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Neumología y cirugía de tórax
Print version ISSN 0028-3746
Abstract
ALMANZO, Santiago et al. The Lean model on the pulmonary lobectomy process: results and pitfalls of a continuous journey. Neumol. cir. torax [online]. 2020, vol.79, n.4, pp.230-235. Epub Mar 14, 2022. ISSN 0028-3746. https://doi.org/10.35366/97965.
Objective:
Our objective was to describe the course and results of implementing a lean methodology program for lobectomy.
Material and methods:
A hospital initiative to improve efficiency started in 2012, applying the lean model in the general thoracic surgery service. Processes were mapped, eliminating non-value adding steps and identifying improvement opportunities. The impact of the lean implementation was assessed for patients that underwent lobectomy. Three periods were defined and compared: Baseline period 2008 to 2012 (period 1); Lean implementation period 2013 to 2014 (period 2); Full implementation period 2015 to 2018 (period 3).
Results:
178 lobectomies were performed: 70, 29 and 79 patients during each period. Mean age was 60.29 ± 12.25 years; 99-178 (55.6%) were males. Hospital length of stay (LOS) decreased significantly during period 3 (6 versus 8 versus 4 days; p < 0.001). Major complications increased significantly during period 2 (8.6 versus 24.1 versus 7.6%; p = 0.036) and stabilized thereafter. There were no differences in 30-day mortality and readmission rates between periods. Direct economic contribution margin improved significantly (-0.35 to 9.51%; p = 0.002).
Conclusions:
Lean implementation for lobectomy can result in decreased LOS and improved direct contribution margin. Efforts should be directed to minimize the negative impact that changing prevailing standards could have.
Keywords : Lobectomy; process improvement; Lean.