Background Sending a patient to the operating room is the first step in surgery. Delayed patient transport causes the patient to go hungry for a longer time, aggravating the patient’s physical discomfort and psychological stress. The issue of delays in transporting inpatients to the operating room has rarely been discussed in the literature. The Toyota production system is a famous and excellent scientific method of reducing waste and increasing efficiency. Our goal is to use the Toyota method to decrease the time required to transport the inpatient to the operating room and to review the concepts underlying lean thinking. Methods We employed an A3 8-step problem-solving process. A current value stream map featuring numerical data (concerning 46 patients) measured in the workplace was developed. The total time spent on transport was 53 min, but we expected patients to be transported within 30 min. We hoped to reduce the time wasted by half, i.e., by 23*50% = 12 min. These 12 min were saved by reducing the time spent on “waiting for an attendant at the ward” by 9 min and the time spent on “elevator transport” by 3 min. According to the value stream map featuring the time measurements, the root causes of delayed transportation can be divided into process-related, attendant-related, and elevator-related factors. We formulated 5 countermeasures. The ECRS (Eliminate, Combine, Rearrange, Simplify) technique was used to rearrange, combine, and simplify the existing process. Hospital executives established norms for attendant prioritization of work and rules for elevator use. Results According to the original indicators, all goals were attained. “Total time spent” decreased by 62.3%. The time required for attendants to report to the nursing station decreased by 56.5%. The time spent on elevator transport decreased by 44.4%. We developed a process for future use based on information-assisted patient and staff identification. Finally, we standardized successful processes. Conclusion The seemingly trivial factors that delay patient transport are associated with seven types of waste. The A3 8-step problem-solving process is useful in this context. In proposing this improvement process, we believe that we are following the spirit of the Toyota production system.
Additive manufacturing (AM) has the potential to create geometrically complex parts that require a high degree of customization, using less material and producing less waste. Recent studies have shown that AM can be an economically viable option for use by the industry, yet there are some inherent challenges associated with AM for wider acceptance. The lack of standards in AM impedes its use for parts production since industries primarily depend on established standards in processes and material selection to ensure the consistency and quality. Inability to compare AM performance against traditional manufacturing methods can be a barrier for implementing AM processes. AM process sustainability has become a driver due to growing environmental concerns for manufacturing. This has reinforced the importance to understand and characterize AM processes for sustainability. Process characterization for sustainability will help close the gaps for comparing AM performance to traditional manufacturing methods. Based on a literature review, this paper first examines the potential environmental impacts of AM. A methodology for sustainability characterization of AM is then proposed to serve as a resource for the community to benchmark AM processes for sustainability. Next, research perspectives are discussed along with relevant standardization efforts.
ABSTRACT We report results from a blind comparison of five analytical laboratories ISO/IEC 17025 (International Organization for Standardization/International Electrotechnical Commission) accredited for the analysis of sulfate collected in H2O2(aq) from industrial stacks in accordance with the European Standard Reference Method (SRM) for sulfur dioxide (SO2) (EN 14791): the method produced under European Commission mandate to support the enforcement of the Industrial Emissions Directive (IED). Both “synthetic” (sodium sulfate dissolved in aqueous hydrogen peroxide [H2O2(aq)]) and “real” (extracted and collected from a stack simulator facility in accordance with EN 14791) samples were prepared across 2–10 and 10–290 mg·m0−3 emission equivalent concentration ranges, respectively. From the measurements returned by the laboratories, it was found that in 35% of the former and 28% of the latter the stated expanded uncertainty limits did not intersect with the mean. It was also found with the real samples that in 30% of the 46 different concentration test levels the stated expanded uncertainty of at least two of the laboratories did not intersect. With respect to compliance monitoring, it was found that EN 14791 was capable of enforcing emission limits under the IED associated with waste incinerators (i.e., 50 mg·m0−3), as only 3% of the deviations were in excess of the required uncertainty (commensurate with a 95% level of confidence). However, with respect to the use of EN 14791 for calibration of automated measuring systems (AMSs), it was found that 38.5% of the deviations were in excess of the uncertainty recommended by at least one national regulator as being necessary for EN 14791 to be an “effective tool” for the calibration of AMSs. With emission limits under the IED and the Best Available Technique Reference (BREF) documents it adopts becoming increasingly stringent, it is clear that more work is needed to determine the capability of the SRM and also alternative methods based on portable instruments. Implications: The deviations observed between laboratories ISO/IEC 17025 accredited for sulfate analysis bring into question the monitoring communities’ ability to routinely meet the uncertainty requirements associated with increasingly stringent SO2 emission limits under the European Union’s Industrial Emissions Directive. Furthermore, with even further reductions in the near future due to legislative adoption of BREF documents, such issues are only likely to be exacerbated. If the European monitoring community is to have confidence in the capability of the existing Standard Reference Method described in EN 14791 for enforcing increasingly stringent limits, work is needed to validate this method at these lower emission levels.
Urine may be a waste product, but it contains an enormous amount of information. Well-standardized procedures for collection, transport, sample preparation and analysis should become the basis of an effective diagnostic strategy for urinalysis. As reproducibility of urinalysis has been greatly improved due to recent technological progress, preanalytical requirements of urinalysis have gained importance and have become stricter. Since the patients themselves often sample urine specimens, urinalysis is very susceptible to preanalytical issues. Various sampling methods and inappropriate specimen transport can cause important preanalytical errors. The use of preservatives may be helpful for particular analytes. Unfortunately, a universal preservative that allows a complete urinalysis does not (yet) exist. The preanalytical aspects are also of major importance for newer applications (e.g. metabolomics). The present review deals with the current preanalytical problems and requirements for the most common urinary analytes.