The usefulness of lean six sigma to the development of a clinical pathway for hip fractures

ObjectiveMedication reconciliation is a strategy for reducing medication discrepancies and improving patient safety. Transitions through different levels of care contribute to medication discrepancies caused by lack of communication. In October 2011, St Olav's Hospital initiated a fast-track model for patients with hip fractures, where clinical pharmacists (CPs) are a part of a multidisciplinary team. The purpose of this study was to examine discrepancies discovered in medication lists by CPs at the orthopaedic ward and consider their clinical relevance.MethodThis prospective study was conducted at an orthopaedic ward at St Olav's Hospital in the period October 2011–August 2012. Medication reconciliation by CPs was done for all patients with a hip fracture using a systematic method. Information was obtained by the CP by interview with the patient and additional sources, for example, medication list from general practitioner and nursing home. An independent expert group consisting of a geriatrician, an orthopaedist and a CP considered level of clinical relevance of the discrepancies found in the collected data.ResultsA total of 410 discrepancies were registered for all 317 patients, Discrepancies were found in 159 (50%) patients with an average of 2.6 per patient affected. Of the total amount of discrepancies, the expert group evaluated 68% and 19% as potentially moderate and severe, respectively, if they were unattended during hospitalisation and after discharge.ConclusionsBy using CPs in medication reconciliation at orthopaedic wards, discrepancies that can lead to serious discomfort or clinical deterioration of patients can be avoided.

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“…The FT method is a way of organising clinical pathways using principles from lean methodology 4. The aim is to improve quality.…”

Section: Introductionmentioning

confidence: 99%

Medication reconciliation of patients with hip fracture by clinical pharmacists

Gjerde¹,

Aa²,

Sund

et al. 2015

Eur J Hosp Pharm

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“…[5][6][7][8][9][10] In fact, surgical disciplines have lagged far behind other specialties, such as interventional cardiology, 11 critical care, 12,13 and anesthesia, 14,15 but recently, several surgical fields have reported success with these initiatives, including transplantation, 16,17 orthopedic surgery, [18][19][20] otolaryngology, 21,22 hepatobiliary surgery, 23,24 and trauma. 25 We hypothesized that implementation of a Six Sigma program in perforator flap breast reconstruction could improve operational, financial, and clinical outcomes, by reducing variation, improving quality and efficiency, and optimizing throughput.…”

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confidence: 98%

Implementation and Analysis of a Lean Six Sigma Program in Microsurgery to Improve Operative Throughput in Perforator Flap Breast Reconstruction

Hultman

Kim

Lee

et al. 2016

Annals of Plastic Surgery

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A Six Sigma program in microsurgical breast reconstruction was associated with better operational and financial outcomes. These incremental gains were maintained over the course of the study, suggesting that these benefits were due, in part, to process improvements. However, continued reductions in total operative time and length of stay, well after the intervention period, support the possibility that "learning curve" phenomenon may have contributed to the improvement in these outcomes.

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“…Currently, various hospitals have incorporated Six Sigma, Lean Management or Lean Six Sigma in their organization and have published several cases describing improvement projects [13,14,18,26,28,[31][32][33]. Like the current study, these studies mostly implement LSS for singular improvement projects [12,14,17,[26][27][28][29]. This is both an advantage and a disadvantage of LSS.…”

Section: Discussionmentioning

confidence: 95%

Decreasing the dispatch time of medical reports sent from hospital to primary care with Lean Six Sigma

Basta

Zwetsloot

Klinkenbijl

et al. 2016

Evaluation Clinical Practice

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The usefulness of lean six sigma to the development of a clinical pathway for hip fractures

Abstract: 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.

Cited by 57 publications

References 27 publications

Medication reconciliation of patients with hip fracture by clinical pharmacists

Medication reconciliation of patients with hip fracture by clinical pharmacists

Implementation and Analysis of a Lean Six Sigma Program in Microsurgery to Improve Operative Throughput in Perforator Flap Breast Reconstruction

Decreasing the dispatch time of medical reports sent from hospital to primary care with Lean Six Sigma

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