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Standardized care toyota

Lizabeth D Martin, Eliot B Grigg, Shilpa Verma, Gregory J Latham, Sally E Rampersad, Lynn D Martin
The Institute of Medicine has called for development of strategies to prevent medication errors, which are one important cause of preventable harm. Although the field of anesthesiology is considered a leader in patient safety, recent data suggest high medication error rates in anesthesia practice. Unfortunately, few error prevention strategies for anesthesia providers have been implemented. Using Toyota Production System quality improvement methodology, a multidisciplinary team observed 133 h of medication practice in the operating room at a tertiary care freestanding children's hospital...
June 2017: Paediatric Anaesthesia
Mypinder S Sekhon, Peter Gooderham, Brian Toyota, Navid Kherzi, Vivien Hu, Vinay K Dhingra, Morad S Hameed, Dean R Chittock, Donald E Griesdale
Background Traditionally, the delivery of dedicated neurocritical care (NCC) occurs in distinct NCC units and is associated with improved outcomes. Institution-specific logistical challenges pose barriers to the development of distinct NCC units; therefore, we developed a consultancy NCC service coupled with the implementation of invasive multimodal neuromonitoring, within a medical-surgical intensive care unit. Our objective was to evaluate the effect of a consultancy NCC program on neurologic outcomes in severe traumatic brain injury patients...
July 2017: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
K John McConnell, Anna Marie Chang, Thomas M Maddox, Douglas R Wholey, Richard C Lindrooth
BACKGROUND: Management practices, including, for example, "Lean" methodologies originally developed at Toyota, may represent one mechanism for improving healthcare performance. METHODS: We surveyed 597 nurse managers at cardiac units to score management on the basis of poor, average, or high performance on 18 practices across 4 dimensions (Lean operations, performance measurement, targets, and employee incentives). We assessed the relationship of management scores to hospital characteristics (size, non-profit status) and market level variables...
July 2014: Healthcare
James A Bassuk, Ida M Washington
The purpose of this study was to illustrate the application of A3 Problem Solving Reports of the Toyota Production System to our research vivarium through the methodology of Continuous Performance Improvement, a lean approach to healthcare management at Seattle Children's (Hospital, Research Institute, Foundation). The Report format is described within the perspective of a 10-step scientific method designed to realize measurable improvements of Issues identified by the Report's Author, Sponsor and Coach. The 10-step method (Issue, Background, Current Condition, Goal, Root Cause, Target Condition, Countermeasures, Implementation Plan, Test, and Follow-up) was shown to align with Shewhart's Plan-Do-Check-Act process improvement cycle in a manner that allowed for quantitative analysis of the Countermeasure's outcomes and of Testing results...
2013: PloS One
Antonio Greco, Leandro Cascavilla, Francesco Paris, Filomena Addante, Leonardo Miscio, Gabriella De Vincentis, Domenico Di Bisceglie, Domenico Crupi
Nephrologists worldwide are gradually coping with elderly patients. This is because of the burden of chronic disease in the aging population and specifically chronic kidney disease (CKD). CKD in the elderly rarely occurs in isolation from other chronic conditions and can often be a marker of these conditions themselves. Geriatricians usually take care of chronic conditions and are trained to perform comprehensive geriatric assessment, a tool to estimate frailty, that is the risk of adverse outcome, disability, and death in the clinical setting of elderly inpatients...
2012: Journal of Nephrology
Paula Atkinson, Elizabeta B Mukaetova-Ladinska
OBJECTIVES: Liaison Psychiatric Services for Older Adults in the UK have been established over the last decade, with rather divergent team composition and involvement. The latest documents (National Dementia Strategy, Who Cares Wins) set the gold standard for liaison services for older adults in England, requiring a proactive approach to services and integrating assessment and treatment of mental disorder into routine general hospital practice. This requires a physical presence of liaison services in the hospital, with collaboration with medical colleagues...
April 2012: Journal of Psychosomatic Research
N Hayashi, T Okanoue, H Tsubouchi, J Toyota, K Chayama, H Kumada
The aims of this phase III study were to assess the efficacy and safety of telaprevir in combination with peginterferon alfa-2b (PEG-IFN) and ribavirin (RBV) for difficult-to-treat patients who had not achieved sustained virological response (SVR) to prior regimens in Japan. The subjects were 109 relapsers (median age of 57.0 years) and 32 nonresponders (median age of 57.5 years) with hepatitis C virus genotype 1. Patients received telaprevir (750 mg every 8 h) for 12 weeks and PEG-IFN/RBV for 24 weeks. The SVR rates for relapsers and nonresponders were 88...
February 2012: Journal of Viral Hepatitis
Frederick A Meier, Ruan C Varney, Richard J Zarbo
BACKGROUND: : Amended surgical pathology reports record defects in the process of transforming tissue specimens into diagnostic information. OBJECTIVE: : Systematic study of amended reports tests 2 hypotheses: (a) that tracking amendment frequencies and the distribution of amendment types reveals relevant aspects of quality in surgical pathology's daily transformation of specimens into diagnoses and (b) that such tracking measures the effect, or lack of effect, of efforts to improve surgical pathology processes...
September 2011: Advances in Anatomic Pathology
Itaru Ozeki, Jun Akaike, Yoshiyasu Karino, Tomohiro Arakawa, Yasuaki Kuwata, Takumi Ohmura, Takahiro Sato, Naohiro Kamiya, Ichimaro Yamada, Kazuaki Chayama, Hiromitsu Kumada, Joji Toyota
BACKGROUND/AIMS: Anemia is commonly observed as a side effect in a treatment with protease inhibitors combined with peginterferon alpha and ribavirin for hepatitis C virus infection. This study assessed the safety, tolerability, viral kinetics, and selection of variants in telaprevir monotherapy for 24 weeks, and outcomes of the off-study treatment with peginterferon alpha-2b and ribavirin among Japanese female patients at a median age of 54 years who were difficult to treat with the standard therapy (peginterferon alpha-2b and ribavirin) alone in Japan...
July 2011: Journal of Gastroenterology
Makoto Toyota, Yuka Sasaki
Tuberculosis in the elderly remains a health burden in Japan. Most of the elderly aged more than 70 years in Japan had become infected with Mycobacterium tuberculosis in their youth, and the elderly represent a population at a special high risk for developing tuberculosis owing to comorbidity and age-related immunosuppression. The characteristics of tuberculosis in the elderly are different from young patients. To reduce active tuberculosis in the elderly, treatment of latent tuberculosis infection for compromised host could be strengthened, however its impact might be limited...
December 2010: Kekkaku: [Tuberculosis]
Clancy J Clark, Sarah L Sindell, Richard P Koehler
OBJECTIVE: Report our implementation of a standardized handover process in a general surgery residency program. DESIGN: The standardized handover process, sign-out template, method of implementation, and continuous quality improvement process were designed by general surgery residents with support of faculty and senior hospital administration using standard work principles and business models of the Virginia Mason Production System and the Toyota Production System...
January 2011: Journal of Surgical Education
Elcio Yamamoto, Juliana Marotti, Tomie Toyota de Campos, Pedro Tortamano Neto
PURPOSE: The aim of this study was to evaluate, using scanning electron microscopy (SEM), the accuracy of four impression techniques for osseointegrated implants (with or without acrylic resin splinting and with irreversible hydrocolloid or polyvinyl siloxane [PVS] impression material). MATERIALS AND METHODS: A metal master model was made with three implant analogs and two prosthetic spaces. This model was used as the standard for all impressions. Two impression materials were used (irreversible hydrocolloid and PVS) and two transfer techniques were used (squared impression copings indexed by the impression material and squared impression copings splinted with acrylic resin)...
November 2010: International Journal of Oral & Maxillofacial Implants
Kenji Ishitsuka, Hiroo Katsuya, Tomona Toyota, Masanao Ishizu, Naoko Kunami, Mana Fujita, Hidenori Sasaki, Yasushi Takamatsu, Masanobu Uchiyama, Haruo Fujikane, Kentaro Ogata, Shuuji Hara, Kazuo Tamura
Combination therapy with interferon-α and zidovudine (IFN/AZT) has been regarded as standard care for acute and indolent (i.e., chronic and smouldering) ATL based on reports involving a limited number of patients. This treatment approach has not been evaluated in Japan, a major endemic area of this disease in the world. This is the first Japanese report of IFN/AZT for ATL. It is impossible to draw any definitive conclusion from this small study; however, IFN/AZT showed clear anti-ATL effects for refractory/relapsed ATL patients...
December 2010: International Journal of Hematology
Fumio Yamagishi, Makoto Toyota
UNLABELLED: With this symposium, we focused on the relapse of tuberculosis in Japan. Out of 19,893 tuberculosis patients registered in 2007 in Japan, 7.48% were classified as relapse cases. Relapse cases have the risk of acquired drug resistance. But we have few analyses of the proportion of relapse tuberculosis cases with standard short course regimens for six months, factors contributing to tuberculosis relapse and the proportion of drug resistance among relapse TB cases in Japan. Therefore we analyzed the relapse tuberculosis cases in two rural areas and three urban areas...
December 2009: Kekkaku: [Tuberculosis]
Joe Rutledge, Min Xu, Joanne Simpson
To meet the increased clinical demands of our hospital expansion, improve quality, and reduce costs, our tertiary care, pediatric core laboratory used the Toyota Production System lean processing to reorganize our 24-hour, 7 d/wk core laboratory. A 4-month, consultant-driven process removed waste, led to a physical reset of the space to match the work flow, and developed a work cell for our random access analyzers. In addition, visual controls, single piece flow, standard work, and "5S" were instituted. The new design met our goals as reflected by achieving and maintaining improved turnaround time (TAT; mean for creatinine reduced from 54 to 23 minutes) with increased testing volume (20%), monetary savings (4 full-time equivalents), decreased variability in TAT, and better space utilization (25% gain)...
January 2010: American Journal of Clinical Pathology
Joseph R Siebert
CONTEXT: -When autopsy reports are delayed, clinicians and families do not receive information in a timely fashion. OBJECTIVE: -Using lean principles derived from the Toyota Production System, we set out to streamline our autopsy reporting process. DESIGN: -In a formal workshop setting, we identified the steps involved in producing an autopsy report, then sought to eliminate, abbreviate, or reschedule them into a more efficient format. We established intermediate deadlines for each case, taking care to make them visible; we initiated a weekly quality assurance review, giving attention to both scientific issues and approaching deadlines...
December 2009: Archives of Pathology & Laboratory Medicine
John Q Young, Robert M Wachter
BACKGROUND: Health care organizations have increasingly embraced industrial methods, such as the Toyota Production System (TPS), to improve quality, safety, timeliness, and efficiency. However, the use of such methods in psychiatric hospitals has been limited. METHODS: A psychiatric hospital applied TPS principles to patient transfers to the outpatient medication management clinics (MMCs) from all other inpatient and outpatient services within the hospital's system...
September 2009: Joint Commission Journal on Quality and Patient Safety
Christopher S Kim, David A Spahlinger, Jeanne M Kin, Richard J Coffey, John E Billi
BACKGROUND: Lean Thinking is a management philosophy derived from the manufacturing industry, where Toyota has long been the gold standard. Health care organizations have started to apply this approach to patient care. After initial experimentation, the University of Michigan Health System (UMHS) has adopted Lean Thinking as its uniform approach to quality improvement and is striving to become a complete Lean organization. PROJECTS: In 2005, the senior leadership selected an initial set of projects in areas that traced the patient's journey across different care settings within our health system...
August 2009: Joint Commission Journal on Quality and Patient Safety
Robert R Muder, Candace Cunningham, Ellesha McCray, Cheryl Squier, Peter Perreiah, Rajiv Jain, Ronda L Sinkowitz-Cochran, John A Jernigan
OBJECTIVE: To measure the effectiveness of an industrial systems-engineering approach to a methicillin-resistant Staphylococcus aureus (MRSA) prevention program. DESIGN: Before-after intervention study. SETTING: An intensive care unit (ICU) and a surgical unit that was not an ICU in the Pittsburgh Veterans Administration hospital. PATIENTS: All patients admitted to the study units. INTERVENTION: We implemented an MRSA infection control program that consisted of the following 4 elements: (1) the use of standard precautions for all patient contact, with emphasis on hand hygiene; (2) the use of contact precautions for interactions with patients known to be infected or colonized with MRSA; (3) the use of active surveillance cultures to identify patients who were asymptomatically colonized with MRSA; and (4) use of an industrial systems-engineering approach, the Toyota Production System, to facilitate consistent and reliable adherence to the infection control program...
August 2008: Infection Control and Hospital Epidemiology
Stephen S Raab, Dana Marie Grzybicki, Daniel Sudilovsky, Ronald Balassanian, Janine E Janosky, Colleen M Vrbin
Our objective was to determine whether the Toyota Production System process redesign resulted in diagnostic error reduction for patients who underwent cytologic evaluation of thyroid nodules. In this longitudinal, nonconcurrent cohort study, we compared the diagnostic error frequency of a thyroid aspiration service before and after implementation of error reduction initiatives consisting of adoption of a standardized diagnostic terminology scheme and an immediate interpretation service. A total of 2,424 patients underwent aspiration...
October 2006: American Journal of Clinical Pathology
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