Applying Lean Healthcare in the hospitalization and patient discharge process: an integrative review.
Livia Barrionuevo El Hetti Fuentes, Lucas Gardim, Thaís Oliveira da Silva and 2 others
PMID 37970967WHAT IT FOUND
Faster discharge, less physical therapy rework, and shorter pediatric emergency stays were reported after hospital redesigns that combined Lean tools with other workflow changes in three US studies.
Key findings
01In a general medicine service, a Lean-based multidisciplinary round redesign, with a hospital digital system and patient survey, reported discharges before noon rising from 6.9% to 10.7% and estimated discharge date recording rising from 31.4% to 41.3%, with no change in patient satisfaction.
02In a trauma discharge process, a standardized morning report within a multidisciplinary Lean approach reported unanswered consultation questions falling from 67% to 34% and physical therapy rework falling from 35% to 19%.
03In a pediatric psychiatric emergency department, a dedicated non-physician-led mental health team plus process mapping, electronic record and security database changes, team training, and adjustments to physical environment, visitor guidance and medical care organization reported mean length of stay falling from 332 to 244 minutes and restraints falling from 1.7% to 0.1%.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for RNs
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What it does not show
Only three studies were included, all from the United States, so the review may not apply to Brazilian hospitals or other settings. All three studies were before-and-after designs without randomisation, so other changes happening at the same time could explain the results. The reviewers did not use bias analysis tools for intervention studies. Each intervention bundled several changes, such as rounds, digital systems, surveys, process mapping, environment changes, training, and record or security systems, so the effect of Lean alone cannot be separated. The included studies had different patient groups, units, sample sizes, and outcomes. Comparison across them is difficult. A study reported no change in patient satisfaction, although the review's conclusion speaks positively about satisfaction.
The easy way to misread this
Do not conclude that Lean alone reduced length of stay or rework. The three studies were before-and-after hospital changes that also included digital systems, surveys, multidisciplinary rounds, standardized morning reports, process mapping, environment adjustments, visitor guidance, medical care organization, team training, and record or security database changes, and they did not randomise patients.