The Use of Lean Six Sigma Methodology in the Reduction of Patient Length of Stay Following Anterior Cruciate Ligament Reconstruction Surgery.

Sinead Moffatt,Martin Mcnamara,Sean Paul Teeling,Hannah Mccann,Marie Ward,Catherine Garry

doi:10.3390/ijerph19031588

Abstract

Background: The purpose of this study was to reduce the length of stay of anterior cruciate ligament reconstruction patients within a private hospital in Ireland, reducing any non-value-added activity in the patient pathway, with the goal of increasing patient flow, bed capacity, and revenue generation within the hospital system, while maintaining patient satisfaction. Methods: We used a pre-/post-intervention design and Lean Six Sigma methods and tools to assess and improve the current process. Results: A reduction in inpatient length of stay by 57%, and a reduction in identified non-value-added activity by 88%, resulted in a new day-case surgery pathway for anterior cruciate ligament reconstruction patients. The pathway evidenced no re-admissions and demonstrated patient satisfaction. Conclusion: Six months post-project commencement, we had successfully achieved our goals of reducing our anterior cruciate ligament reconstruction patient’s length of stay. This study contributes to the growing body of published evidence which shows that adopting a Lean Six Sigma approach can be successfully employed to optimise care and surgical pathways in healthcare.

Highlights

A meniscectomy is the surgical removal of the meniscus
Six months post-project start, we achieved a 57% reduction in anterior cruciate ligament reconstruction (ACLR) patients’ length of stay post-intervention, thereby increasing patient flow, patient satisfaction, bed capacity, and revenue generation
We reduced our non-value added from 60% to 7%; an 88% reduction from the project start

Summary

Introduction

At the commencement of our study, patients undergoing anterior cruciate ligament reconstruction (ACLR) surgery at the hospital had a two-day length of stay. This was in contrast with many other hospitals nationally and internationally, where patients undergo ACLR as a day-case procedure [1,2]. Within the peer-reviewed literature, there was evidence that patients do not routinely require hospital admission post-ACLR surgery, as ACLR day-case procedures have demonstrated extremely low complication rates post-operatively [3,4,5]. The British Association of Day Surgery advises that 90% of patients who undergo ACLR should be discharged on the day of surgery [6]

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Discussion

Conclusion