Lean Six Sigma Approach for Reducing Length of Hospital Stay for Patients with Femur Fracture in a University Hospital

Abstract

Surgical intervention within 48 h of hospital admission is the gold standard procedure for the management of elderly patients with femur fractures, since the increase in preoperative waiting time is correlated with the onset of complications and longer overall length of stay (LOS) in the hospital. However, national evidence demonstrates that there is still the need to provide timely intervention for this type of patient, especially in some regions of central southern Italy. Here we discuss the introduction of a diagnostic–therapeutic assistance pathway (DTAP) to reduce the preoperative LOS for patients undergoing femur fracture surgery in a university hospital. A Lean Six Sigma methodology, based on the DMAIC cycle (Define, Measure, Analyze, Improve, Control), is implemented to evaluate the effectiveness of the DTAP. Data were retrospectively collected and analyzed from two groups of patients before and after the implementation of DTAP over a period of 10 years. The statistics of the process measured before the DTAP showed an average preoperative LOS of 5.6 days (standard deviation of 3.2), thus confirming the need for corrective actions to reduce the LOS in compliance with the national guidelines. The influence of demographic and anamnestic variables on the LOS was evaluated, and the impact of the DTAP was measured and discussed, demonstrating the effectiveness of the improvement actions implemented over the years and leading to a significant reduction in the preoperative LOS, which decreased to an average of 3.5 days (standard deviation of 3.60). The obtained reduction of 39% in the average LOS proved to be in good agreement with previously developed DTAPs for femur fracture available in the literature.

Efficiency measures of emergency departments: an Italian systematic literature review

“…The most important challenge for healthcare systems is to provide assistance, improving efficiency, productivity, and the appropriateness and quality of care and its departments and for this aim, various tools and approaches have been proposed in the literature so far in different healthcare settings and for different objectives aimed at improving the quality of the provided services. [4][5][6][7][8][9] However, no objective and officially parameters that can assess the true efficiency and quality of these EDs Open access were recognised. This study aims to review the literature on the issues encountered in the efficiency of EDs worldwide.…”

Application of DMAIC Cycle and Modeling as Tools for Health Technology Assessment in a University Hospital

“…Nowadays, several methodologies and approaches are used in healthcare to help in the clinical decision-making process [2][3][4][5][6][7][8], to aid physicians in defining the diagnosis and prognosis of patients [9][10][11], and to analyze quality improvement in hospital processes [12,13]. A useful methodology for these purposes is the Health Technology Assessment (HTA), a multidisciplinary process for medicalclinical, social, organizational, economic, technological, ethical, and legal implication analysis of health technology through the evaluation of efficiency, security, costs, and social and organizational impact [14,15].…”

Improving performance of the hospitalization process by applying the principles of Lean Thinking

“…Through rigorous LSS analysis, they allowed patients stable medical conditions and adequate pain relief, reducing the inappropriate lengthening of LOS. Again, Ricciardi et al (2019) and Scala et al (2020Scala et al ( , 2021 analysed the introduction of the diagnostic-therapeutic-care pathway (DTAP), using the LSS methodology. They reported a statistically significant reduction in LOS (Ricciardi et al, 2019;Scala et al, 2021) and in preoperative-LOS (Scala et al, 2020); therefore the implementation of DTAP has brought advantages for both hospitals and patients.…”