasure the respiratoryrate, But need an openspace (post operative oremergency care rooms), Alarm sound mayinterfer with anotherequipment. Allows increasingnumber of patients, Don’t need a nurse to« monitor the monitor » Early warning, Reduce cost byprevention of shortintubation
  25. 25. Nurse flow with RRA / Safety Net
  26. 26. Lean Healthcare• Muda• Reduction of workingtimeRRA• Increase number ofpatients• Increase staff availability• Reduce tiredness• Reduce risksSafetyNet
  27. 27. 3S 5S is a process of lean management RRA / Safety Net duo is 3SRRA /Safety NetSafetyStaffEconomySurveillanceNon Stop
  28. 28. Monitoring equipments
  29. 29. Others respiratory rate monitoring systems Multiples competitors : Respiratory rate measure bymeasure of thoracic impedance ; old system withpoor outcome. Covidien : Software algorithm for calculating therespiratory rate based on pulse oximetry ; notavailable on market
  30. 30. Really new?...
  31. 31. Thanks for your attention…… and sorry for the french accent!