Reducing the Healthcare-Associated Infections in a Rehabilitation Hospital under the Guidance of Lean Six Sigma and DMAIC

Cesarelli, Giuseppe; Petrelli, Rita; Ricciardi, Carlo; D’Addio, Giovanni; Monce, Orjela; Cesarelli, Mario

doi:10.3390/healthcare9121667

Cited by 8 publications

(8 citation statements)

References 40 publications

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“…We designed and evaluated our quality improvement intervention using the DMAIC framework. DMAIC is a data-driven quality strategy derived from industry quality improvement methodology that has been used in healthcare to address important quality metrics such as patient satisfaction [ 19 ], reduction in hospital acquired infections [ 20 ], and optimization of post-operative opioid prescription practices [ 21 ]. The five phases of DMAIC are defining the problem and improvement activity (‘Define’), measuring baseline process performance (‘Measure’), analyzing the existing process to determine the root causes of variation (‘Analyze’), improving the process by addressing the root causes (‘Improve’), and controlling the improved process and future process outcomes (‘Control’) [ 22 ].…”

Section: Methodsmentioning

confidence: 99%

Improving pain management and safe opioid use after surgery: A DMAIC-based quality intervention

Fender¹,

Bleicher²,

Johnson³

et al. 2023

Surgery Open Science

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Section: Methodsmentioning

confidence: 99%

Improving pain management and safe opioid use after surgery: A DMAIC-based quality intervention

Fender¹,

Bleicher²,

Johnson³

et al. 2023

Surgery Open Science

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“…These problem solving examples illustrate the DMAIC (Define, Measure, Analyze, Improve and Control) process, which is a problem-solving tool used in Six Sigma that is also used in antimicrobial stewardship and other quality improvement projects 42 .…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Anticoagulation Stewardship to Bridge the Implementation Gap in Perioperative Anticoagulation Management

Tafur,

Barnes,

Bhagirath

et al. 2024

TH Open

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Lack of alignment of care protocols among providers in healthcare is a driver of increased costs and suboptimal patient outcomes. Perioperative anticoagulation management is a good example of a complex area where protocol creation is a clinical challenge that demands input of multiple experts. Questions regarding the need for anticoagulation interruptions are frequent. Yet, due to layers of complexity involving analysis of anticoagulation indication, surgical risk, and anesthesia-associated bleeding risk as well as institutional practices, there is heterogeneity in how these interruptions are approached. The recent perioperative anticoagulation guidelines from the American College of Chest Physicians summarize extensive evidence for the management of anticoagulant and antiplatelet medications in patients who undergo elective interventions. However, implementation of these guidelines by individual clinicians is highly varied and often does not follow the best available clinical evidence. Against this background, anticoagulation stewardship units, which exist to improve safety and quality monitoring for the anticoagulated patient, are of growing interest. These units provide a bridge for implementation of value-based, high quality guidelines for patients who need perioperative anticoagulation interruption. We use a case to pragmatically illustrate the problem and tactics for change management and implementation science that may facilitate adoption of perioperative anticoagulation guidelines.

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“…Moreover, the DMAIC improvement methodology has recently been utilized in the field of infection prevention and control through research that aimed at reducing healthcare-associated infections (HAIs) at different levels of rehabilitation centers. The research showed the valuable use of the DMAIC approach in reducing HAIs and their consequences such as extended length of stay and treatment costs (Cesarelli et al ., 2021).…”

Section: Theoretical Backgroundmentioning

confidence: 99%

Improving VTE prophylaxis in ward and ICU surgical urology patients: a Six-Sigma DMAIC methodology improvement project

Mousli

Sayed

Zaki

et al. 2023

TQM

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PurposeThis study intends to improve the quality of venous thromboembolism (VTE) prophylaxis practices including proper VTE risk assessment and the appropriate prophylaxis measures for surgical urology patients.Design/methodology/approachThe authors applied the Six-Sigma define, measure, analyze, improve and control (DMAIC) improvement methodology in a pre–post interventional study that involved all adult patients above 18 years old indicated and scheduled for urology surgical interventions including endoscopic urological surgeries in a urology specialized 60-bed hospital. The pre-intervention sample included all patients meeting the inclusion criteria over a period of six months. Post-intervention sample included all patients meeting the inclusion criteria over a period of six months. The improvement areas included both the VTE risk assessment as well as the VTE prophylaxis prescription.FindingsDMAIC methodology has achieved a substantial sustained improvement in surgical urology VTE prophylaxis practices with an average of 70% on both levels; VTE risk assessment practices and VTE prophylaxis prescribing practices were statistically significant. The post-intervention results also showed a statistically controlled process with no special cause variations. Based on the study results, the Six-Sigma DMAIC methodology can be considered of high value when applied in healthcare clinical practice improvement projects.Research limitations/implicationsThe project study includes some pitfalls that can be addressed as follows: 1. The lack of VTE rate incidence tracking. This limitation can be partly refuted when the authors conduct a literature review and explore that the VTE prophylaxis effectiveness had been proven with sufficient evidence to an extent that pushed several scientific societies to develop their own guidelines to support VTE prophylaxis. (Algattas et al., 2018). 2. Another limitation of this study can be that it handled only surgical patients and more specifically surgical urology patients. Of course, VTE prophylaxis is a crucial life-threatening problem not only for the surgical admitted patients but also for all the medical admitted patients either in hospital wards or ICUs. However, the prediction that surgical patients especially surgical urology patients are more prone to VTE development risk as they have -in several cases-two or three main additive risk factors which are age, procedure duration and malignancy in elderly men. (Tikkinen et al., 2014). So, the authors consider the study project to be a prototype that hopefully can be utilized for future study projects that will manage both other surgical specialty patients and medical patients on the national level and can track accurately and effectively report the VTE incidence rates.Practical implicationsSeveral recommendations can be extracted from the research project that is summarized in the following points: Paying focused attention to continuous healthcare quality improvement initiatives and projects as a main approach for healthcare improvement especially for the public health-related problems. This might be achieved through periodic region-specific or specialty-specific focus groups from which public health problems could be addressed and prioritized to be considered as a part of country healthcare campaigns regarding cost-utility and feasibility studies. The adoption of a system thinking approach in dealing with the improvement strategies; all efforts and resources are to be employed to achieve a common objective. This includes the generation of a national-wide electronic health information system that can aid in healthcare resource allocation and direct the healthcare efforts towards the most important, high-priority public health problems. Electronic national-wide health record is really an effort, and resources consuming activity, but actually, it's worth exerting efforts, and its valuable outcomes may be seen several years later. 3. Development of unified national specialized VTE prophylaxis pathways to standardize the patient-specific VTE prophylaxis plans. Standardization of healthcare pathways enables healthcare professionals to follow an evidence-based practice which will be reflected on the improvement of healthcare quality level, cost-effectiveness enhancement, and timely patient care on all levels especially in high critical areas like ER and ICU. 4. Incorporation of VTE prophylaxis costs in the universal health insurance diagnosis-related group (DRG) insurance packages and service pricing. Universal health insurance is a nationwide strategy that is aiming to cover all Egypt residents by the year 2030. Universal health insurance is being following the DRG reimbursement policy that is thought to control all the healthcare-associated costs so, the VTE prophylaxis costs shall be added as the main cost item to encourage all healthcare facilities to follow an evidence-based VTE prophylaxis pathway taking into consideration the high-risk patient categories who will definitely represent a high-cost burden on the long run if they suffer a VTE event.Originality/valueDMAIC improvement methodology applications in healthcare are still relatively limited, especially on the clinical level. The study can be considered one of a kind in Egypt dealing with a comprehensive DMAIC methodology application on the clinical level.

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Reducing the Healthcare-Associated Infections in a Rehabilitation Hospital under the Guidance of Lean Six Sigma and DMAIC

Cited by 8 publications

References 40 publications

Improving pain management and safe opioid use after surgery: A DMAIC-based quality intervention

Improving pain management and safe opioid use after surgery: A DMAIC-based quality intervention

Anticoagulation Stewardship to Bridge the Implementation Gap in Perioperative Anticoagulation Management

Improving VTE prophylaxis in ward and ICU surgical urology patients: a Six-Sigma DMAIC methodology improvement project

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