1
|
Lean Six Sigma to reduce the acute myocardial infarction mortality rate: a single center study. TQM JOURNAL 2023. [DOI: 10.1108/tqm-03-2022-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PurposeCardiovascular diseases are the leading cause of death worldwide. In Italy, acute myocardial infarction (AMI) is a major cause of hospitalization and healthcare costs. AMI is a myocardial necrosis event caused by an unstable ischemic syndrome. The Italian government has defined an indicator called “AMI: 30-day mortality” to assess the quality of the overall care pathway of the heart attacked patient. In order to guarantee high standards, all hospitals had to implement techniques to increase the quality of care pathway. The aim of the paper is to identify the root cause and understand the mortality rate for AMI and redesign the patient management process in order to improve it.Design/methodology/approachA Lean Six Sigma (LSS) approach was used in this study to analyze the patient flow in order to reduce 30-days mortality rate from AMI registered by Complex Operative Unit (COU) of Cardiology of an Italian hospital. Value stream mapping (VSM) and Ishikawa diagrams were implemented as tools of analysis.FindingsProcess improvement using LSS methodology made it possible to reduce the overall times from 115 minutes to 75 minutes, with a reduction of 35%. In addition, the corrective actions such as the activation of a post-discharge outpatient clinic and telephone contacts allowed the 30-day mortality rate to be lowered from 16% before the project to 8% after the project. In this way, the limit value set by the Italian government was reached.Research limitations/implicationsThe limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.Practical implicationsThe LSS approach has brought significant benefits to the process of managing patients with AMI. Corrective actions such as the activation of an effective shared protocol or telephone interview with checklist can become the gold standard in reducing mortality. The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.Originality/valueLSS, applied for the first time to the management of cardiovascular diseases in Italy, is a methodology which has proved to be strategic for the improvement of healthcare process. The simple solutions implemented could serve as a guide for other hospitals to pursue the national AMI mortality target.
Collapse
|
2
|
Niñerola A, Sánchez-Rebull MV, Hernández-Lara AB. Quality improvement in healthcare: Six Sigma systematic review. Health Policy 2020; 124:438-445. [DOI: 10.1016/j.healthpol.2020.01.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 12/19/2019] [Accepted: 01/02/2020] [Indexed: 12/26/2022]
|
3
|
Improta G, Balato G, Ricciardi C, Russo MA, Santalucia I, Triassi M, Cesarelli M. Lean Six Sigma in healthcare. TQM JOURNAL 2019. [DOI: 10.1108/tqm-10-2018-0142] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Since healthcare spending accounts for approximately 6.6 per cent of the gross domestic product, reducing waste in health facilities is necessary to generate significant cost savings. After previous work concerning the application of Lean Six Sigma (LSS) to hip surgery, the purpose of this paper is to use LSS as the correct methodology to analyse a clinical pathway. Fast track surgery was introduced to the Complex Operative Unit of Orthopaedic and Traumatology of the University Hospital “Federico II” to improve quality and further reduce costs associated with prosthetic hip replacement surgery.
Design/methodology/approach
The DMAIC (Define, measure, analyse, improve, control) roadmap was used as the typical problem-solving approach of the LSS methodology. A rigorous process of defining, measuring, analysing, improving and controlling business problems can be used to reach fixed goals. The paper was written following the Standards for Quality Improvement Reporting Excellence (SQUIRES Guidelines).
Findings
In this work, the authors found that multiple variables could influence the length of hospital stay (LOS) for inpatient treatment, thereby increasing patient management costs due to longer periods of hospitalisation. Therefore, LSS analysis of the implemented corrective actions demonstrated the efficacy and efficiency of the novel protocol. The average LOS was reduced from 10.66 to 7.8 days (−26.8 per cent).
Originality/value
The introduction of fast track surgery was validated through a rigorous LSS analysis, which demonstrated that the new protocol benefitted both patients and the hospital.
Collapse
|
4
|
Ultrasound-Guided Peripheral Intravenous Catheters to Reduce Central Venous Catheter Use on the Inpatient Medical Ward. Qual Manag Health Care 2019; 27:30-32. [PMID: 29280905 DOI: 10.1097/qmh.0000000000000156] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The traditional technique of placing a peripheral intravenous (IV) catheter is successful in most cases on inpatient wards. However, when the traditional method fails, a central venous catheter may be placed to maintain IV access. These catheters are associated with risks including central line-associated bloodstream infection. METHODS We evaluated the effectiveness and acceptability of an ultrasound-guided peripheral IV service to reduce the number of newly placed central venous catheters on an inpatient ward. Central venous catheters were counted daily on intervention and control wards using a standard protocol, and rates of newly placed catheters were compared using a Poisson regression model. Nurses were surveyed to assess acceptability and perceived benefit. RESULTS We found a reduction in the rate of newly placed central venous catheters on the intervention unit compared with the control unit at 90 days: mean 0.47 versus 0.67 newly placed central venous catheters/day, but the difference was not significant (P = .08). Nurses were in favor of the ultrasound-guided IV service, with perceived benefit to their patients. CONCLUSION Ultrasound-guided peripheral IV might reduce unnecessary central venous catheters on general inpatient wards. A portable ultrasound used for this purpose was found to be acceptable by nursing staff.
Collapse
|
5
|
Price DW, Lang DM. Practical Quality Improvement for the Allergist/Immunologist. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:660-664. [PMID: 28117271 DOI: 10.1016/j.jaip.2016.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/05/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
Abstract
Quality improvement (QI) has long been part of organized medicine, but has become increasingly more important in the last few years. Clinical expertise and input into QI activities are critical to keep QI grounded in evidence and practice. Busy clinicians face many competing demands; practical strategies are needed to help busy clinicians successfully engage in QI. This article provides a brief history of QI in medicine, notes several commonly used frameworks for QI in health care, and presents a practical QI model that can be applied to the clinical practice of allergy and immunology.
Collapse
Affiliation(s)
- David W Price
- American Board of Medical Specialties Research and Education Foundation, Chicago, Ill; American Board of Medical Specialties Multispecialty Portfolio Approval Program, Chicago, Ill; Department of Family Medicine, University of Colorado School of Medicine, Denver, Colo.
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
6
|
Basta YL, Zwetsloot IM, Klinkenbijl JHG, Rohof T, Monster MMC, Fockens P, Tytgat KMAJ. Decreasing the dispatch time of medical reports sent from hospital to primary care with Lean Six Sigma. J Eval Clin Pract 2016; 22:690-8. [PMID: 26853431 DOI: 10.1111/jep.12518] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/28/2015] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Timely communication is important to ensure high-quality health care. To facilitate this, the Gastro Intestinal Oncology Center Amsterdam (GIOCA) stipulated to dispatch medical reports on the day of the patient's visit. However, with the increasing number of patients, administrative processes at GIOCA were under pressure, and this standard was not met for the majority of patients. The aim and objective of this study was to dispatch 90% of medical reports on the day of the patient's visit by improving the logistic process. METHODS To assess the main causes for a prolonged dispatch time and to design improvements actions, the roadmap offered by Lean Six Sigma (LSS) was used, consisting of five phases: Define, Measure, Analyze, Improve and Control (DMAIC roadmap). RESULTS Initially, 12.3% of the reports were dispatched on the day of the patient's visit. Three causes for a prolonged dispatch time were identified: (1) determining which doctors involved with treatment would compose the report; (2) the reports composed by a senior resident had to be reviewed by a medical specialist; and (3) a medical specialist had to authorize the administration to dispatch the reports. To circumvent these causes, a digital form was implemented in the electronic medical record that could be completed during the multidisciplinary team meeting. After implementation, 90.6% of the reports were dispatched on the day of the visit. CONCLUSION The dispatch time of reports sent from hospital to primary care can be significantly reduced using Lean Six Sigma, improving the communication between hospital and primary care.
Collapse
Affiliation(s)
- Yara L Basta
- Departments of Gastroenterology & Hepatology, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - Inez M Zwetsloot
- IBIS UvA, Department of Operations Management, Amsterdam Business School, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Thomas Rohof
- Gastro Intestinal Oncology Center, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | | | - Paul Fockens
- Department of Surgery, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | | |
Collapse
|
7
|
Minami CA, Sheils CR, Bilimoria KY, Johnson JK, Berger ER, Berian JR, Englesbe MJ, Guillamondegui OD, Hines LH, Cofer JB, Flum DR, Thirlby RC, Kazaure HS, Wren SM, O'Leary KJ, Thurk JL, Kennedy GD, Tevis SE, Yang AD. Process improvement in surgery. Curr Probl Surg 2015; 53:62-96. [PMID: 26806271 DOI: 10.1067/j.cpsurg.2015.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 11/10/2015] [Indexed: 11/22/2022]
Affiliation(s)
- Christina A Minami
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Healthcare Studies in the Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Catherine R Sheils
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; University of Rochester School of Medicine, University of Rochester, Rochester, NY
| | - Karl Y Bilimoria
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Healthcare Studies in the Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Julie K Johnson
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Healthcare Studies in the Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Elizabeth R Berger
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Julia R Berian
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Surgery, University of Chicago Medical Center, Chicago, IL
| | - Michael J Englesbe
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI
| | | | - Leonard H Hines
- Department of Surgery, University of Tennessee College of Medicine, Knoxville, TN
| | - Joseph B Cofer
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, TN
| | - David R Flum
- Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | | | - Hadiza S Kazaure
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - Sherry M Wren
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - Kevin J O'Leary
- Division of Hospital Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jessica L Thurk
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Gregory D Kennedy
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Sarah E Tevis
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Anthony D Yang
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Healthcare Studies in the Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| |
Collapse
|
8
|
Improta G, Balato G, Romano M, Carpentieri F, Bifulco P, Alessandro Russo M, Rosa D, Triassi M, Cesarelli M. Lean Six Sigma: a new approach to the management of patients undergoing prosthetic hip replacement surgery. J Eval Clin Pract 2015; 21:662-72. [PMID: 25958776 DOI: 10.1111/jep.12361] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2015] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES In 2012, health care spending in Italy reached €114.5 billion, accounting for 7.2% of the Gross Domestic Product (GDP) and 14.2% of total public spending. Therefore, reducing waste in health facilities could generate substantial cost savings. The objective of this study is to show that Lean Six Sigma represents an appropriate methodology for the development of a clinical pathway which allows to improve quality and to reduce costs in prosthetic hip replacement surgery. METHODS The methodology used for the development of a new clinical pathway was Lean Six Sigma. Problem solving in Lean Six Sigma is the DMAIC (Define, Measure, Analyse, Improve, Control) roadmap, characterized by five operational phases which make possible to reach fixed goals through a rigorous process of defining, measuring, analysing, improving and controlling business problems. RESULTS The following project indicated several variables influencing the inappropriate prolongation of the length of stay for inpatient treatment and corrective actions were performed to improve the effectiveness and efficiency of the process of care. The average length of stay was reduced from 18.9 to 10.6 days (-44%). CONCLUSION This article shows there is no trade-off between quality and costs: Lean Six Sigma improves quality and, at the same time, reduces costs.
Collapse
Affiliation(s)
- Giovanni Improta
- Department of Public Health of the University Hospital, University of Naples 'Federico II', Naples, Italy
| | - Giovanni Balato
- Orthopaedy and Ortho-traumatology, Department of Public Health of the University Hospital, University of Naples 'Federico II', Naples, Italy
| | - Maria Romano
- DSMC Department, University 'Magna Graecia' of Catanzaro, Italy
| | | | - Paolo Bifulco
- DIETI, University of Naples 'Federico II', Naples, Italy
| | - Mario Alessandro Russo
- Department of Public Health of the University Hospital, University of Naples 'Federico II', Naples, Italy
| | - Donato Rosa
- Orthopaedy and Ortho-traumatology, Department of Public Health of the University Hospital, University of Naples 'Federico II', Naples, Italy
| | - Maria Triassi
- Department of Public Health of the University Hospital, University of Naples 'Federico II', Naples, Italy
| | | |
Collapse
|
9
|
Niemeijer GC, Flikweert E, Trip A, Does RJMM, Ahaus KTB, Boot AF, Wendt KW. The usefulness of lean six sigma to the development of a clinical pathway for hip fractures. J Eval Clin Pract 2013; 19:909-14. [PMID: 22780308 DOI: 10.1111/j.1365-2753.2012.01875.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2012] [Indexed: 01/08/2023]
Abstract
AIMS AND OBJECTIVES The objective of this study was to show the usefulness of lean six sigma (LSS) for the development of a multidisciplinary clinical pathway. METHODS A single centre, both retrospective and prospective, non-randomized controlled study design was used to identify the variables of a prolonged length of stay (LOS) for hip fractures in the elderly and to measure the effect of the process improvements--with the aim of improving efficiency of care and reducing the LOS. RESULTS The project identified several variables influencing LOS, and interventions were designed to improve the process of care. Significant results were achieved by reducing both the average LOS by 4.2 days (-31%) and the average duration of surgery by 57 minutes (-36%). The average LOS of patients discharged to a nursing home reduced by 4.4 days. CONCLUSION The findings of this study show a successful application of LSS methodology within the development of a clinical pathway. Further research is needed to explore the effect of the use of LSS methodology at clinical outcome and quality of life.
Collapse
Affiliation(s)
- Gerard C Niemeijer
- Department of Lean Six Sigma (5Q202), Martini Hospital Groningen, Groningen, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
10
|
|
11
|
Elbireer A, Le Chasseur J, Jackson B. Improving laboratory data entry quality using Six Sigma. Int J Health Care Qual Assur 2013; 26:496-509. [DOI: 10.1108/ijhcqa-08-2011-0050] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|