Improving patient care in cardiac surgery using Toyota production system based methodology.
BACKGROUND
A new cardiac surgery program was developed in a community hospital setting using the operational excellence (OE) method, which is based on the principles of the Toyota production system. The initial results of the first 409 heart operations, performed over the 28 months between March 1, 2008, and June 30, 2010, are presented.


METHODS
Operational excellence methodology was taught to the cardiac surgery team. Coaching started 2 months before the opening of the program and continued for 24 months.


RESULTS
Of the 409 cases presented, 253 were isolated coronary artery bypass graft operations. One operative death occurred. According to the database maintained by The Society of Thoracic Surgeons, the risk-adjusted operative mortality rate was 61% lower than the regional rate. Likewise, the risk-adjusted rate of major complications was 57% lower than The Society of Thoracic Surgeons regional rate. Daily solution to determine cause was attempted on 923 distinct perioperative problems by all team members. Using the cost of complications as described by Speir and coworkers, avoiding predicted complications resulted in a savings of at least $884,900 as compared with the regional average.


CONCLUSIONS
By the systematic use of a real time, highly formatted problem-solving methodology, processes of care improved daily. Using carefully disciplined teamwork, reliable implementation of evidence-based protocols was realized by empowering the front line to make improvements. Low rates of complications were observed, and a cost savings of $3,497 per each case of isolated coronary artery bypass graft was realized.
Ed Dardanell Heart and Vascular Center, Forbes Regional Hospital, Monroeville, Pennsylvania 15146, USA. mhculigmd@aol.com
Michael H
MH
Culig
Richard F
RF
Kunkle
Diane C
DC
Frndak
Naida
N
Grunden
Thomas D
TD
Maher
George J
GJ
Magovern
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000191:economics / Q000379:methods* / Q000592:standards; D001026:Coronary Artery Bypass / Q000191:economics / Q000379:methods; D003363:Cost Control; D004059:Diffusion of Innovation; D017598:Efficiency, Organizational; D055317:Evidence-Based Practice / Q000379:methods* / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007324:Institutional Management Teams / Q000458:organization & administration; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration; D010414:Pennsylvania; D011340:Problem Solving; D016730:Program Development; D011785:Quality Assurance, Health Care; D013903:Thoracic Surgery / Q000379:methods* / Q000458:organization & administration*