Journal Article

72 Application of the lean principle in a pre-hospital emergency setting to improve the occurrence, variance and accident (OVA) reporting system

Ramos, Jerome, Sidaya, Elizabeth, Ma Cleo Al Cantara, Derbel, Emna, Santos, Mark, Farid Ahmad Sohail, Al-Shaikh, Loua, Al-Ishaq, Moza, Abraham, Ranjith, Laughton, James, Al-Buyaradah, Mashaal, Varghese, Anish, Veettilakath, Fahad, Farhat, Hassan, Khedhir, Rafik, Fatma Babay EP Rekik

2025

Overview

BackgroundHamad Medical Corporation (HMC) has been utilising the Occurrence, Variance, and Accident (OVA) reporting system to monitor, investigate, and improve potential or occurred adverse events. Pre-hospital emergency care is time-critical, and reporting OVAs is essential whilst ensuring ambulance availability for access to effective out-of-hospital care. This project aimed to reduce the average time consumed in incident reporting using the OVA system by HMC Ambulance Service (HMCAS) personnel from six minutes on 13 September 2022 to three minutes on 08 October 2022.MethodsA new incident reporting access icon with items customised to HMCAS operational needs was developed and integrated into the OVA reporting system. A sample of 483 OVAs (168 baselines; 315 following the streamlined process) reported to the HMCAS quality and patient safety department between 13 September and 08 October 2022 was considered. The time elapsed to fill an OVA was recorded. A sample of 22 OVAs before and after the intervention was used to create Shewhart’s t-chart, which assessed the impact of the HMCAS-specified incident reporting icon created in the OVA system on reducing the reporting time. Student t-tests for paired groups and bivariate regression analyses were conducted to evaluate the impact of the ‘Lean’ reporting process.1ResultsThe mean time of reporting an OVA dropped from 328.90 to 145.09 seconds. In table 1, the p-values <0.05 indicate a significant impact of the implemented intervention on the OVA reporting process. The Shewhart’s t-chart visually demonstrated the impact of the ‘Lean’ reporting process with fewer data points (figure 1).ConclusionsImplementing the new icon helped identify the new intervention’s significant impact on reducing time wasted reporting an OVA. This converges with the Lean principle by optimising internal procedures to reduce time wasted during incident reporting. It also helped ensure ambulances’ availability to respond to pre-hospital emergency calls.2Abstract 72 Figure 1Reduction in time spent completing OVA since the introduction of the new HMCASG RL-Datix icon and form[Figure omitted. See PDF]Abstract 72 Table 1Student-t-test for paired groups and bivariate regression analysest-Test: Paired Two Sample for Means Pre-intervention observations samplePost-intervention observations sampleP(T<=t) two-tailObservations 11 11 0.003 Mean 328.909 145.109 Variance 26041.091 16774.651 df 10 Bivariate Regression analysis Coefficients R Square Adjusted R Square p-value Lower 95% Upper 95% Time to complete OVAs 247.597 0.202 0.114 0.007 87.705 407.488 ReferencesDeming WE. Out of the crisis. MIT Press 2018;450.Akmal A, Greatbanks R, Foote J. Lean thinking in healthcare – findings from a systematic literature network and bibliometric analysis. Health Policy [Internet] 2020 Jun 1[Accessed 2023 Jan 8];124(6):615–27. Available from: https://www.sciencedirect.com/science/article/pii/S0168851020300932Ethical Approval/IRB StatementThis project was approved by the Hamad Medical Corporation Ambulance Service, Doha, Qatar, as a Quality Improvement project on 15/03/2022.Disclosures and AcknowledgmentsWe want to thank all of the Hamad Medical Corporation Corporate Quality and Patient Safety Department for their support of this project.

• Publisher: BMJ Publishing Group LTD
• Subject: Ambulance services / Bibliometrics / Emergency medical care / Hospitals / Patient safety / Regression analysis