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Rra   safety net Masimo : An help for Lean Healthcare
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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

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

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  • 1. RRA - Safety NetLean Healthcare : A new vision in hospital managementDr Arnaud Depil DuvalChief of Emergency Department Evreux France
  • 2. Lean Management andHealthcare System
  • 3. Lean Concept Industrial method, Created by Toyota, Player centered, Lean Healthcare : application to health system.
  • 4. Lean ManagementImprove productivityStaffrestrictionRéduction ofmaterialcostsOptimizationof flows
  • 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. MUDATreatmentMovementWaitingStocksTransfersOver-productionCorrectionQuality
  • 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. 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. Muda : Quality Correction : Time spent to do, to verify or correcterrors.
  • 10. When to measure respiratoryrate
  • 11. When to measure respiratory rate Post opérative, Intensive Care Unit, Continuous Medical Care, Emergency Room, Post Emergency Hopitalization Unit (UHCD)
  • 12. When to measure respiratory rate Post extubation, Medical intoxications, Opioids treatment (Patient Controlled Analgesia), Mild sedation, Acute intoxications (alcohol, drugs…) Palliative care…
  • 13. Use of PCA in post emergencyunitApplication of Lean Healthcare
  • 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. 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. Nurse charges and PCA 1 mesure each15 minutes 1st hour, Then each 2 hours, So 10 mesures per12 hours.
  • 17. Nurse charges Mean cost of nurse is about 18€/hour, Measure of respiratory rate needs 3 minutes bypatient.
  • 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. Nurse flow
  • 20. Nurse charges and flow 5 patients = 2h30 working time / 12 hours.Limitationof patientnumberPoormonitoring
  • 21. RRA / Safety Net and LeanManagement
  • 22. Advantages of RRA Non invasive, Confortable for patient (and staff), Reliability, Continuous monitoring, Monitoring both respiratory rateand oxymetry.
  • 23. Safety net The Safety net allows increasing number of patientwith monitoring, Safety Net allows « nurse ubiquity » by « continuousmonitoring in pocket »
  • 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. Nurse flow with RRA / Safety Net
  • 26. Lean Healthcare• Muda• Reduction of workingtimeRRA• Increase number ofpatients• Increase staff availability• Reduce tiredness• Reduce risksSafetyNet
  • 27. 3S 5S is a process of lean management RRA / Safety Net duo is 3SRRA /Safety NetSafetyStaffEconomySurveillanceNon Stop
  • 28. Monitoring equipments
  • 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. Really new?...
  • 31. Thanks for your attention…… and sorry for the french accent!