Improving ward level efficiency using a modified treatment room layout according to Lean methodologies

Abstract

Standardised ward treatment rooms have the potential to improve efficiency in performing routine tasks. Our aim was to produce a standardised layout for commonly used equipment using a Lean approach. A standardised layout was devised for equipment used for venepuncture, intravenous cannulation (IVC), arterial blood gas sampling, urinary catheter insertion and nasogastric tube insertion. Stakeholder engagement was sought from house officers (HO), nursing staff, store staff and care attendants. HO were timed gathering equipment pre- and post-intervention, and a questionnaire was distributed. Feedback from all potential stakeholders contributed to the final design using repeat Plan, Do, Study, Act (PDSA) cycles. The intervention was implemented across 20 inpatient wards, in 3 tertiary university teaching hospitals. The mean time taken to gather equipment for IVC significantly reduced, from 94.9 to 33.9 s (n\u2009=\u2009166; p\u2009<\u20090.0001). Self-reported frustration among HO with the treatment room significantly decreased from 54.9 to 4.5% (p\u2009<\u20090.0001). There was a 62.3% reduction in the need for HO to ask other ward staff for help to locate equipment. This study demonstrates improved efficiency with a time saving of over 1 min for a very commonly performed ward-based task. Ward-based staff reported reduced frustration and less interruptions following the standardisation and optimisation of treatment room layouts.