Proposta da aplicação das ferramentas lean healtchare para a diminuição do tempo de permanência do paciente no centro cirúrgico

Abstract

Hospitals are complex organizations in which processes and sectors are interconnected. The Surgical Center (SC) is one of the most relevant hospital sectors, as it concentrates high care demand, intensive use of resources, and directly impacts patient flow. In this context, measuring operational times is essential for monitoring the efficiency of the sector, including admission time, anesthesia time, surgical procedure time, post-anesthetic recovery time, and total patient stay in the Surgical Center. Prolonged surgical flow times may lead to delays in subsequent procedures, increased operational costs, staff overload, and negative impacts on patient experience. This study aimed to propose the implementation of Lean Healthcare tools to reduce patient length of stay in the Surgical Center, based on the analysis of the care flow and the identification of the main causes related to prolonged process times. This is a qualitative study developed through a single and in-depth case study at the Surgical Center of Hospital Universitário Júlio Muller, in Cuiabá, Mato Grosso, Brazil. An exploratory literature review was also conducted to identify waste related to surgical processes. Data collection was performed through the analysis of records related to admission, anesthesia, surgery start and end, post-anesthetic recovery, and discharge times, in addition to direct observation of the surgical flow and interviews with professionals involved in the surgical process, including surgeons, anesthesiologists, nurses, nursing technicians, and residents. A total of 85 elective surgical procedures were analyzed. Data were organized in digital spreadsheets and submitted to descriptive statistical analysis using means and standard deviations for each stage of the process. The results showed an average patient stay in the Surgical Center of 6h18min (±2h06min). The average admission time was 39 minutes (±18 min), anesthesia time 3h09min (±1h39min), surgical time 2h01min (±1h31min), and post-anesthetic recovery time 1h44min (±51 min). The main sources of waste identified included communication failures among teams, delays in room preparation, unavailability of materials, and lack of process standardization. As improvement proposals, Lean Healthcare tools were applied, including Value Stream Mapping (VSM), Ishikawa Diagram, 5W2H method, Kaizen, and multidisciplinary “bate-mapa” meetings. The Future State VSM demonstrated the potential reduction of total Lead Time from 5h44min to 5h10min, mainly associated with the reduction of non-value-added activities and improvement in communication between sectors. It was concluded that the application of Lean Healthcare tools proved promising for identifying waste, optimizing surgical processes, and improving operational efficiency in the Surgical Center, contributing to greater predictability of care flow, reduction of delays, and strengthening of patient care quality and safety.