Application of Lean Theory to Poison Center Quality Management Processes

Background: Lean theory uses the "less is more" concept - a systemic approach to identifying and eliminating waste (non-value-added activities) through continuous quality improvement (CQI). This approach describes the current state of a process, maps the value stream, and applies the 5 S Principles (sort, set in order, shine, standardize, sustain). We applied lean thinking to a poison center (PC) charting process. Case Report: Documentation required a 10-step process: recording full product name in case notes, choosing the name in the computer pick-list (current state), and CQI review. Value stream mapping revealed that although this process was designed to ensure accuracy, inconsistencies still resulted. Lean thinking (future state) resulted in a 5-step process that eliminated duplication, sped charting, and reduced CQI review time. After lean implementation (recording the product in the product name field only), CQI performed initial and follow-up 30-day case studies comparing the product selected to the quality control audiotape. Initial study revealed an accuaracy rate of 92.9% (131/141), and follow-up, 12 months after process change showed an accuracy rate of 92.9% (143/154). Case Discussion: Initial and repeat metrics showed that product identification accuracy remained over 90% before and after the lean process. In addition, daily CQI review time was decreased by 50%. Three of the 5S Principles were used in this process change: sort, standardize, sustain. Sorting identified actions that either created no value or were duplicative. Standardization sped up documentation. The process is sustained by repeating CQI review at yearly intervals or sooner if it is determined that a problem exists. Conclusion: Using lean thinking sped chart completion, maintained product identification accuracy, reduced need for paper review (decreasing paper use and and CQI staff time to print charts), and cut CQI review time. Future CQI follow-up studies will monitor the process to ensure accuracy is maintianed over 90% (no process decay). Lean theory may have application to many other PC processes.