Using Lean tools to improve the efficiency of awake fibreoptic intubation setup

BackgroundAwake fibreoptic intubation is a complex advanced airway technique used by anaesthesiologists in the management of a difficult airway. The time to setup this important procedure can be significant which may dissuade its use by some providers. In our institution, the awake intubation setup process was highly variable and error prone.MethodsWe deployed Lean methods to improve the efficiency and accuracy of the awake fibreoptic intubation setup process. A 2-day improvement event with a multidisciplinary team addressed the setup process, tested solutions and created standard work documents. Twenty awake fibreoptic intubation simulations were conducted before and after the intervention to quantify gains in setup efficiency and error reduction.ResultsVariability in the setup process, including clinical locations visited, was reduced through creating a standardised process. The average time to for an awake fibreoptic intubation setup was reduced by approximately 50%, from 23 min to 11 min (p<0.001). In addition, awake fibreoptic intubation equipment set out without error increased in the postintervention simulations from 59% to 85% (p=0.003).ConclusionUsing Lean tools, we were able to make the setup of awake fibreoptic intubation not only more efficient, but also more accurate. A similar methodological approach may have value for other complex anaesthesia procedures.

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The Availability of Advanced Airway Equipment and Experience with Videolaryngoscopy in the UK: Two UK Surveys

Anesthesiology Research and Practice ◽

10.1155/2015/152014 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

Rachel L. Gill ◽

Audrey S. Y. Jeffrey ◽

Alistair F. McNarry ◽

Geoffrey H. C. Liew

Keyword(s):

Difficult Airway ◽

High Frequency ◽

Fibreoptic Intubation ◽

Skill Levels ◽

Teaching Competence ◽

Equipment Availability ◽

Fibreoptic Laryngoscopy ◽

Advanced Airway ◽

Airway Equipment ◽

The Uk

Fibreoptic intubation, high frequency jet ventilation, and videolaryngoscopy form part of the Royal College of Anaesthetists compulsory higher airway training module. Curriculum delivery requires equipment availability and competent trainers. We sought to establish (1) availability of advanced airway equipment in UK hospitals (Survey I) and (2) if those interested in airway management (Difficult Airway Society (DAS) members) had access to videolaryngoscopes, their basic skill levels and teaching competence with these devices and if they believed that videolaryngoscopy was replacing conventional or fibreoptic laryngoscopy (Survey II). Data was obtained from 212 hospitals (73.1%) and 554 DAS members (27.6%). Most hospitals (202, 99%) owned a fiberscope, 119 (57.5%) had a videolaryngoscope, yet only 62 (29.5%) had high frequency jet ventilators. DAS members had variable access to videolaryngoscopes with Airtraq 319 (59.6%) and Glidescope 176 (32.9%) being the most common. More DAS members were happy to teach or use videolaryngoscopes in a difficult airway than those who had used them more than ten times. The majority rated Macintosh laryngoscopy as the most important airway skill. Members rated fibreoptic intubation and videolaryngoscopy skills equally. Our surveys demonstrate widespread availability of fibreoptic scopes, limited availability of videolaryngoscopes, and limited numbers of experienced videolaryngoscope tutors.

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Evaluating the Implementation of the “Build-Back-Better” Concept for Critical Infrastructure Systems: Lessons from Saint-Martin’s Island Following Hurricane Irma

Sustainability ◽

10.3390/su13063133 ◽

2021 ◽

Vol 13 (6) ◽

pp. 3133

Author(s):

Rita Der Sarkissian ◽

Anas Dabaj ◽

Youssef Diab ◽

Marc Vuillet

Keyword(s):

Decision Making ◽

Conceptual Analysis ◽

Scientific Literature ◽

Critical Infrastructure ◽

Methodological Approach ◽

Infrastructure Systems ◽

Before And After ◽

Study Offer ◽

Hurricane Irma ◽

Operational Aspects

A limited number of studies in the scientific literature discuss the “Build-Back-Better” (BBB) critical infrastructure (CI) concept. Investigations of its operational aspects and its efficient implementation are even rarer. The term “Better” in BBB is often confusing to practitioners and leads to unclear and non-uniform objectives for guiding accurate decision-making. In an attempt to fill these gaps, this study offers a conceptual analysis of BBB’s operational aspects by examining the term “Better”. In its methodological approach, this study evaluates the state of Saint-Martin’s CI before and after Hurricane Irma and, accordingly, reveals the indicators to assess during reconstruction projects. The proposed methods offer practitioners a guidance tool for planning efficient BBB CI projects or for evaluating ongoing programs through the established BBB evaluation grid. Key findings of the study offer insights and a new conceptual equation of the BBB CI by revealing the holistic and interdisciplinary connotations behind the term “Better” CI: “Build-Back-resilient”, “Build-Back-sustainable”, and “Build-Back-accessible to all and upgraded CI”. The proposed explanations can facilitate the efficient application of BBB for CI by operators, stakeholders, and practitioners and can help them to contextualize the term “Better” with respect to their area and its CI systems.

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Secrets to a successful awake fibreoptic intubation (AFOI) on a patient with odentogenous abscess

BMJ Case Reports ◽

10.1136/bcr-2020-238600 ◽

2021 ◽

Vol 14 (2) ◽

pp. e238600

Author(s):

Ming Kai Teah ◽

Esther Huey Ring Liew ◽

Melvin Teck Fui Wong ◽

Tat Boon Yeap

Keyword(s):

Tracheal Intubation ◽

Airway Management ◽

Difficult Airway ◽

Patient Outcomes ◽

Fibreoptic Intubation

Awake fibreoptic intubation (AFOI) is an established modality in patients with anticipated difficulty with tracheal intubation. This case demonstrates that with careful and meticulous preparations, AFOI can lead to improved airway management and excellent patient outcomes. A 38-year-old woman presented with severe trismus secondary to odentogenous abscess was identified preoperatively as having a potential difficult airway. AFOI was performed successfully using combined Spray-As-You-Go and dexmedetomidine technique.

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Fibreoptic intubation in ankylosing spondylitis patients

MedPulse International Journal of Anesthesology ◽

10.26611/10151914 ◽

2021 ◽

Vol 19 (1) ◽

pp. 17-20

Author(s):

Raghu K C ◽

◽

Nagesh R ◽

Viswash G K ◽

◽

...

Keyword(s):

Spinal Cord ◽

Ankylosing Spondylitis ◽

Difficult Airway ◽

Fibreoptic Intubation ◽

Cardiovascular Complications ◽

Inflammatory Disorder ◽

Double Blind Study ◽

Double Blind ◽

Chronic Inflammatory Disorder ◽

Group A

Background: Ankylosing spondylytes is a chronic inflammatory disorder characterized by inflammation in spines and spinal arthritis with a complex polygenic aetiology. The disease is more common in young males and risk factors include both genetic and environmental. Anesthesia management for ankylosing spondylitis is a challenge due to management of difficult airway, respiratory and cardiovascular complications, as well as the medications for disease and pain control. Both airway management and neuraxial access may prove to be difficult. Awake fibreoptic intubation is the safest option (²) in these patients with a potentially difficult airway as it allows continuous neurological monitoring while achieving a difficult airway. Methods: This is a Prospective Randomized Double-Blind Study conducted in Sri Sathya Sai Institute of Higher Medical Sciences; Total 70 Patients (Group A – 35, Group A – 35). All the subjects included after informed consent, blood samples and urine samples are collected from the all the subjects. Hb, RBCs, WBCs and Platelets was measured by laboratory standard methods. Along with Chest X- ray and ECG-for patients over 40 years of age. Results: This study was evaluated that in ankylosing spondylitis cases most of the physicians prefer to give general anaesthesia because to prevent trauma to the spinal cord but in these cases spine and surrounding tissues also it will involve at that time for maintain airway to the patient is challenge to the physicians by using fibreoptic intubation is good way to approach and maintain airway to the ankylosing patients. Conclusion: In this study suggest that in ankylosing spondylitis patients during surgery in place of tracheal intubation fibreoptic intubation is the best way to maintain airway to the patients and also we can prevent spinal cord damage.

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Effects of Lean Tools in Achieving Lean Warehousing

Economic Themes ◽

10.1515/ethemes-2016-0026 ◽

2016 ◽

Vol 54 (4) ◽

pp. 517-534 ◽

Cited By ~ 5

Author(s):

Aleksandra Anđelković ◽

Marija Radosavljević ◽

Danijela Stošić

Keyword(s):

Lean Principles ◽

Before And After ◽

Lean Tools ◽

And Performance ◽

The Individual ◽

Warehouse Operations

Abstract The acceptance of lean philosophy in the company means not only respecting the lean principles in the manufacturing but in all the processes that are performed inside the company. All processes in the company that are a potential places for making losses and waste and thus require the application of lean principles. Among others, warehouse and warehouse operations, as a centre of costs and waste, must be supported through the implementation of lean philosophy in the company by respecting lean principles. The implementation of lean principles in the warehouse is a certain step of improvement warehouse process and performance, but also of the whole company. In that sense, the paper presents the analysis of the warehousing process and its performances before and after implementation of the lean tools in a selected Serbian company as a practical example. In addition, research shows which parts of warehousing need to be improved, in analysed company, as well as correlation between the individual parts of warehousing, according to employees' opinion from next sectors: purchasing, production and logistics.

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Comparison of Hemodynamic Response and Complications in Patients with Difficult Airway Using Two Techniques-Retrograde and Fibreoptic Intubation

Journal of Anesthesia & Clinical Research ◽

10.4172/2155-6148.1000709 ◽

2017 ◽

Vol 08 (03) ◽

Author(s):

Abhimanyu Pokhriyal ◽

Anil Kumar Paswan ◽

Rajesh Meena ◽

Sekhar Verma ◽

Shashi Prakash ◽

...

Keyword(s):

Difficult Airway ◽

Fibreoptic Intubation ◽

Hemodynamic Response

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From Lean Manufacturing to Lean Construction: How Principles, Tools, and Techniques Evolved

10.5772/intechopen.96191 ◽

2021 ◽

Author(s):

Sevilay Demirkesen

Keyword(s):

Construction Industry ◽

Automotive Industry ◽

Lean Manufacturing ◽

Traditional Approach ◽

Lean Construction ◽

Work Practices ◽

Lean Tools ◽

Low Efficiency ◽

Tools And Techniques ◽

Lean Methods

Lean manufacturing first emerged in the automotive industry. However, low productivity and low efficiency in production are major problems for the majority of industries relying on a heavy workforce. Being one of these, the construction industry suffers from low productivity rates along with inefficient work practices. To prevent those, the industry has shifted its focus from the traditional approach to a more innovative one, which is called Lean construction. Lean construction aims to maximize value while minimizing waste. Therefore, it intends to create safer, smoother, and more efficient processes to eliminate waste. This chapter focuses on Lean construction and highlights the generic Lean tools and techniques practiced in the construction industry indicating its historical journey from Lean manufacturing. The chapter aims to raise awareness towards the efficiency of Lean methods in the construction industry with respect to practices observed in manufacturing.

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Application of Lean principles to improve early cardiac care in the emergency department

CJEM ◽

10.2310/8000.2011.110284 ◽

2011 ◽

Vol 13 (05) ◽

pp. 325-332 ◽

Cited By ~ 9

Author(s):

Zoë Piggott ◽

Erin Weldon ◽

Trevor Strome ◽

Alecs Chochinov

Keyword(s):

Emergency Department ◽

Cardiac Care ◽

Early Care ◽

Rapid Improvement ◽

Lean Principles ◽

Standard Work ◽

Coronary Syndrome ◽

Physician Assessment ◽

Before And After ◽

Electrocardiogram Ecg

ABSTRACTObjective:To achieve our goal of excellent emergency cardiac care, our institution embarked on a Lean process improvement initiative. We sought to examine and quantify the outcome of this project on the care of suspected acute coronary syndrome (ACS) patients in our emergency department (ED).Methods:Front-line ED staff participated in several rapid improvement events, using Lean principles and techniques such as waste elimination, supply chain streamlining, and standard work to increase the value of the early care provided to patients with suspected ACS. A chart review was also conducted. To evaluate our success, proportions of care milestones (first electrocardiogram [ECG], ECG interpretation, physician assessment, and acetylsalicylic acid [ASA] administration) meeting target times were chosen as outcome metrics in this before-and-after study.Results:The proportion of cases with 12-lead ECGs completed within 10 minutes of patient triage increased by 37.4% (p< 0.0001). The proportion of cases with physician assessment initiated within 60 minutes increased by 12.1% (p= 0.0251). Times to ECG, physician assessment, and ASA administration also continued to improve significantly over time (pvalues < 0.0001). Post-Lean, the median time from ECG performance to physician interpretation was 3 minutes. All of these improvements were achieved using existing staff and resources.Conclusions:The application of Lean principles can significantly improve attainment of early diagnostic and therapeutic milestones of emergency cardiac care in the ED.

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Investigation of Wasteful Activities Using Lean Methodology: In Perspective of Kazakhstan’s Construction Industry

Buildings ◽

10.3390/buildings9050113 ◽

2019 ◽

Vol 9 (5) ◽

pp. 113

Author(s):

Md Aslam Hossain ◽

Assel Bissenova ◽

Jong Ryeol Kim

Keyword(s):

Construction Industry ◽

Value Stream Mapping ◽

Construction Productivity ◽

Value Stream ◽

Survey Results ◽

Lean Tools ◽

The Impact ◽

Lean Methods

Like many other countries, the presence of wasteful activities is very common in Kazakhstan’s construction industry. This severely affects the productivity of construction processes. Lean methodology maximizes the value of a process by minimizing wasteful or non-value adding (NVA) activities. This study aims to explore and quantify the impact NVA items on construction productivity. Several observations were made for construction processes in Astana, Kazakhstan to investigate and quantify various types of wasteful activities. Moreover, a survey was conducted to examine the general understanding of wasteful activities and Lean methods within the construction industry in Kazakhstan. In terms of wasteful activities, a similarity was found between the observed construction processes and survey results. Furthermore, apart from the commonly found seven types of wasteful activities, some other sources of waste, such as “preparation” and “break”, were found from the observations. Finally, wasteful activities were mapped with commonly used Lean tools, as found in the literature, so that productivity can be improved by minimizing NVA activities. From the mapping and the survey results, value stream mapping (VSM) was found to be the most effective Lean tool, since it facilitates increased visualization.

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Low skill fibreoptic intubation using i-gel™ and air-Q™ in simulated difficult airways: A randomised study in manikin and in patients

Proceedings of Singapore Healthcare ◽

10.1177/2010105820929049 ◽

2020 ◽

Vol 29 (3) ◽

pp. 156-162

Author(s):

Jacqueline Xiu Ling Sim ◽

Geoffrey Haw Chieh Liew ◽

Hairil Abdullah ◽

Theodore Gar Ling Wong ◽

Patrick Wong

Keyword(s):

Difficult Airway ◽

Primary Outcome ◽

Second Generation ◽

Fibreoptic Intubation ◽

Cervical Collar ◽

P Value ◽

Success Rates ◽

Paired Data ◽

Patient Study ◽

Manikin Study

Background: Fibreoptic intubation via a supraglottic device (SAD) is ‘low skill fibreoptic intubation’ (LSFOI). ‘Standard’ second generation SADs (i-gelTM) have a gastric port. ‘Specialised’ second generation SADs (air-QTM) are designed to facilitate LSFOI and have wider ventilation ports. Our hypothesis was that performance of LSFOI differs between i-gelTM and air-QTM in a manikin with a simulated difficult airway. Methods: Our primary outcome was fibreoptic intubation success rate. Our secondary outcomes included SAD insertion and LSFOI times. A difficult airway was simulated by applying a hard cervical collar to a manikin. Anaesthetists performed LSFOI serially using both SADs in a random sequence. In the manikin study, 80 anaesthetists were recruited. To test the robustness of the conclusion from our manikin study, we repeated the study in 22 anaesthetised patients. Patients were fitted with the same cervical collar and randomly allocated to either devices. We used McNemar’s statistical test to analyse our primary outcome of successful intubations and paired nominal data. A Wilcoxon signed-ranks test was used to analyse nonparametric paired data and a Mann–Whitney U test was used for unpaired data analysis where appropriate. A p-value of <0.05 was considered statistically significant. Results: In the manikin study, the i-gelTM was superior to the air-QTM for successful tracheal intubation (98.8% vs 83.8%, respectively; p=0.002) and LSFOI times (34.0 s vs 36.0 s, respectively; p=0.012). In the patient study, LSFOI success rates were not significantly different between i-gelTM and air-QTM (100% vs 91.6%, respectively; p=0.545) but intubation times were shorter (52.5 s vs 60.0 s, respectively; p=0.036). Conclusion: In conclusion, we obtained LSFOI success rates for the i-gelTM or air-QTM of 98.8% and 83.8% respectively in a manikin; and 100% and 91.6% respectively in patients. It is in fact ‘low skill’ as many participants were successful despite no prior experience with LSFOI. The i-gelTM is superior for LSFOI compared with the air-QTM. This is despite being a ‘standard’ second generation SAD as compared to a ‘specialised’ second generation SAD (air-QTM). Trial Registration: The manikin and patient studies were conducted after being approved by the SingHealth Centralised Institutional Review Board (CRB reference number 2014/2039 and 2016/2069, respectively). The patient study was registered at ClinicalTrials.gov (ID: NCT02663843).

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