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Grassi MO, Furino C, Recchimurzo N, De Vitis F, Sborgia G, Sborgia L, Meleleo A, Molfetta T, Piepoli M, Locatelli P, Boscia F, Alessio G. Implementation of Lean healthcare methodology in designing an Intravitreal Injection Center: first Italian experience. Int Ophthalmol 2020; 40:2607-2615. [PMID: 32514665 DOI: 10.1007/s10792-020-01441-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/23/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The principles of the Lean methodology, introduced by Toyota to improve productivity, are relevant to other settings, including healthcare. We aimed to use Lean methodology to design a new setting in our ophthalmology clinic to improve the management of patients receiving an intravitreal injection for ocular diseases. METHODS The location of services, days of operation, scheduling and processing of patients, utilization of staff, data recording methods, and examination and surgical procedures were analyzed, and a new Intravitreal Injection Center was developed according to Lean principles. RESULTS The new setting, which is confined to a single floor, in contrast to the previous system, which necessitated that patients visit various locations spread over three floors of the hospital, demonstrated benefits for patients and improved the flow and management of patients through the system with a need for fewer team members. The intravitreal injection service improved with regard to both the quality and speed of the overall procedure and the efficient use of staff. CONCLUSION Our aim to achieve a fast and one-way route to move patients through intravitreal injection administration was achieved, limiting any waste of time and space and improving the capacity management of the center. The system is of relevance to other ophthalmology clinic settings and facilitates the collection of valuable epidemiological and clinical information on the response of patients to different drugs and treatment regimens.
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Affiliation(s)
- Maria Oliva Grassi
- Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico, University of Bari, Piazza Giulio Cesare, 11, 70124, Bari, BA, Italy.
| | - Claudio Furino
- Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico, University of Bari, Piazza Giulio Cesare, 11, 70124, Bari, BA, Italy
| | - Nicola Recchimurzo
- Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico, University of Bari, Piazza Giulio Cesare, 11, 70124, Bari, BA, Italy
| | - Fabio De Vitis
- Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico, University of Bari, Piazza Giulio Cesare, 11, 70124, Bari, BA, Italy
| | - Giancarlo Sborgia
- Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico, University of Bari, Piazza Giulio Cesare, 11, 70124, Bari, BA, Italy
| | - Luigi Sborgia
- Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico, University of Bari, Piazza Giulio Cesare, 11, 70124, Bari, BA, Italy
| | - Arianna Meleleo
- Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico, University of Bari, Piazza Giulio Cesare, 11, 70124, Bari, BA, Italy
| | - Teresa Molfetta
- Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico, University of Bari, Piazza Giulio Cesare, 11, 70124, Bari, BA, Italy
| | - Marina Piepoli
- Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico, University of Bari, Piazza Giulio Cesare, 11, 70124, Bari, BA, Italy
| | | | - Francesco Boscia
- Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico, University of Bari, Piazza Giulio Cesare, 11, 70124, Bari, BA, Italy
| | - Giovanni Alessio
- Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico, University of Bari, Piazza Giulio Cesare, 11, 70124, Bari, BA, Italy
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Lim LW, Yip LW, Tay HW, Ang XL, Lee LK, Chin CF, Yong V. Sustainable practice of ophthalmology during COVID-19: challenges and solutions. Graefes Arch Clin Exp Ophthalmol 2020; 258:1427-36. [PMID: 32314034 DOI: 10.1007/s00417-020-04682-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 03/27/2020] [Accepted: 04/01/2020] [Indexed: 01/05/2023] Open
Abstract
Purpose The Coronavirus (COVID-19) outbreak is rapidly emerging as a global health threat. With no proven vaccination or treatment, infection control measures are paramount. In this article, we aim to describe the impact of COVID-19 on our practice and share our strategies and guidelines to maintain a sustainable ophthalmology practice. Methods Tan Tock Seng Hospital (TTSH) Eye Centre is the only ophthalmology department supporting the National Centre for Infectious Diseases (NCID), which is the national screening center and the main center for management of COVID-19 patients in Singapore. Our guidelines during this outbreak are discussed. Results Challenges in different care settings in our ophthalmology practice have been identified and analyzed with practical solutions and guidelines implemented in anticipation of these challenges. First, to minimize cross-infection of COVID-19, stringent infection control measures were set up. These include personal protective equipment (PPE) for healthcare workers and routine cleaning of “high-touch” surfaces. Second, for outpatient care, a stringent dual screening and triaging process were carried out to identify high-risk patients, with proper isolation for such patients. Administrative measures to lower patient attendance and reschedule appointments were carried out. Third, inpatient and outpatient care were separated to minimize interactions. Last but not least, logistics and manpower plans were drawn up in anticipation of resource demands and measures to improve the mental well-being of staff were implemented. Conclusion We hope our measures during this COVID-19 pandemic can help ophthalmologists globally and serve to guide and maintain safe access in ophthalmology clinics when faced with similar disease outbreaks.
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Abstract
PURPOSE OF REVIEW Heart failure is associated with an enormous burden on both patients and health care systems in the USA. Several national policy initiatives have focused on improving the quality of heart failure care, including reducing readmissions following hospitalization, which are common, costly, and, at least in part, preventable. The transition from inpatient to ambulatory care setting and the immediate post-hospitalization period present an opportunity to further optimize guideline concordant medical therapy, identify reversible issues related to worsening heart failure, and evaluate prognosis. It can also provide opportunities for medication reconciliation and optimization, consideration of device-based therapies, appropriate management of comorbidities, identification of individual barriers to care, and a discussion of goals of care based on prognosis. RECENT FINDINGS Recent studies suggest that attention to detail regarding patient comorbidities, barriers to care, optimization of both diuretic and neurohormonal therapies, and assessment of prognosis improve patient outcomes. Despite the fact that the transition period appears to be an optimal time to address these issues in a comprehensive manner, most patients are not referred to programs specializing in this approach post hospital discharge. The objective of this review is to provide an outline for early post discharge care that allows clinicians and other health care providers to care for these heart failure patients in a manner that is both firmly rooted in the guidelines and patient-centered. Data regarding which intervention is most likely to confer benefit to which subset of patients with this disease is lacking and warrants further study.
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Affiliation(s)
- Richard J Soucier
- Sections of Cardiovascular Medicine, Yale University School of Medicine, 135 College Street, Suite 230, New Haven, CT, 06520, USA
| | - P Elliott Miller
- Sections of Cardiovascular Medicine, Yale University School of Medicine, 135 College Street, Suite 230, New Haven, CT, 06520, USA
| | - Joseph J Ingrassia
- Division of Cardiology, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT, 06032, USA
| | - Ralph Riello
- Division of Pharmacy, Yale University School of Medicine, New Haven, CT, USA
| | - Nihar R Desai
- Sections of Cardiovascular Medicine, Yale University School of Medicine, 135 College Street, Suite 230, New Haven, CT, 06520, USA.,Center for Outcomes Research and Evaluation, Yale New Haven Health System, Yale New Haven Hospital, New Haven, CT, USA
| | - Tariq Ahmad
- Sections of Cardiovascular Medicine, Yale University School of Medicine, 135 College Street, Suite 230, New Haven, CT, 06520, USA.
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