title: Lean processes for optimizing OR capacity utilization: prospective analysis before and after implementation of value stream mapping (VSM).
abstract: BACKGROUND
  The decision to optimize the processes in the operating tract was based on two factors: competition among clinics and a desire to optimize the use of available resources. The aim of the project was to improve operating room (OR) capacity utilization by reduction of change and throughput time per patient.
  
  
  METHODS
  The study was conducted at Centre Hospitalier Emil Mayrisch Clinic for specialized care (n = 618 beds) Luxembourg (South).
  
  
  METHODS
  A prospective analysis was performed before and after the implementation of optimized processes. Value stream analysis and design (value stream mapping, VSM) were used as tools. VSM depicts patient throughput and the corresponding information flows. Furthermore it is used to identify process waste (e.g. time, human resources, materials, etc.). For this purpose, change times per patient (extubation of patient 1 until intubation of patient 2) and throughput times (inward transfer until outward transfer) were measured. VSM, change and throughput times for 48 patient flows (VSM A(1), actual state = initial situation) served as the starting point. Interdisciplinary development of an optimized VSM (VSM-O) was evaluated. Prospective analysis of 42 patients (VSM-A(2)) without and 75 patients (VSM-O) with an optimized process in place were conducted.
  
  
  RESULTS
  The prospective analysis resulted in a mean change time of (mean ± SEM) VSM-A(2) 1,507 ± 100 s versus VSM-O 933 ± 66 s (p < 0.001). The mean throughput time VSM-A(2) (mean ± SEM) was 151 min (±8) versus VSM-O 120 min (±10) (p < 0.05). This corresponds to a 23% decrease in waiting time per patient in total.
  
  
  CONCLUSIONS
  Efficient OR capacity utilization and the optimized use of human resources allowed an additional 1820 interventions to be carried out per year without any increase in human resources. In addition, perioperative patient monitoring was increased up to 100%.
authors.affiliation: Department Block OP Centre Hospitaylier Emile Mayrisch (CHEM), Esch-sur-Alzette, Luxembourg.
authors.forename: Patric
authors.initials: P
authors.lastname: Schwarz
authors.forename: Klaus Dieter
authors.initials: KD
authors.lastname: Pannes
authors.forename: Michel
authors.initials: M
authors.lastname: Nathan
authors.forename: Hans Jorg
authors.initials: HJ
authors.lastname: Reimer
authors.forename: Axel
authors.initials: A
authors.lastname: Kleespies
authors.forename: Nicole
authors.initials: N
authors.lastname: Kuhn
authors.forename: Anne
authors.initials: A
authors.lastname: Rupp
authors.forename: Nikolaus Peter
authors.initials: NP
authors.lastname: Zügel
mesh_terms: D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008189:Luxembourg; D008297:Male; D009873:Operating Rooms / Q000706:statistics & numerical data*; D009936:Organizational Innovation; D005791:Patient Care; D011446:Prospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods / Q000706:statistics & numerical data*; D017748:Time Management; D017749:Total Quality Management; D014850:Waiting Lists; D016526:Workload