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Improving the effectiveness of the referral process in a tertiary NICU using lean methodology concepts

International Journal of Pregnancy & Child Birth
Claudia Chetcuti Ganado, Sherif Dabbour, Yasin Fatin


Aim: To reduce the administrative time trainees spent when completing a patient referral to specialist teams in a tertiary Neonatal Intensive care setting.

Methods: We designed a pre intervention and post intervention questionnaire completed prospectively by trainees describing the tasks they needed to undertake to complete a referral, the time perceived as ‘wasted’ and suggest potential solutions over a 2 month period between 1st June 2020 and 1st August 2020. We used Lean methodology to identify waste as steps that did not add value to quality patient care. We designed a NICU referral directory containing the standard operating steps, the appropriate proformas and contact details of receiving unit, a process algorithm and a collective consultant email address. Results: Our project achieved a reduction in the median time to complete a referral from 27.5 minutes to 6 minutes (p = 0.0087). The time perceived ‘wasted’ by trainees was reduced from 20 minutes to 0 minutes (p=0.006).

Conclusion: Our project is a simple intervention and supports using Lean methodologies to identify waste and bring about quick improvements without significant capital investments. We demonstrate how front line staff can be engaged in identifying inefficiencies, suggest solutions which help in the successful adoption and sustainability of quality improvements


neurology, neuromuscular teams, endocrine, hyperinsulinism teams, respiratory teams, neuroradiologist opinions