Structured syncope care pathways based on lean six sigma methodology optimises resource use with shorter time to diagnosis and increased diagnostic yield.

Leon Martens,Johan F H Wold,Grahame Goode,Christian Perings,Lucas Baggerman,Pelle Stolt,Lionel Beck,Georgina Martin,Daniel Morgan

doi:10.1371/journal.pone.0100208

Abstract

AimsTo conduct a pilot study on the potential to optimise care pathways in syncope/Transient Loss of Consciousness management by using Lean Six Sigma methodology while maintaining compliance with ESC and/or NICE guidelines.MethodsFive hospitals in four European countries took part. The Lean Six Sigma methodology consisted of 3 phases: 1) Assessment phase, in which baseline performance was mapped in each centre, processes were evaluated and a new operational model was developed with an improvement plan that included best practices and change management; 2) Improvement phase, in which optimisation pathways and standardised best practice tools and forms were developed and implemented. Staff were trained on new processes and change-management support provided; 3) Sustaining phase, which included support, refinement of tools and metrics. The impact of the implementation of new pathways was evaluated on number of tests performed, diagnostic yield, time to diagnosis and compliance with guidelines. One hospital with focus on geriatric populations was analysed separately from the other four.ResultsWith the new pathways, there was a 59% reduction in the average time to diagnosis (p = 0.048) and a 75% increase in diagnostic yield (p = 0.007). There was a marked reduction in repetitions of diagnostic tests and improved prioritisation of indicated tests.ConclusionsApplying a structured Lean Six Sigma based methodology to pathways for syncope management has the potential to improve time to diagnosis and diagnostic yield.

Highlights

Syncope and transient loss of consciousness (TLoC) account for a substantial proportion of healthcare resource use
Data from the United Kingdom (UK) show that in 2010–11, syncope and collapse were among the top three cardiology-related admissions and that .90% of syncopal admissions are to emergency departments (ED) [1]
The diagnostic pathways were found to be compliant with current guidelines for the diagnosis and management of syncope, the inconsistencies and differences between centres and patients showed significant scope for improvements

Summary

Introduction

Syncope and transient loss of consciousness (TLoC) account for a substantial proportion of healthcare resource use. Data from the United Kingdom (UK) show that in 2010–11, syncope and collapse were among the top three cardiology-related admissions and that .90% of syncopal admissions are to emergency departments (ED) [1]. In Germany, around 150,000 syncoperelated hospitalisations are reported yearly. Syncope presents a diagnostic conundrum to clinics. Patients are usually recovered by the time of presentation and the event itself was rarely captured by qualified bystanders. A large number of tests are typically employed to detect underlying aetiologies and the patient journey from presentation to diagnosis is often unstructured [2] with low diagnostic yields, often ,50% [3]

Methods

Results

Conclusion