Impact of LEAN implementation in restocking ambulances in an emergency department and on ambulance rotation within the Hamad Medical Corporation Ambulance Service

Background: With the advent of the Fédération Internationale de Football Association (FIFA) World Cup 2022 in Qatar, all healthcare systems were gearing up for an influx of patients. The Hamad Medical Corporation Ambulance Service (HMCAS) has also refined its patient supply chain (SC) processes to improve ambulance turnaround times (ATATs) at the emergency departments (EDs). International ambulance services (AS) are complex, and these ambulances are equipped with approximately 500 individual items, which include various types of medical consumables and equipment used during emergencies. By organizing individual medical items into stock units called “pre-packs”, according to the needs of the patients and type of clinical interventions, the inventory or stock-taking time of items stored in ambulances can be significantly reduced. Implementing reduced inventory lists of items and standardized pre-pack storage across the ambulance fleet has significantly improved the efficiency and accuracy of ambulance checking, restocking, and recovery time, improving overall ATAT at the ED.

Aim: This study evaluates the staff’s perceived impact of modular pre-pack kits on ambulance restocking processes and ED ATAT.

Methods: In this cross-sectional study, a fit-for-purpose survey was designed and distributed to all operational staff at HMCAS. The survey aims to assess HMCAS staff’s opinions about the implemented LEAN pre-pack system. Cronbach’s alpha was calculated to assess the reliability of the survey. The Mann-Whitney U-test was conducted to compare if there was a difference between the group’s opinions. The Shewhart control chart was created to monitor the impact of the implemented intervention on the ATAT at the ED. IBM-SPSS® (Statistical Package for Social Sciences) Version 26 was utilized for data analysis.

Results: A group of 287 employees with different backgrounds participated and completed the survey. The Cronbach’s alpha was equal to 0.739, indicating a satisfactory level of reliability of the Mann-Whitney U-test. The descriptive analysis and the Shewhart chart revealed that most staff found that the pre-pack concept helped improve LEAN restocking processes, access to clinical applications, and ambulance checks. Overall, this concept matched the international benchmarks for turnaround time.

Conclusion: The pre-pack concept promoted easy and quick processing of clinical applications, restocking procedures, and ambulance checks, and this positively impacted the ATAT at the ED. Further, it improved responses to emergency calls and enhanced access to effective care for patients. This approach also simplified the tasks above when many locum staff is employed on a short-term basis to cover mega-events such as the FIFA World Cup.