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NIMHANS study illustrates the use of Lean Six Sigma in the stroke intervention program

NIMHANS study illustrates the use of Lean Six Sigma in the stroke intervention program
NIMHANS study illustrates the use of Lean Six Sigma in the stroke intervention program

A study by researchers at NIMHANS has illustrated the use of a statistical quality control method known as Lean Six Sigma (LSS) in developing an acute stroke intervention program in the institute’s emergency department. The paper was recently published in the International Journal of Quality and Reliability Management.

LSS is a process improvement methodology widely used in industry that combines two quality improvement methodologies: Lean and Six Sigma. Lean encompasses a set of tools aimed at reducing “waste” or “non-value-added” activities in the process. “Adapting the Lean methodology is intended to improve process efficiency and reduce costs,” explains PR Srijithesh, associate professor of neurology at NIMHANS, the lead author of the paper.

Stroke management

An acute ischemic stroke is caused by a sudden blockage of the cerebral arteries. It causes sudden paralysis, facial deformities, speech, vision or balance disorders. If not treated in time, it leads to permanent disability.

“Artery opening treatment (acute revascularization) is effective when initiated before brain tissue is damaged. The window of time between the onset of artery blockage and irreversible brain tissue damage is quite narrow. It varies in each patient, and the first few hours are the golden hours. Over time, the degree of brain tissue damage increases exponentially,” said Dr. Srijithesh. The Hindu.

Systematic protocol

“To make optimal use of resources, one needs a systematic protocol and workflow. At NIMHANS, the number of acute stroke revascularizations (ASRs) was limited before 2017 due to several factors. In this study, conducted between March 2018 and March 2020, we report on the application of the principles and methods of LSS in addressing the issues that hampered workflow in acute stroke,” the doctor said.

The doctor noted that the ASR increased fivefold during the study period and said that 65% of the 131 patients treated improved with a positive clinical outcome.

“This study – conducted in collaboration with the Statistical Quality Control Unit of the Indian Statistical Institute – is unique in that it applies LSS principles to a core area of ​​medicine. Applying LSS is a time-consuming process. But once applied, it integrates well into the system and seems to have always been embedded in the system,” he said.

Larger hub-and-spoke system

“Based on the findings from this study, the Government of Karnataka has approved a proposal for a large hub-and-spoke system covering two time-critical interventions – acute stroke and head trauma – as a state-wide project,” the doctor said.

The study was a collaboration between the departments of neurology, neuroradiology and interventional radiology with support from the departments of neurosurgery, neuroanesthesia and emergency room nursing staff, the doctor added.

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