Applying the Lean Production System to Improve Stroke Fast Track Care in Lampang

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Thanin Lokeskrawee
Chadapa Boonsri
Nantnalin Nakakul
Kesara Kawong
Ladda Yottou


Background : Currently the standard treatment for adult patients with acute ischemic stroke within 4.5 hours of onset of symptoms is intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA). It should be given within 60 minutes of arrival in the emergency department. In July 2010, Lampang Hospital began a stroke fast track program, employing Lean/Toyota production system principles to improve wait times and quality of care.
Objective: To compare the process cycle efficiency, indicators, treatment outcome and complication before and after program implementation. 
Material and method: An interrupted time, observational study was conducted on 62 patients with acute ischemic stroke who receiving intravenous rtPA at emergency department of Lampang Hospital between June 2008 – February 2011. Twenty-eight patients were classified into pre-Lean group and 34 were in post-Lean group. Timing for each step, complication, clinical
outcome and mortality rate were recorded. The process cycle efficiency (PCE) and Thailand hospital indicator project (THIP) were calculated and compared between groups by using Fisher’s exact and t-test.
Results: The mean age was 63.6 ± 12.7 years (range, 38-91) and 51.6 % was female. The mean door-to-needle time decreased from 75.0 ± 22.4 minutes to 53.0 ± 20.5 minutes (p<0.001) and PCE improved from 18.0% to 24.7% (p<0.001). Percentage of patients receiving rtPA within 60 minutes of arrival (THIP) improved from 32.1% to 88.2% (p<0.001). The post-Lean group had lower incidence of symptomatic intracranial hemorrhage (5.9% vs 7.1%, p=1.000), mortality rate at 3 months (8.8% vs 10.7%, p=1.000) and higher favorable outcome (44.1% vs 21.4%, p=0.105)
Conclusion: Applying Lean/Toyota production system principles to stroke fast track system in Lampang Hospital could improve the process cycle efficiency, door-to-needle time and THIP. Major complications and mortality rate were not significantly reduced.

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How to Cite
Lokeskrawee, T., Boonsri, C. ., Nakakul, N. ., Kawong, K. ., & Yottou, L. (2022). Applying the Lean Production System to Improve Stroke Fast Track Care in Lampang. Lampang Medical Journal, 33(2), 90–102. Retrieved from
Original Article


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