Nav: Home

Implementation of lean processes shows potential to reduce surgical wait times at VA hospitals

September 07, 2016

In a study published online by JAMA Surgery, Andrew C. Eppstein, M.D., of the Indiana University School of Medicine, Indianapolis, and colleagues examined whether lean processes can be used to improve wait times for surgical procedures in Veterans Affairs hospitals.

The Veterans Health Administration (VHA) is the largest integrated health care network in the United States, providing a unique system of health care delivery and access to 9 million veterans. However, it has come under increased media scrutiny over the past 2 years for delays in scheduling, lengthy patient wait times, and lack of access.

In this study, various databases were examined to assess changes in wait times for elective general surgical procedures and clinical volume before, during, and after implementation of lean processes over 3 fiscal years (FYs) at a tertiary care Veterans Affairs medical center (Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis). The surgery service and systems redesign service performed an analysis in FY 2013, culminating in multiple rapid process improvement workshops. Multidisciplinary teams identified systemic inefficiencies and strategies to improve interdepartmental and patient communication to reduce canceled consultations and cases, diagnostic rework, and no-shows. High-priority triage with enhanced operating room flexibility was instituted to reduce scheduling wait times. General surgery department pilot projects were then implemented mid-FY 2013.

The researchers found that average patient wait times for elective general surgical procedures decreased from 33 days in FY 2012 to 26 days in FY 2013. In FY 2014, average wait times were half the value of the previous FY at 12 days. This was a 3-fold decrease from wait times in FY 2012. Operative volume increased from 931 patients in FY 2012 to 1,090 in FY 2013 and 1,072 in FY 2014. Combined clinic, telehealth, and e-consultation encounters increased from 3,131 in FY 2012 to 3,460 in FY 2013 and 3,517 in FY 2014, while the number of no-shows decreased from 366 in FY 2012 to 227 in FY 2014.

"This study demonstrated a significant reduction in patient wait times for surgical procedures and an improvement in access in the clinical and operative settings when implementing lean processes. The improvement gained was noted over multiple areas and seen during the implementation of new technologies. The changes in the measured outcome categories occurred early, and the differences were sustained across the entire observation period," the authors write.

"Improvement in the overall surgical patient experience can stem from multidisciplinary collaboration among systems redesign personnel, clinicians, and surgical staff to reduce systemic inefficiencies. Monitoring and follow-up of system efficiency measures and the employment of lean practices and process improvements can have positive short- and long-term effects on wait times, clinical throughput, and patient care and satisfaction."
(JAMA Surgery. Published online September 7, 2016. doi:10.1001/jamasurg.2016.2808. This study is available pre-embargo at the For The Media website.)

Editor's Note: This material is the result of work supported with resources and the use of facilities at the Richard L. Roudebush Veterans Affairs Medical Center. No conflict of interest disclosures were reported.

Commentary: Building a Lean, Mean Patient Care Machine

"These results support the conclusion that Veterans Affairs and other large health care delivery systems may benefit from lean process. Implementing such change requires multidisciplinary collaboration," write Juliet June Ray, M.D., M.S.P.H., and Seth A. Spector, M.D., of the University of Miami Leonard M. Miller School of Medicine, in an accompanying commentary.

"The stakes are high, and process, organization, and infrastructure must be reformed to ensure that health care delivery, research, education, and training proceed at the highest standard. This crisis provides the private and public sectors with an opportunity to consider lean transformations to expand access, reduce cost, and, most importantly, improve health outcomes and the patient experience."

(JAMA Surgery. Published online September 7, 2016. doi:10.1001/jamasurg.2016.2834. This article is available pre-embargo at the For The Media website.)

Editor's Note: No conflict of interest disclosures were reported.

The JAMA Network Journals

Related Surgical Procedures Articles:

ACS NSQIP surgical risk calculator predicts outcomes for geriatric surgical patients
The NSQIP Surgical Risk Calculator can now accurately predict four specific quality-of-life outcomes that transcend traditional measures of successful surgery, such as complication and mortality rates, and now reflects the expected effects of surgery on the ability of older patients to function independently.
Surgical site infection rates differ by gender for certain procedures
Men and women are at differing risks of developing surgical site infections depending on the type of operation they undergo, according to new research being presented at this year's European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Amsterdam, Netherlands (April 13-16, 2019).
Family opioid use and risk of opioid use among teens, young adults following surgical, dental procedures
This study looked at whether long-term opioid use by one or more family members was associated with long-term opioid use by adolescents and young adults prescribed opioids for the first time after common surgical or dental procedures.
Antibiotic overuse is high for common urology procedures
A new study suggests that antibiotics are being overused in up to 60 percent of patients undergoing common urological procedures.
Is the efficacy of antibiotic prophylaxis for surgical procedures decreasing?
Antibiotic prophylaxis regimens are becoming less effective at preventing surgical site infections following colorectal surgery, researchers at the Center for Disease Dynamics, Economics & Policy and Princeton University determined through a systematic review of available literature.
Use of bivalirudin for anticoagulation in interventional cardiovascular procedures
In the current issue of Cardiovascular Innovations and Applications (Volume3, Number 2, 2018, pp.
Patient motivations behind cosmetic procedures
What motivates patients to seek minimally invasive cosmetic procedures? Most patients want the procedures to please themselves, not others, and, apart from aesthetic appearance to look younger and fresher, patient motivations ranged from physical health and psychological well-being to looking good at work and increasing self-confidence.
Johns Hopkins experts create opioid prescribing guidelines for 20 common surgical procedures
A Johns Hopkins expert panel of health care providers and patients have announced what is, to their knowledge, the nation's first set of operation-specific opioid prescribing guidelines.
Reducing opioid prescriptions for one operation can also spill over to other procedures
Study results show revised recommendations resulted in about 17 fewer pills being dispensed per patient for four major operations.
Safety program for surgical patients sharply drops surgical site infections
Surgical site infections (SSIs) in patients undergoing colorectal operations were reduced by 61 percent in less than two years in Hawaiian hospitals participating in the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Surgery, according to new study findings published as an 'article in press' on the website of the Journal of the American College of Surgeons ahead of print.
More Surgical Procedures News and Surgical Procedures Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

Accessing Better Health
Essential health care is a right, not a privilege ... or is it? This hour, TED speakers explore how we can give everyone access to a healthier way of life, despite who you are or where you live. Guests include physician Raj Panjabi, former NYC health commissioner Mary Bassett, researcher Michael Hendryx, and neuroscientist Rachel Wurzman.
Now Playing: Science for the People

#544 Prosperity Without Growth
The societies we live in are organised around growth, objects, and driving forward a constantly expanding economy as benchmarks of success and prosperity. But this growing consumption at all costs is at odds with our understanding of what our planet can support. How do we lower the environmental impact of economic activity? How do we redefine success and prosperity separate from GDP, which politicians and governments have focused on for decades? We speak with ecological economist Tim Jackson, Professor of Sustainable Development at the University of Surrey, Director of the Centre for the Understanding of Sustainable Propserity, and author of...
Now Playing: Radiolab

An Announcement from Radiolab