Lean ManagementCost reduction : Increase productivity : War on waste (muda) : Equipment Staff Optimization of flow, Just in time,Simplify : Standards developement, Implication of teamwork (Kaizen)
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.
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.
Muda : Quality Correction : Time spent to do, to verify or correcterrors.
When to measure respiratory rate Post opérative, Intensive Care Unit, Continuous Medical Care, Emergency Room, Post Emergency Hopitalization Unit (UHCD)
When to measure respiratory rate Post extubation, Medical intoxications, Opioids treatment (Patient Controlled Analgesia), Mild sedation, Acute intoxications (alcohol, drugs…) Palliative care…
Use of PCA in post emergencyunitApplication of Lean Healthcare
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
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
Nurse charges and PCA 1 mesure each15 minutes 1st hour, Then each 2 hours, So 10 mesures per12 hours.
Nurse charges Mean cost of nurse is about 18€/hour, Measure of respiratory rate needs 3 minutes bypatient.
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.
Advantages of RRA Non invasive, Confortable for patient (and staff), Reliability, Continuous monitoring, Monitoring both respiratory rateand oxymetry.
Safety net The Safety net allows increasing number of patientwith monitoring, Safety Net allows « nurse ubiquity » by « continuousmonitoring in pocket »
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