Lean management enhances antimicrobial stewardship in a Chinese psychiatric hospital: a quality improvement study on aetiological submission rates

Background Antimicrobial resistance poses a significant threat to global health, exacerbated by the misuse of antibiotics. The aetiology examinations are crucial for rational antibiotic use but often inadequate in clinical practices. This study aimed to improve the aetiological submission rate before therapeutic antibiotic use (aetiological submission; AS rate) in a provincial psychiatric hospital in China using lean management to improve antimicrobial stewardship.Methods A quality improvement initiative was conducted from June 2021 to April 2022 by employing the Define, Measure, Analyze, Improve, Control (DMAIC) lean model. The effectiveness of the intervention was evaluated by comparing the aetiological submission status of 885 hospitalised patients receiving therapeutic antibiotics during the baseline period (June to October 2021) with that of 904 inpatients during the postintervention period (November 2021 to April 2022) and by evaluating whether there was a significant difference in the AS rates within the five targeting departments before and after the intervention.Results The hospital-wide AS rate significantly increased from 12.43% (110/885) at baseline to 84.96% (768/904) after intervention (χ²=941.24, p<0.001), exceeding the target of 50%. Significant improvements (all p<0.001) were also observed in all targeting departments.Conclusion The application of lean management, specifically the DMAIC lean model, proved highly effective in enhancing the AS rate. This systematic approach provides an improvement model for antimicrobial stewardship and offers valuable experience and reference for other healthcare institutions in their antimicrobial stewardship practices.