Implementing fast track surgery in hip and knee arthroplasty using the lean Six Sigma methodology

Abstract

PurposeOne of the biggest challenges in the health sector is that of costs compared to economic resources and the quality of services. Hospitals register a progressive increase in expenditure due to the aging of the population. In fact, hip and knee arthroplasty surgery are mainly due to primary osteoarthritis that affects the elderly population. This study was carried out with the aim of analysing the introduction of the fast track surgery protocol, through the lean Six Sigma, on patients undergoing knee and hip prosthetic replacement surgery. The goal was to improve the arthroplasty surgery process by reducing the average length of stay (LOA) and hospital costsDesign/methodology/approachLean Six Sigma was applied to evaluate the arthroplasty surgery process through the DMAIC cycle (define, measure, analyse, improve and control) and the lean tools (value stream map), adopted to analyse the new protocol and improve process performance. The dataset consisted of two samples of patients: 54 patients before the introduction of the protocol and 111 patients after the improvement. Clinical and demographic variables were collected for each patient (gender, age, allergies, diabetes, cardiovascular diseases and American Society of Anaesthesiologists (ASA) score).FindingsThe results showed a 12.70% statistically significant decrease in LOS from an overall average of 8.72 to 7.61 days. Women patients without allergies, with a low ASA score not suffering from diabetes and cardiovascular disease showed a significant a reduction in hospital days with the implementation of the FTS protocol. Only the age variable was not statistically significant.Originality/valueThe introduction of the FTS in the orthopaedic field, analysed through the LSS, demonstrated to reduce LOS and, consequently, costs. For each individual patient, there was an economic saving of € 445.85. Since our study takes into consideration a dataset of 111 patients post-FTS, the overall economic saving brought by this study amounts to €49,489.35.

Lean Six Sigma to reduce the acute myocardial infarction mortality rate: a single center study

“…Further work used an LSS approach, and in particular the DMAIC (Define, Measure, Analyze, Improve and Control) cycle, to improve the process through a decrease in total length of stay (LOS) (Improta et al. , 2017; Latessa et al. , 2021).…”

“…For example (Improta et al, 2018), demonstrated how Lean thinking led to a reduction in overall time in the emergency department through the implementation of the corrective actions after the Lean interventions. Further work used an LSS approach, and in particular the DMAIC (Define, Measure, Analyze, Improve and Control) cycle, to improve the process through a decrease in total length of stay (LOS) (Improta et al, 2017;Latessa et al, 2021).…”

Regression Models to Study the Total LOS Related to Valvuloplasty

“…Biomedical data analytics is key to improving processes, reducing costs, and giving clinicians new tools to manage all different patients. There are many approaches used in the literature for data analysis, including lean six sigma [ 15 , 16 , 17 , 18 , 19 ], health technology assessment [ 20 , 21 , 22 , 23 ], machine learning algorithms [ 24 , 25 , 26 ], and mathematical modelling [ 27 , 28 , 29 ]. The latter approach was chosen for this study.…”

Predictive analysis of lower limb fractures in the orthopedic complex operative unit using artificial intelligence: the case study of AOU Ruggi

“…It has been found that for patients with heart disease the LOS value increases compared to the mean LOS value 12 .The hospital stay and therefore the value of the LOS and the related care costs are lower for patients who are admitted to the Day Hospital 13 . Therefore, in order to reduce hospital costs, it is necessary to plan the surgery as soon as possible which, according to what is reported by the studies in the literature, is also useful for improving the effectiveness of early intervention on the reduction of orthopedic surgery and other surgical processes [14][15][16][17][18][19][20][21][22] In fact, according to the Italian surgical guidelines it is preferable to reduce the risk of complications and the relative stay in the health facility and the relative LOS value [23][24][25][26] .Mathematical modeling was employed in the healthcare sector for several purposes: to optimize medical waste management processes in an Ethiopian hospital 27 ; to forecast the propagation of viruses and bacteria 28,29 ; to predict the LOS of patients undergoing valvuloplasty surgery 30 .…”

“…The hospital stay and therefore the value of the LOS and the related care costs are lower for patients who are admitted to the Day Hospital 13 . Therefore, in order to reduce hospital costs, it is necessary to plan the surgery as soon as possible which, according to what is reported by the studies in the literature, is also useful for improving the effectiveness of early intervention on the reduction of orthopedic surgery and other surgical processes [14][15][16][17][18][19][20][21][22] In fact, according to the Italian surgical guidelines it is preferable to reduce the risk of complications and the relative stay in the health facility and the relative LOS value [23][24][25][26] .…”