Using Lean Six Sigma to improve rates of day of surgery admission in a national thoracic surgery department.

Aoife Brady,Denise Carter,Donna Eaton,Eoin Moore,Marie Brennan,Marie Ward,Petra Grehan,Rachel Brown,Seán Paul Teeling

doi:10.1093/intqhc/mzz083

Abstract

ObjectiveThe aim of this study is to improve rates of day of surgery admission (DOSA) for all suitable elective thoracic surgery patients.DesignLean Six Sigma (LSS) methods were used to enable improvements to both the operational process and the organizational working of the department over a period of 19 months.SettingA national thoracic surgery department in a large teaching hospital in Ireland.ParticipantsThoracic surgery staff, patients and quality improvement staff at the hospital.Intervention(s)LSS methods were employed to identify and remove the non-value-add in the patient’s journey and achieve higher levels of DOSA. A pre-surgery checklist and Thoracic Planning Meeting were introduced to support a multidisciplinary approach to enhanced recovery after surgery (ERAS), reduce rework, improve list efficiency and optimize bed management.Main Outcome Measure(s)To achieve DOSA for all suitable elective thoracic surgery patients in line with the National Key Performance Indicator of 75%. A secondary outcome would be to further decrease overall length of stay by 1 day.ResultsOver a 19 month period, DOSA has increased from 10 to 75%. Duplication of preoperative tests reduced from 83 to <2%. Staff and patient surveys show increased satisfaction and improved understanding of ERAS.ConclusionsUsing LSS methods to improve both operational process efficiency and organizational clinical processes led to the successful achievement of increasing rates of DOSA in line with national targets.

Highlights

Enhanced recovery after surgery (ERAS) is a multi-modal, evidencebased approach to delivering healthcare [1]
Meetings were held over a 6-month period, and multiple Lean Six Sigma (LSS) methods were applied, which will be outlined below using the structure of DMAIC
day of surgery admission (DOSA) for elective thoracic surgery patients was 10.9% in 2016, and following the introduction of the DOSA pathway, this increased to 75.3% in the year 2017

Summary

Introduction

Enhanced recovery after surgery (ERAS) is a multi-modal, evidencebased approach to delivering healthcare [1]. It is designed to optimize the surgical care pathway from point of referral to discharge [2]. The principles of ERAS have been applied to a variety of surgical specialities. It has been adopted to thoracic surgery and considered to be the optimal “standard of care” for elective surgery [3]. Using LSS to improve rates of day of surgery admission Article

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Discussion

Conclusion