Session Description
Poster presentation about implementing a Lean methodology performance improvement project using percutaneous tracheostomy on the bedside instead of referring to ENT, thus decreasing waiting time, lowering hazards of infection in ICU, decreasing length of stay, while eliminating adverse events during transport to OR.
Problem:
Tracheostomy is a common procedure in ICU to facilitate liberation from mechanical ventilation. When ICU patients are referred to ENT for tracheostomy, the average waiting time was about 5 days, this exposes patients to complications like infection and VAE, and prolongs ICU LOS.
Measurement:
Brain storming and fishbone diagram to identify causes of delay. Infection control surveillance to record VAE, run chart to trac average ICU length of stay, and reported adverse events during transport including levels of harm.
Analysis:
Value stream mapping identified several steps in the process that could be eliminated to decrease waste.
average waiting time, and ICU length of stay were compared by Wilcoxon ran SUm test before and after.
Implementation:
A team of experts (The tracheostomy team) performs percutaneous tracheostomy on the bedside, instead of referring to ENT. Organizing the team and defining each member’s role, and level of expertise was, while gaining the buy in of all ICU staff was challenging. We gained support through lectures and presentatins.
Results/Discussion
Waiting time for tracheostomy significantly decreased (5 vs. 0.9 days, p < 0.001), ICU length of stay decreased from 10.5 days to 7.1 days, ventilator associated events rates from 7.7 to 3 / 1000 ventilator days. The team is official part of ICU with teaching opportunities to all ICU staff.
