Lean Six Sigma for Intravenous Therapy Optimization: A Hospital Use of Lean Thinking to Improve Occlusion Management

Background: Continual improvement is a necessary part of hospital culture. This occurs by identifying opportunities for improvement that influence efficiency while saving money. Methodology: An investigation of intravenous device-related practices was performed by the nurses of the intravenous access team, pharmacy, and hospital operations at Hartford Hospital using Lean Six Sigma methodology. Central venous access device occlusion and tissue plasminogen activator variability was identified. Using observation, measurement of performance, and root cause analysis, the hospital's practices, policies, and equipment were evaluated for the process of occlusion management. The team utilized a Six Sigma strategy employing the elements define, measure, analyze, improve, and control, which is a disciplined, data-driven methodology that focuses on eliminating defects (waste). Interventions initiated based on the assessment performed by the team using the define, measure, analyze, improve, and control approach included replacement of negative displacement needleless connectors with antireflux needleless connectors and specialty team assessment before tissue plasminogen activator use. Results: Over the course of the 26-month study, Hartford Hospital experienced a 69% total reduction in tissue plasminogen activator use representing a total 26-month savings of $107,315. Other cost savings were reflected in areas of flushing, flushing disposables, and in a decrease in needleless connector consumption. Central line-associated bloodstream rates fell 36% following the intervention as an unexpected secondary gain, resulting in further savings related to treating this nonreimbursable hospital-acquired condition. Conclusions: This study examined the influence of using Lean Thinking and Six Sigma methodology as a tool in saving hospital money, resulting in better patient outcomes.

Gertrude Lamb’s Pioneering Concept of the Clinical Medical Librarian

Objective – To determine if “the medical librarian with special skills and training in tested methods for approaching medical literature serve a valuable interface between the professional who is taking care of patients and the knowledge explosion in medicine wherein lies the key to better patient care” (p. 78). Design – Qualitative study involving the participant librarians keeping a reflective journal of all interactions with the subjects involved in the first 6 months of the study (September 1974 – March 1975). Setting – Hartford Hospital, Connecticut. Subjects – Teaching physicians, house staff, and medical students at Hartford Hospital. Methods – This pilot project, funded by a two-year grant from the U.S. Public Health service and the National Library of Medicine, placed three medical librarians (two full-time and one part-time) on rounds with pediatrics, medicine, and surgery teams. The librarians kept diaries to record “critical incidents” (p. 86), including the “acceptance of the program, its impact on patient care, its potential for changing the information seeking behavior of health professionals, and its usefulness for developing a core collection of clinical readings” (p. 86). Main Results – Despite a few physicians’ initial apprehension, each of the three clinical librarians recorded indications of acceptance by clinical staff, including a dramatic increase in literature search requests; increased phone calls, drop-ins, pages, and requests for research assistance; and gestures of acceptance from house staff and students. More broadly, the literature searches in Lamb’s report identifies direct patient care (including to “resolve a debate” (p. 84)), medical teaching/education, and searching techniques for clinicians. It is implied that these interactions resulted in a higher profile of the resources and services offered through the library; as one patron queried, “Would you show me how to find articles and where everything is in the library sometime?” (p. 83). Conclusions – The authors state that while their conclusions are only preliminary and no firm conclusions can be drawn, there are four observations of note: 1. The clinical librarian can be accepted as part of a patient care teaching team by contributing to educational activities. 2. The clinical librarian provides quick and useful information to assist in the decisions and management of patient problems. 3. There is an opportunity to strengthen and modify the information seeking behavior of the health professional. 4. As patient care questions recur, there is a need for a “patient care information system” which can be initiated and supported through the provision of photocopied articles (p. 86).