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Injury. 2011 Nov;42(11):1234-7. doi: 10.1016/j.injury.2010.11.024. Epub 2011 Jan 11.

Lean thinking: can it improve the outcome of fracture neck of femur patients in a district general hospital?

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Department of Trauma and Orthopaedics, The Heart of England Foundation Trust, Good Hope Hospital, Birmingham, UK.


We present our experience in the management of hip fracture patients after the application of a value-stream approach, the Lean framework, in our trust. This system uses available resources in an efficient manner whilst eliminating waste. A statistically significant reduction of 5% and 9.3% was noted in the 30-day and overall mortality, respectively, after implementing 'Lean thinking'. Further improvements were also noted in door-to-theatre time, use of trauma beds and early discharge from hospitals. To our knowledge, this is the largest study in the literature where the Lean framework has been successfully employed for the management of a very challenging health-care issue faced by the National Health Service. Future prospective studies are, however, needed to reconfirm these results and to evaluate the components that are most critical to the success of the implemented framework.

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