Optimising PVI workflow with lean six sigma: enhancing efficiency and patient care in complex EP labs

Pulmonary vein isolation (PVI) via radiofrequency ablation is a complex procedure for treating atrial fibrillation (AF) that requires advanced equipment and specialised personnel. Optimising workflow in the electrophysiology (EP) lab is critical for efficiency and optimal clinical outcomes. Preparation, execution, and turnover times can significantly increase daily procedure capacity . Lean Six Sigma (L6S), originally from manufacturing, has proven effective in healthcare by reducing inefficiencies, optimising resources, and enhancing process consistency in complex settings like the EP lab.

This study aims to identify and streamline both inter- and intra-procedural processes to optimise patient care, reduce procedure times, and increase hospital capacity for managing AF cases.

We analysed 353 PVI only procedures. Using Lean Six Sigma tools, we evaluated inter-procedural times, including patient arrival, room setup, and post-procedure cleaning, along with intra-procedural intervals. By categorising procedural times based on patient profiles and procedural complexity, we sought to identify improvement areas and standardise process times.

Inter-procedural analysis revealed that the average time between patients (from one patient exiting to the next entering the operating room) was 41±23 minutes, with interquartile values [24, 40, 56]. The mean waiting time from patient arrival at the pre-op room to operating room entry was 10±10 minutes [4, 8, 13]. Other inter-procedural intervals included time from procedure end to patient exit (19±8 minutes [14, 17, 22]), the interval from patient entry to interventionist arrival (18±10 minutes [10, 15, 22]), cleaning team arrival time after patient exit (8±8 minutes [1, 5, 10]), and the cleaning duration itself (7±4 minutes [5, 7, 8]). (Table 1) Intra-procedural time analysis showed an average time of 14±10 minutes [7, 11, 19] from interventionist arrival to femoral puncture. The time from femoral puncture to transseptal puncture averaged 17±10 minutes [12, 15, 21], and the time from transseptal puncture to procedure end was 58±23 minutes [43, 54, 68]. The total procedure time (from femoral puncture to completion) was 74±24 minutes [60, 70, 85]. These findings indicate notable variability across both inter- and intra-procedural phases, suggesting opportunities for standardisation and process improvement. (Figure 1)

Our initial data collection and analysis highlight substantial variation in both inter- and intra-procedural times during PVI procedures. Applying Lean Six Sigma methodology provides a structured approach to identifying bottlenecks and standardising processes. These insights establish a foundation for further optimisation, potentially increasing daily procedural throughput and improving overall patient care in the EP labTable 1  Figure 1