title: Lean techniques to improve the flow of critically ill patients in a health region with its epicenter in the intensive care unit of a reference hospital.
abstract: OBJECTIVE
  To analyze whether the application of Lean techniques to improve the flow of critically ill patients in a health region with its epicenter in the intensive care unit (ICU) of a reference hospital.
  
  
  METHODS
  Observational study with pre and post intervention analysis.
  
  
  METHODS
  ICU of a reference hospital.
  
  
  METHODS
  We design projects and a value stream map of flow and compared pre and post intervention.
  
  
  METHODS
  We recorded demographic data, patient transfers by EMS for lack of beds and delay times in the discharge from ICU to ward. Multidisciplinary meetings and perform daily visual panel, with high priority ICU discharge. We promote temporary relocation of critically ill patients in other special areas of the hospital. We performed a professional satisfaction questionnaire with pre and post implementation of process. We make a statistical analysis of pre and post-intervention comparisons.
  
  
  RESULTS
  We planned for 2013 and progressively implemented in 2014. Analysis of patients entering the critical process flow 1) evaluate patients who must transfer for lack of beds, focusing on a diagnosis: pre 10/22 vs. 3/21 post (P=.045); 2) analysis of time delay in the discharge from the ICU to ward: 360.8±163.9minutes in the first period vs. 276.7±149.5 in the second (P=.036); and 3) personal professional satisfaction questionnaire, with 6.6±1.5 points pre vs. 7.5±1.1 in post (P=.001). Analysis of indicators such as the ICU acquired infections, length of ICU stay, the rate of re-admissions and mortality, with no significant differences between the two periods.
  
  
  CONCLUSIONS
  The application of Lean techniques in the critically ill process had a positive impact on improving patient flow within the health region, noting a decrease of transfers outside the region due to lack of beds, reduced delayed discharge from ICU to conventional ward and increased satisfaction of ICU professionals.
authors.affiliation: Servicio de Medicina Intensiva (UCI), Hospital Universitari de Girona Doctor Josep Trueta, Grupo de Microbiología e Infección, IDIBGI, CIBERES, Girona, España. Electronic address: jsirvent.girona.ics@gencat.cat.
authors.forename: J M
authors.initials: JM
authors.lastname: Sirvent
authors.affiliation: Actio-Consulting, Barcelona, España.
authors.forename: M
authors.initials: M
authors.lastname: Gil
authors.affiliation: Servicio de Medicina Intensiva (UCI), Hospital Universitari de Girona Doctor Josep Trueta, Grupo de Microbiología e Infección, IDIBGI, CIBERES, Girona, España.
authors.forename: T
authors.initials: T
authors.lastname: Alvarez
authors.affiliation: Servicio de Medicina Intensiva (UCI), Hospital Universitari de Girona Doctor Josep Trueta, Grupo de Microbiología e Infección, IDIBGI, CIBERES, Girona, España.
authors.forename: S
authors.initials: S
authors.lastname: Martin
authors.affiliation: Servicio de Medicina Intensiva (UCI), Hospital Universitari de Girona Doctor Josep Trueta, Grupo de Microbiología e Infección, IDIBGI, CIBERES, Girona, España.
authors.forename: N
authors.initials: N
authors.lastname: Vila
authors.affiliation: Servicio de Medicina Intensiva (UCI), Hospital Universitari de Girona Doctor Josep Trueta, Grupo de Microbiología e Infección, IDIBGI, CIBERES, Girona, España.
authors.forename: M
authors.initials: M
authors.lastname: Colomer
authors.affiliation: Secretaría Técnica, Hospital Universitari de Girona Doctor Josep Trueta, Girona, España.
authors.forename: E
authors.initials: E
authors.lastname: March
authors.affiliation: Servicio de Cardiología, Hospital Universitari de Girona Doctor Josep Trueta, Girona, España.
authors.forename: P
authors.initials: P
authors.lastname: Loma-Osorio
authors.affiliation: Servicio de Anestesiología, Hospital Universitari de Girona Doctor Josep Trueta, Girona, España.
authors.forename: T
authors.initials: T
authors.lastname: Metje
mesh_terms: D001509:Bed Occupancy; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010351:Patient Discharge; D010360:Patient Transfer; D010362:Patients' Rooms; D012017:Referral and Consultation; D013030:Spain; D062606:Tertiary Care Centers / Q000458:organization & administration*
keywords: Critically ill process; Flujo de pacientes; Intensive care unit; Lean; Patient flow; Proceso de críticos; Professional satisfaction; Satisfacción profesional; Unidad de cuidados intensivos