Key result
Lean and telehealth program linked to ~15% greater thrombolytic adherence in prehospital ACS care.
Why the study?
Variability in adherence to evidence-based protocols in Brazil's prehospital emergency care presents a major barrier to effective STEMI care.
Does a structured continuous improvement program integrating Lean principles and telehealth improve ACS care processes in prehospital emergency care?
Observational
Yes
Does a structured continuous improvement program integrating Lean principles and telehealth improve ACS care processes in prehospital emergency care?
Integrating Lean principles and telehealth in prehospital emergency care significantly improves critical ACS care process metrics such as door-to-ECG and door-to-needle times.
Answers are grounded in this paper and cite their sources.
Enhances thrombolytic adherence in acute care; extends support for targeted quality-improvement protocols in MI.
Background Timely management of Acute Coronary Syndrome (ACS) is essential to improving patient outcomes. In Brazil's Unified Health System, variability in adherence to evidence-based protocols in prehospital emergency care represents a significant barrier to effective ST-elevation myocardial infarction (STEMI) care. Purpose To determine the effectiveness of structured continuous improvement programs integrating Lean Healthcare principles, Improvement Science methodologies and while integrating telehealth strategies to enhance ACS care processes and patient outcomes within Brazil's fixed prehospital units. Results Preliminary findings indicate progressive improvement in ACS care process indicators among participating units. Adherence to thrombolytic therapy increased from 52% at baseline to 60% (p<0.01), representing a 15.4% relative improvement. This was accompanied by a significant reduction in critical time metrics: median door-to-needle time decreased from 58 to 42 minutes (28% reduction), while door-to-ECG (Figure 1) time improved from 24 to 14 minutes (42% reduction, p<0.001). The intervention also optimized overall system efficiency: total prehospital length of stay decreased from 797 to 534 minutes (33% reduction), and interfacility transfer time was reduced from 621 to 476 minutes (23% improvement), demonstrating enhanced patient flow coordination (Figure 2). Clinical outcomes remained stable despite increased patient volume: the mortality rate maintained at 2% (vs 2% baseline) while the elopement rate decreased from 4.1% to 3.0%, and 72% of teleconsultation cases received specialist feedback within target timeframe. Conclusion(s) The integration of telediagnosis and cardiology teleconsultation with Lean and Improvement Science methods proved feasible and improved ACS care processes in Brazil’s pre-hospital emergency network. This initiative underscores the value of structured quality improvement strategies for sustainable, evidence-based enhancement of acute cardiovascular care.
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Toth et al. (2026) conducted an observational in Acute Coronary Syndrome (ACS). Structured continuous improvement program integrating Lean principles and telehealth vs. Baseline (pre-intervention) was evaluated on Adherence to thrombolytic therapy (p=<0.01). A structured continuous improvement program integrating Lean principles and telehealth increased adherence to thrombolytic therapy from 52% to 60% (p<0.01) in prehospital ACS care.
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