Implementation of the Lean Healthcare System in the Emergency Room of the Clinical Hospital of the Federal University of Uberlândia: A Case Study.

The objective of this study was to analyze the effectiveness of the implementation of the lean healthcare system at the emergency room of the Clinical Hospital of the Federal University of Uberlândia, based on a comparison of hospital indicators obtained over the three phases corresponding to the period of one year before the implementation (T1), the year during the implementation (T2) and one year after implementation (T3). The methodology applied through this study can be classified as a case study that is exploratory and descriptive and developed in stages. Based herein on the search for hospital indicators, as occurred in the implementation of a lean process at the Clinical Hospital Emergency Department, along with a description of the implemented lean system. During the collection period of data relevant to the National Emergency Department Overcrowding Score and Length of Stay Indicator, the motivation of the teams grew, but with a notable tension between municipal management and hospital management. It was found that, despite the fluctuations, the patient length of stay in the Emergency Room remained high. With the exception of the variable of female deaths before 24 h of hospitalization, all other variables showed percentage increases before and after the intervention. This study reported the difficulties encountered by HC-UFU in implementing the lean project in an emergency room, thus ensuring that other institutions that intend to implement this project do not make the same types of mistakes.

Arterial stiffness in elderly patients with normotension and hypertension in Brazil.

Data on arterial stiffness in older populations, according to blood pressure (BP) levels, are scarce in Brazil. The objective of this study was to establish reference values for core measures of arterial stiffness, including carotid-femoral pulse wave velocity (cf-PWV) and aortic augmentation index (AIx), in a cohort of older individuals with normotension (NT) and hypertension. Cross-sectional analysis was performed with applanation tonometry data from 1192 patients aged 60 years or older. The authors classified patients according to their BP levels as having NT, controlled hypertension (CH), and uncontrolled hypertension (UH). The cf-PWV values were 9.11 ± 0.16 m/s (NT), 9.12 ± 0.18 m/s (CH), and 9.42 ± 2.2 m/s (UH) (P < 0.005; UH vs NT and CH). The AIx was 33.3% for the entire cohort and similar across all groups. The cf-PWV increased with age but reached a ceiling at 75 years. Compared with men, women had a higher AIx but similar cf-PWV levels. In conclusion, the markers of arterial stiffness were similar among individuals with NT/CH and higher among individuals with UH.