La aplicación de Lean Healthcare en el proceso de hospitalización y alta del paciente: revisión integrativa

Fuentes, Livia Barrionuevo El Hetti; Gardim, Lucas; Silva, Thaís Oliveira da; Moura, André Almeida de; Bernardes, Andrea

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Revista Brasileira de Enfermagem

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Sumário

REVIEW • Rev. Bras. Enferm. 76 (5) • 2023 • https://doi.org/10.1590/0034-7167-2022-0751 copiar

La aplicación de Lean Healthcare en el proceso de hospitalización y alta del paciente: revisión integrativa

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos:

identificar evidencia científica sobre el uso del enfoque Lean Healthcare en el proceso de hospitalización y alta del paciente.

Métodos:

se realizó una revisión integrativa en las bases de datos PubMed, LILACS, SCOPUS, CINAHL, Web of Science y Embase.

Resultados:

de los 904 registros identificados, se incluyeron tres en esta revisión. Los estudios demostraron que, cuando se aplica en la planificación del alta, la filosofía Lean produce resultados favorables al mejorar la comunicación y ayudar a organizar el flujo de trabajo, reducir el tiempo de estancia y mejorar la calidad de la atención.

Consideraciones Finales:

aunque la metodología Lean muestra resultados positivos, su aplicación en las instituciones de salud no es sostenible, ya que a menudo se limita a algunos departamentos o servicios. Por lo tanto, para maximizar el éxito de la implementación, la filosofía Lean debe ser incorporada a la cultura organizacional, lo que representa el mayor desafio.

Descriptores:
Gestión de Calidad Total; Hospitalización; Alta del Paciente; Hospitales; Revisión

Databases	Search strategy
PubMed	(“Total Quality Management” OR “Lean Healthcare” OR “Lean System” OR “Lean methodology”) AND (“Patient Discharge”) AND (Hospitalization)
LILACS	(“Total Quality Management” OR “Lean Healthcare” OR “Lean System” OR “Lean methodology”) AND (“Patient Discharge”) AND (Hospitalization)
SCOPUS	(“Total Quality Management” OR “Lean Healthcare” OR “Lean System” OR “Lean methodology”) AND (“Patient Discharge”) AND (Hospitalization)
CINAHL	(“Total Quality Management” OR “Lean Healthcare” OR “Lean System” OR “Lean methodology”) AND (“Patient Discharge”) AND (Hospitalization)
Web of Science	(“Total Quality Management” OR “Lean Healthcare” OR “Lean System” OR “Lean methodology”) AND (“Patient Discharge”) AND (Hospitalization)
Embase	(“Total Quality Management” OR “Lean Healthcare” OR “Lean System” OR “Lean methodology”) AND (“Patient Discharge”) AND (Hospitalization)

Title	Year/Country	Design and Number of Participants	Interventions	Outcomes
Lean-Based Redesign of Multidisciplinary Rounds on General Medicine Service(²⁰20 Kane M, Rohatgi N, Heidenreich P, Thakur A, Winget M, Shum K, et al. Lean-Based redesign of multidisciplinary rounds on general medicine service. J Hosp Med. 2018;13(7):482-85. https://doi.org/10.12788/jhm.2908 https://doi.org/10.12788/jhm.2908... )	United States, 2018.	Quantitative approach; Design: quasi-experimental (pre- and post-intervention). n = 6,085 patients.	Hospital Digital System, using the “Press Ganey Survey” instrument.	Discharges before noon increased from 6.9% to 10.7% (p<0.001). The recording of estimated discharge dates increased from 31.4% to 41.3% (p<0.001). However, there was no change in patient satisfaction.
Lean methodology for performance improvement in the trauma discharge process(²¹21 O'Mara MS, Ramaniuk A, Graymire V, Rozzell M, Martin S. Lean methodology for performance improvement in the trauma discharge process. J Trauma Acute Care Surg. 2014;77(1):137-42. https://doi.org/10.1097/TA.0000000000000261 https://doi.org/10.1097/TA.0000000000000... )	United States, 2014.	Quantitative approach; Design: quasi-experimental (pre- and post-intervention). n = 4,000 admissions annually.	Satisfaction Survey.	Changes focused on a standardized morning report structure resulted in a decrease in the number of unanswered consultation questions from 67% to 34% (p=0.0021). Physical therapy rework was reduced from 35% to 19% (p=0.016). Patients admitted to non-trauma service units had 1.6 times longer length of stay (p<0.0001).
Use of a Dedicated, Non-Physician-led Mental Health Team to Reduce Pediatric Emergency Department Lengths of Stay(²²22 Uspal NG, Rutman LE, Kodish I, Moore A, Migita RT. Use of a dedicated, non-physician-led mental health team to reduce paediatric emergency department lengths of stay. Acad Emerg Med. 2016;23(4):440-7. https://doi.org/10.1111/acem.12908 https://doi.org/10.1111/acem.12908... )	United States, 2016.	Quantitative approach; Design: quasi-experimental (pre- and post-intervention). n = 1,640 visits.	Electronic Medical Record and Emergency Services Security Database.	There was a statistically significant decrease in the mean emergency department length of stay (332 minutes vs. 244 minutes, p<0.001). Significant reductions were also observed in the median emergency department length of stay (225 minutes vs. 204 minutes, p=0.001), physical security interventions (2.0% vs. 0.4%, p=0.004), and use of restraints (1.7% vs. 0.1%, p<0.001).

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[1] Corresponding author: Andrea Bernardes E-mail: andreab@eerp.usp.br