Improving health care for stroke patients. Reorganizing a stroke unit applying Lean methodology.

Abstract

In 2009 stroke care in the University Hospital of Northern Norway was reorganized. Until that year the hospital provided stroke care in two separate locations: patients 75 years and older were treated in the Geriatric Unit of the Medical Department while those younger were treated in the Neurological Department. Waiting times in the emergency unit were long, especially for the older patients. With the objective of reducing waiting times and offering equal service to all patients, reorganization by merging the two stroke units into one acute stroke unit was carried out. Lean methodology was applied in this process. This thesis presents and evaluates the effect of the reorganization. A medical record review of patients admitted before and after the reorganization was performed. The main findings were reductions in waiting time for CT scans and for first doctor’s visit for the geriatric patients. Furthermore, the proportion of patients receiving thrombolytic therapy increased. No major differences could be found concerning duration of hospitalization or discharge location. Thus, some of the objectives for the reorganization were achieved, while others were not.