Improving the Quality of Emergency Intrahospital Transport for Critically Ill Patients by Using Toyota Production System Methods

Figures & data

Figure 1 Process of using TPS to improve the quality of emergency intrahospital transport for critically ill patients.

Table 1 Intrahospital Transport Time for Critically Ill Patients Before and After TPS Management

Step of Process	Time Spent M (IQR) (Min)		Z-value	P-value	Value Category
	Before TPS Management	After TPS Management
Issuance of medical advice by relevant doctor, review of nurse	1 (1)	1 (1)	−1.086	0.227	Indirect value
Informing the patient of relevant conditions and risks and signing	3 (2)	2 (2)	−1.821	0.069	Direct value
Admission procedures	7 (3)	5 (1)	−5.603	<0.001	Direct value
Severity evaluation	6 (2)	6 (1)	−1.722	0.085	Indirect value
Ward preparation	11 (2)	N/A	N/A	N/A	Indirect value
Waiting for nursing workers	5 (2)	N/A	N/A	N/A	No value
Waiting for elevators	5 (1)	4 (1)	−5.620	<0.001	No value
Transport	6 (1)	5 (1)	−4.813	<0.001	No value
Ward handover	5 (2)	4 (2)	−4.365	<0.001	Direct value
Total time of process	39 (4)	27 (3)	−6.587	<0.001	N/A

Note: 1. N/A: not applicable; 2. the longest duration for three parallel steps (ie, severity evaluation, ward preparation, and waiting for nursing workers) from admission procedures to transport was taken.

Table 2 Situation of Transport Process for Critically Ill Patients Before and After TPS Management

		Direct Value	Indirect Value	No Value	Total	Process Efficiency (%)	Value Efficiency (%)
Before TPS management	Steps (quantity)	3	3	3	9	33.33	38.46
	Percentage of steps (%)	33.33	33.33	33.33	100
	Time spent M (IQR) (min)	15	12	12	39
	Percentage of time (%)	38.46	30.77	30.77	100
After TPS management	Steps (quantity)	3	2	2	7	42.86	40.74
	Percentage of steps (%)	42.86	28.57	28.57	100
	Time spent M (IQR) (min)	11	7	9	27
	Percentage of time (%)	40.74	25.93	33.33	100

Note: process efficiency = steps for direct value /total steps ×100%; value efficiency = time spent on direct value /total time ×100%.

Table 3 Comparison Between Groups Before and After PSM Balancing

Item		Pre-TPS Management Group	Post-TPS Management Group	P value
Criteria for transport grading: I/II/III (cases)	Before PSM	20/20/28	16/32/15	0.038
	After PSM	8/12/10	9/12/9	0.804
Gender: male/female (cases)	Before PSM	33/35	33/30	0.030
	After PSM	17/13	15/15	0.398
Age (years)	Before PSM	58.2±14.5	55.9±13.9	0.036
	After PSM	56.0±12.9	55.9±13.0	0.772
History of hypertension: yes/no (cases)	Before PSM	41/27	39/24	0.496
	After PSM	18/12	17/13	0.500
History of diabetes: yes/no (cases)	Before PSM	38/30	40/23	0.239
	After PSM	16/14	15/15	0.500
History of malignant tumor: yes/no (cases)	Before PSM	21/47	32/31	0.016
	After PSM	9/21	7/23	0.386

Table 4 Comparison of Satisfaction of Receiving Departments and Patients Before and After TPS Management

Group	Cases (n)	Satisfaction of Receiving Departments [N (%)]	Patient Satisfaction [N (%)]
Pre-TPS management group	30	22 (73.33)	23 (76.67)
Post-TPS management group	30	29 (96.67)	29 (96.67)
P-value	N/A	0.013	0.026

Notes: 1. N/A: not applicable; 2. satisfaction = number of satisfied people/total number of people under investigation ×100%; 3. statistical method: Fisher’s exact probability method.

Figure 2 Intrahospital transport time and adverse event rate for critically ill patients during intrahospital transport before and after TPS management.

Note: (A) Intrahospital transport time; (B) adverse event rate.

Figure 3 Satisfaction concerning emergency intrahospital transport for critically ill patients before and after TPS management.

Note: (A) Satisfaction of receiving departments; (B) patient satisfaction.