Lean thinking in total nursing care for mechanically ventilated patients: A new concept in ICU

Abstract

Background: Lean approach is one of the coming revolutions for a better, improved, high-value-based care to maximize the benefit from nursing care activities. Additionally, it can shorten the mechanical ventilation duration and the total intensive care unit stay with a time and cost effective process. Lean is an improvement strategy based on the concept of eliminating the waste and creation of value-added care practices to the patients. Applying lean strategy for mechanically ventilated patients requires critical evaluation of all steps of the care to identify which add value and which do not.

Methods: A descriptive research design was used in the current study and two tools were used for data collection in this study: “Lean assessment observational checklist of total care for mechanically ventilated patients”, and “Critical care nurses’ self-report about waste during total care of mechanically ventilated patients”.

Results: The differences between value added and non-value added care practice items were not statistically significant in ventilator and patient care practices items (p = .232 and .884) respectively, while there was no statistical difference between the value added and non-value added care practice items in tube care. The differences between the time consumed in all care practices items were statistically significant (p < .001). According to the nurses' self-report, direct care for patients was ranked as the first care category that can increase the cost and effort followed by the indirect care category.

Conclusions: Not all care items for mechanically ventilated patients have been added value to the patients. Waste outcomes as reported by nurses resulted in increase their efforts, time of care, in addition to increase the cost of care.