Des outils simples de 'Toyota Production Systems' comme '5S'peut générer des gains rapides en efficacité, réduction de gaspillage et d'argent

1. Using lean methods to achieve safer
care in theatres
Dr Ahmed CHEKAIRI
Consultant anaesthetist
The Whittington Hospital NHS Trust

2. Background
• 3.0% Adverse events among surgical patients
• 50% of these are preventable
• <1% drug errors in anaesthetics, but
• Potential for harm is great
-Fasting S (2000) Adverse drug errors in anesthesia, and the impact of coloured syringe labels. CJA 47, 1060–7
-Webster CS (2001) The frequency and nature of drug administration error during anaesthesia.AIC. 29, 494 500
-Thomas (2003). Measuring Errors and Adverse Events in Health Care. J Gen Intern Med. 18, 61–67

3. Improving System Design
• Reason, JT (2005) Safety in the operating theatre – Part 2: Human error and organisational failure. QSHC 14, 56–61
• Reason, JT (2001) Understanding adverse events: the human factor. London, BMJ Publishing Group.
• Reason, JT (2000) Human error: models and management BMJ 320: 768-770

5. 20% LIPID
EMULSION
IV injection of 1.5 ml.kg-1 over 1 min
(For 70 kg100ml)

6. 0
10
20
30
40
50
60
70
80
90
Seconds
Time to find emergency drug -
Non anaesthetic staff
pre lean
post lean
0
20
40
60
80
100
120
140
Secondstofinddrug
Anaesthetic staff
Seconds to find missing
drug

7. ‘…For these organisations, the pursuit of safety
is not so much about preventing isolated
failures, either human or technical, as about
making the system as robust as is practicable
in the face of its human and operational
hazards...’ Reason
Reason J. Human error: models and management. BMJ 2000;:768–770.