NIMHANS study illustrates use of statistical quality control methodology in stroke intervention programme

Acute ischemic stroke occurs due to sudden occlusion in brain arteries. It causes sudden onset of paralysis, facial deviation, speech, visual or balance abnormalities. If not treated on time, it will lead to permanent disability

Updated - July 11, 2024 11:22 am IST

Published - July 11, 2024 10:54 am IST - Bengaluru

The study was carried out by researchers from National Institute of Mental Health & Neuro Sciences (NIMHANS) in Bengaluru.

The study was carried out by researchers from National Institute of Mental Health & Neuro Sciences (NIMHANS) in Bengaluru. | Photo Credit: File photo

A study by researchers from NIMHANS has illustrated the use of a statistical quality control methodology, known as Lean Six Sigma (LSS), in the development of an acute stroke intervention programme in the Emergency Department of the institute. The paper was recently published in the International Journal of Quality and Reliability Management.

LSS is a widely adapted process improvement methodology in the industry, combining two quality improvement methodologies, Lean and Six Sigma. Lean involves a set of tools aimed at reducing ‘wastage’ or ‘non-value-added’ activities in the process. “The adaptation of Lean methodology is intended to improve process efficiency and reduce costs,” explained P.R. Srijithesh Additional Professor of Neurology at NIMHANS, who is the lead author of the paper.

Stroke management

Acute ischemic stroke occurs due to sudden occlusion in brain arteries. It causes sudden onset of paralysis, facial deviation, speech, visual or balance abnormalities. If not treated on time, it will lead to permanent disability. 

“Artery opening treatment (acute revascularisation) is effective if it is instituted before brain tissue gets damaged. The window of opportunity between the onset of occlusion in the artery and irreversible damage to brain tissue is quite narrow. It varies with each patient, and the first few hours are the golden hours. As time lapses, the degree of brain tissue undergoing damage increases in an exponential manner,” Dr Srijithesh told The Hindu.

Systematic protocol

“To optimally use resources, one needs to have a systematic protocol and workflow. At NIMHANS, prior to 2017, the number of acute stroke revascularisation (ASR) was limited due to multiple factors. In this study, carried out between March 2018 and March 2020, we report the application of principles and methodology of LSS in working through the issues that hindered acute stroke workflow,” the doctor said.

Pointing out that ASR increased five-fold during the study period, the doctor said that patients with favourable clinical outcomes improved to 65% of 131 patients treated. 

“This study — conducted in association with the Statistical Quality Control Unit of Indian Statistical Institute — is unique in that LSS principles are used in a core area of medicine. The application of LSS is a time-consuming process. But once applied, it integrates well into the system, appearing as though it is always embedded in the system,” he said.

Larger hub-and-spoke system

“Based on the insights from this study, the Karnataka government has approved a proposal for a large hub-and-spoke system involving two time-sensitive interventions — acute stroke and head trauma — as a State-wide project,” the doctor said.

The study was a collaboration between departments of Neurology, Neuro-radiology and Interventional Radiology with support from the departments of Neurosurgery, Neuro-anesthesia and nursing staff in the emergency department, the doctor added.

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