Using Lean Six Sigma to Redesign the Supply Chain to the Operating Room Department of a Private Hospital to Reduce Associated Costs and Release Nursing Time to Care.

Continuity of the supply chain is an integral element in the safe and timely delivery of health services. Lean Six Sigma (LSS), a continuous improvement approach, aims to drive efficiencies and standardisation in processes, and while well established in the manufacturing and supply chain industries, also has relevance in healthcare supply chain management. This study outlines the application of LSS tools and techniques within the supply chain of an Operating Room (OR) setting in a private hospital in Dublin, Ireland. A pre-/post-intervention design was employed following the Define, Measure, Analyse, Improve, Control (DMAIC) framework and applying LSS methodology to redesign the current process for stock management both within the OR storage area and within a pilot OR suite, through collaborative, inclusive, and participatory engagement with staff. A set of improvements were implemented to standardise and streamline the stock management in both areas. The main outcomes from the improvements implemented were an overall reduction in the value of stock held within the operating theatre by 17.7%, a reduction in the value of stock going out of date by 91.7%, and a reduction in the time spent by clinical staff preparing stock required for procedures by 45%, all demonstrating the effectiveness of LSS in healthcare supply chain management.

Variation in assistive technology use in Motor Neuron Disease according to clinical phenotypes and ALS Functional Rating Scale - Revised Score: A prospective observational study.

BACKGROUND: Assistive devices enhance independence and quality of life for people living with motor neuron disease (MND), but prescription can be challenging. OBJECTIVE: Improved prescription of assistive devices, through improved understanding of the relationship between clinical phenotypes, Amyotrophic Lateral Sclerosis Functional Rating Scale - Revised (ALSFRS-R) functional domain sub-scores and assistive technology required by people living with MND. METHODS: Prospective, observational consecutive-sample study of 269 patients with MND diagnosis. MAIN OUTCOME MEASURES: MND phenotype, ALSFRS-R scores and assistive technology devices in use. RESULTS: A statistically significant difference in total concurrent assistive technology item use was found between phenotypes (p = 0.001), with those with ALS Bulbar onset using the least. There was also a statistically significant difference in assistive technology usage in five of seven assistive technology categories across the clinical phenotypes, namely orthoses (p < 0.000), mobility devices (p < 0.000), transfer devices (p < 0.000), communication devices (p < 0.000), and activities of daily living devices (p = 0.016). Correlations between ALSFRS-R sub-score items and assistive technology count confirmed the utility of this outcome measure for equipment prescription. CONCLUSIONS: Clinicians need to consider MND phenotype and/or ALSFRS-R domain sub-score in clinical decision-making regarding assistive technology, as this will determine the pattern of disease and its progression, and hence assistive technology required.

Adaptive equipment use by people with motor neuron disease in Australia: a prospective, observational consecutive cohort study.

PURPOSE: People with motor neuron sisease require adaptive equipment to enhance life quality. This study aimed to examine total and concurrent equipment items prescribed with phenotype consideration. METHODS: A prospective, observational consecutive cohort study was undertaken. Data regarding Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised, phenotype, symptom onset and Functional Independence Measure (inpatients only) was recorded. Equipment utilized was coded by therapist as: speech devices; transfer devices; mobility devices (including power wheelchairs); orthoses; activities of daily living equipment; assisted technology and home modification equipment. RESULTS: Two hundred and seventy-three people with motor neuron disease participated, mean age 67 years, mean amyotrophic Lateral Sclerosis Functional Rating Scale-Revised score 32, a moderate level of disability. Equipment items per participant ranged from 0 to 20, median 5. The electric lift recliner chair was the most commonly used equipment item, used by 51.2% of the cohort. There was a statistically significant difference in equipment use between flail leg and bulbar (Md 11, 3 items, respectively; p = .005), and flail leg and cervical phenotypes (Md 11, 3.5 items respectively; p = .009). CONCLUSIONS: People with motor neuron disease have high equipment needs to optimize quality of life. Information regarding phenotype relative to equipment requirement, and most frequently prescribed equipment items can assist health-care providers anticipate equipment needs, burden and intensity for those with motor neuron disease. Implications for rehabilitation People with motor neuron disease have high concurrent equipment needs. Electric recliner lift chairs are the most frequently prescribed equipment item by those with motor neuron disease. There is variation in concurrent equipment needs relative to motor neuron disease phenotype.