Software of Lean Rules to Neurosurgical Procedures: The Case of Lumbar Spinal Fusion Surgical procedure, a Literature Evaluate and Pilot Collection.
Oper Neurosurg (Hagerstown). 2018 Mar 14;:
Authors: Liu JJ, Raskin JS, Hardaway F, Holste Ok, Brown S, Raslan AM
BACKGROUND: Supply of upper worth healthcare is an final authorities and public aim. Bettering effectivity by standardization of surgical steps can enhance affected person outcomes, scale back prices, and result in larger worth healthcare. Lean rules and methodology have improved timeliness in perioperative medication; nevertheless, course of mapping of surgical procedure itself has not been carried out.
OBJECTIVE: To use Plan/Do/Examine/Act (PDSA) cycles methodology to lumbar posterior instrumented fusion (PIF) utilizing lean rules to create a typical work circulate, determine waste, take away intraoperative variability, and look at feasibility amongst pilot circumstances.
METHODS: Course of maps for five PIF procedures had been created by a PDSA cycle from 1 college neurosurgeon at 1 establishment. Plan, modularize PIF into fundamental elements; Do, map and time elements; Examine, analyze outcomes; and Act, determine waste. Waste inventories, spaghetti diagrams, and chartings of time spent per step had been created. Procedural steps had been broadly outlined with a view to examine steps regardless of the variability in PIF and had been analyzed with field and whisker plots to judge variability.
RESULTS: Temporal variabilities in length of decompression vs closure and vs closure had been considerably completely different (P = .003). Variability in procedural step length was smallest for closure and largest for publicity. Wastes together with ready and instrument defects accounted for 15% and 66% of all waste, respectively.
CONCLUSION: This pilot collection demonstrates that lean rules can standardize surgical workflows and determine waste. Although time and labor intensive, lean rules and PDSA methodology will be utilized to operative steps, not simply the perioperative interval.
PMID: 29554354 [PubMed – as supplied by publisher]