HealthDay News — According to a study published in JAMA Surgery, implementation of lean practices can decrease wait times and increase operative volumes for patients at Veterans Affairs hospitals.

Nakul Valsangkar, MD, from the Indiana University School of Medicine in Indianapolis, and colleagues examined whether lean practices can be used to improve wait times for surgical procedures in Veterans Affairs hospitals. A value stream analysis was held in fiscal year (FY) 2013, culminating in multiple rapid process improvement workshops. To reduce wait times, high-priority triage with enhanced operating room flexibility was instituted.

The researchers observed a decrease in mean patient wait times for elective general surgical procedures following rapid process improvement workshop project rollouts, from 33.4 days in FY 2012 to 26.0 days in FY 2013 (P=.02). In FY 2014, mean wait times were half that seen in FY 2013, at 12.0 days (P=.07), representing a 3-fold decrease from FY 2012 (P=.02).

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There was an increase in operative volume from 931 patients in FY 2012 to 1090 in FY 2013 and 1072 in FY 2014. There were also increases in combined clinic, telehealth and e-consultation encounters, as well as a decrease in the number of no-shows from FY 2012 to FY 2014.

“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,” the authors write.


Valsangkar NP, Eppstein AC, Lawson RA, Taylor AN. “Effect of Lean Processes on Surgical Wait Times and Efficiency in a Tertiary Care Veterans Affairs Medical Center.” JAMA Surg. Published online September 07, 2016. doi:10.1001/jamasurg.2016.2808

Ray JJ, Spector SA. “Building a Lean, Mean Patient Care Machine.” JAMA Surg. Published online September 07, 2016. doi:10.1001/jamasurg.2016.2834

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