2020, Número 4
El modelo «Lean» en el proceso de la lobectomía pulmonar: resultados y dificultades de un viaje continuo
RESUMENObjective: Our objective was to describe the course and results of implementing a lean methodology program for lobectomy. Material and methods: A hospital initiative to improve efficiency started in 2012, applying the lean model in the general thoracic surgery service. Processes were mapped, eliminating non-value adding steps and identifying improvement opportunities. The impact of the lean implementation was assessed for patients that underwent lobectomy. Three periods were defined and compared: Baseline period 2008 to 2012 (period 1); Lean implementation period 2013 to 2014 (period 2); Full implementation period 2015 to 2018 (period 3). Results: 178 lobectomies were performed: 70, 29 and 79 patients during each period. Mean age was 60.29 ± 12.25 years; 99-178 (55.6%) were males. Hospital length of stay (LOS) decreased significantly during period 3 (6 versus 8 versus 4 days; p ‹ 0.001). Major complications increased significantly during period 2 (8.6 versus 24.1 versus 7.6%; p = 0.036) and stabilized thereafter. There were no differences in 30-day mortality and readmission rates between periods. Direct economic contribution margin improved significantly (-0.35 to 9.51%; p = 0.002). Conclusions: Lean implementation for lobectomy can result in decreased LOS and improved direct contribution margin. Efforts should be directed to minimize the negative impact that changing prevailing standards could have.