Using a Business Model (the 4 Disciplines of Execution) to Improve Consistency, Efficiency, and Length of Stay in Microvascular Autologous Breast Reconstruction

Abstract

Background: Autologous free tissue transfer is a common method of breast reconstruction in the United States, but it involves many care teams and can incur a large cost on an institution. The consistency and efficiency of performing these procedures can be improved with a method called the 4 disciplines of execution (4DX). Methods: Patients that underwent autologous breast reconstruction between 2015 and 2020 were included. Midway through the collection period, several preoperative and intraoperative interventions were implemented using the 4DX. Then, 2 cohorts of patients were analyzed for differences in operative times, length of stay (LOS), and major complications. Results: Thirty-two total patients were included. The median operative time before interventions were implemented was 828 minutes, and the median operative time after interventions was 619 minutes ( P < 0.05). The median LOS in days before interventions was 5 days, and the median LOS after interventions was 3 days ( P < 0.05). There were no statistically significant differences in complications before or after the interventions. Conclusions: The 4DX successfully improved consistency and efficiency in the process of performing autologous breast reconstruction at our institution, as evidenced by a faster median operative time and shorter patient LOS in the hospital.

A clinical practice review on process efficiency in autologous breast reconstruction

“…They retrospectively compared a pre (15 cases of bilateral breast reconstruction) and a post (17 cases of bilateral breast reconstruction) intervention cohort aiming in performing the surgery in less than nine hours. Even if comparing cohorts with different types of autologous breast reconstruction, they were able to show a significant reduction of operative time and length of stay without an increase of complications ( 32 ).…”

“…Easton et al ( 32 ) did include in their retrospective review several different types of flaps [i.e., DIEP, TRAM, profunda artery perforator (PAP), transverse upper gracilis (TUG)]. However, the different steps of the process did not apply equally to all flaps thus quantitative analysis were performed only with DIEP/TRAM flaps.…”