Skip to main content
SpringerLink
Log in

Lean in the Cardiac Intensive Care Unit

  • Chapter
  • First Online:
Pediatric and Congenital Cardiac Care

Abstract

Lean management principles have been used extensively in manufacturing for decades and are increasingly being utilized in healthcare settings over the last 10 years. Lean principles, developed as part of the Toyota Management System, their simultaneous focus on waste reduction and customer satisfaction are vital for healthcare to reach its potential. Lean begins with mapping process flow and then applying lean tools and techniques to optimize the current state, including waste removal, inventory optimization through kanban (signal) systems and standard work. The translation of this manufacturing philosophy to healthcare involves the use of huddles in order to optimize situational awareness and develop clinical standard pathways to ensure that patients with similar pathophysiological abnormalities are treated in a similar fashion.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Institute for Healthcare Improvement. Going Lean in Health Care. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2005. (Available on www.IHI.org).

  2. Holden RJ. Lean thinking in emergency department: a critical review. Ann Emerg Med. 2011;57(3):265–78.

    Article  PubMed  Google Scholar 

  3. Hintzen BL, Knoer SJ, Van Dyke CJ, Milavitz BS. Effect of lean process improvement techniques on a university inpatient pharmacy. Am J Health Syst Pharm. 2009;66(22):2042–7.

    Article  PubMed  Google Scholar 

  4. Buesa RJ. Adapting lean to histology laboratories. Ann Diagn Pathol. 2009;13(5):322–33.

    Article  PubMed  Google Scholar 

  5. Vats A, Goin KH, Villareal MC, Yilmaz T, Fortenberry JD, Keskinocak P. The impact of a lean rounding process in a pediatric intensive care unit. Crit Care Med. 2012;40(2):608–17.

    Article  PubMed  Google Scholar 

  6. Mekontso-Dessap A, de Prost N, Girou E, et al. B-type natriuretic peptide and weaning from mechanical ventilation. Intensive Care Med. 2006;32(10):1529–36.

    Article  CAS  PubMed  Google Scholar 

  7. Chien JY, Lin MS, Huang YC, et al. Changes in B-type natriuretic peptide improve weaning outcome predicted by spontaneous breathing trial. Crit Care Med. 2008;36(5):1421–6.

    Article  CAS  PubMed  Google Scholar 

  8. Foster CB, Spaeder MC, McCarter RJ, et al. The use of near-infrared spectroscopy during an extubation readiness trial as a predictor of extubation outcome. Pediatr Crit Care Med. 2013;14(6):587–92.

    Article  PubMed  Google Scholar 

  9. Quality AfHR. Pocket guide: TeamSTEPPS: US Department of Health and Social Services; 2008.

    Google Scholar 

  10. Ohno T. Toyota production system: beyond large-scale production. Portland: Productivity Press; 1988.

    Google Scholar 

  11. Newth CJ, Venkataraman S, Willson DF, et al. Weaning and extubation readiness in pediatric patients. Pediatr Crit Care Med. 2009;10(1):1–11.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Jouvet PA, Payen V, Gauvin F, et al. Weaning children from mechanical ventilation with a computer-driven protocol: a pilot trial. Intensive Care Med. 2013;39(5):919–25.

    Article  PubMed  Google Scholar 

  13. Deeter KH, Zimmerman JJ. Developing and implementing pull systems in the intensive care unit. In: Wellman J, Hagan P, Jeffries H, editors. Leading the lean healthcare journey. New York: CRC Press; 2011. p. 93–108.

    Google Scholar 

  14. Jouvet P, Hernert P, Wysocki M. Development and implementation of explicit computerized protocols for mechanical ventilation in children. Ann Intens Care. 2011;1:51.

    Article  Google Scholar 

  15. Lellouche F, Mancebo J, Jolliet P, et al. A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation. Am J Respir Crit Care Med. 2006;174(8):894–900.

    Article  PubMed  Google Scholar 

  16. Hermeto F, Bottino MN, Vaillancourt K, et al. Implementation of a respiratory therapist-driven protocol for neonatal ventilation: impact on the premature population. Pediatrics. 2009;123(5):e907–16.

    Article  PubMed  Google Scholar 

  17. Khemani RG, Sward K, Morris A, et al. Variability in usual care mechanical ventilation for pediatric acute lung injury: the potential benefit of a lung protective computer protocol. Intensive Care Med. 2011;37(11):1840–8.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Burns KE, Meade MO, Lessard MR, et al. Wean earlier and automatically with new technology (the WEAN study). A multicenter, pilot randomized controlled trial. Am J Respir Crit Care Med. 2013;187(11):1203–11.

    Article  PubMed  Google Scholar 

  19. Liker JK. Principle 14: becoming a learning organization through relentless reflection (Hansen) and continuous improvement (Kaizen). In: The Toyota way. New York: McGraw-Hill; 2004. p. 250–65.

    Google Scholar 

  20. Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med. 2013;369(22):2126–36.

    Article  CAS  PubMed  Google Scholar 

  21. Jozwiak M, Teboul JL, Anguel N, et al. Beneficial hemodynamic effects of prone positioning in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2013;188(12):1428–33.

    Article  PubMed  Google Scholar 

  22. Gattinoni L, Taccone P, Carlesso E, et al. Prone position in acute respiratory distress syndrome. Rationale, indications, and limits. Am J Respir Crit Care Med. 2013;188(11):1286–93.

    Article  CAS  PubMed  Google Scholar 

  23. Venkatachalam V, Hendley JO, Willson DF. The diagnostic dilemma of ventilator-associated pneumonia in critically ill children. Pediatr Crit Care Med. 2011;12(3):286–96.

    Article  PubMed  Google Scholar 

  24. Muszynski JA, Sartori J, Steele L, et al. Multidisciplinary quality improvement initiative to reduce ventilator-associated tracheobronchitis in the PICU. Pediatr Crit Care Med. 2013;14(5):533–8.

    Article  PubMed  Google Scholar 

  25. Sarter NB, Woods DD. Situation awareness: a critical but ill defined phenomenon. Int J Aviat Psychol. 1991;1:45–7.

    Article  Google Scholar 

  26. Baker D, Gustafson S, Beaubien J, Salas E, Barach P. Medical teamwork and patient safety: the evidence-based relation. AHRQ Publication No. 05–0053. 2005. Available at: http://www.ahrq.gov/qual/medteam/. Accessed 4 Apr 2014.

  27. McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med. 2003;348:1123–33.

    Article  PubMed  Google Scholar 

  28. Merrer J, De Jonghe B, Golliot F, et al. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA. 2001;286:700–7.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Critical Care, Seattle Children’s Hospital, 4800 Sandpoint Way, NE, MB.6.550, Seattle, WA, 98105, USA

    Howard E. Jeffries MD, MBA

  2. Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children’s Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA

    Jerry J. Zimmerman MD, PhD

  3. Pediatric Intensive Care Unit, Department of Pediatric Critical Care Medicine, Seattle Children’s Hospital, 4800 Sand Point Way, NE, M/S MB.10.620, Seattle, WA, 98105, USA

    J. Elaine-Marie Albert MD, MHA

  4. Department of Critical Care Medicine, Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA

    Silvia M. Hartmann MD

Authors
  1. Howard E. Jeffries MD, MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jerry J. Zimmerman MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Elaine-Marie Albert MD, MHA
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Silvia M. Hartmann MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Howard E. Jeffries MD, MBA .

Editor information

Editors and Affiliations

  1. School of Medicine,, University of Oslo, Oslo, Norway

    Paul R. Barach

  2. Division of Cardiac Surgery, Department of Surgery,, Division of Cardiac Surgery, Department of Surgery, Johns Hopkins All Children’s Heart Institute, All Children’s Hospital and Florida Hospital for Children, Johns Hopkins University, St. Petersburg, Tampa, Orlando, FL, USA, Johns Hopkins University, Baltimore, Maryland, USA

    Jeffery P. Jacobs

  3. School of Medicine, Wayne State University, Detroit, Michigan, USA

    Steven E. Lipshultz

  4. University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada

    Peter C. Laussen

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag London

About this chapter

Cite this chapter

Jeffries, H.E., Zimmerman, J.J., Albert, J.EM., Hartmann, S.M. (2015). Lean in the Cardiac Intensive Care Unit. In: Barach, P., Jacobs, J., Lipshultz, S., Laussen, P. (eds) Pediatric and Congenital Cardiac Care. Springer, London. https://doi.org/10.1007/978-1-4471-6566-8_20

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-6566-8_20

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-6565-1

  • Online ISBN: 978-1-4471-6566-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation