Applying Lean Healthcare in the hospitalization and patient discharge process: an integrative review

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

doi:10.1590/0034-7167-2022-0751

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Sumário

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

Applying Lean Healthcare in the hospitalization and patient discharge process: an integrative review

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to identify scientific evidence regarding the use of Lean Healthcare approach in the hospitalization and patient discharge process.

Methods:

this is an Integrative Review conducted in the PubMed, LILACS, SCOPUS, CINAHL, Web of Science, and Embase databases.

Results:

out of 904 records identified, three were included in this review. The studies demonstrated that when applied to discharge planning, the Lean philosophy brings favorable results, promoting improvements in the communication process, as well as assisting in workflow organization, with a reduction in length of stay and improvement in the quality of care.

Final Considerations:

although the Lean methodology presents positive results, it is considered that the application of the philosophy in healthcare institutions is still not sustainable, as it is often restricted to specific departments or services. Thus, to maximize the success of implementation, the Lean philosophy needs to be incorporated into the organizational culture, representing the greatest challenge.

Descriptors:
Total Quality Management; Hospitalization; Patient Discharge; Hospitals; Review

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