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. 2021 Mar 11;18(6):2843.
doi: 10.3390/ijerph18062843.

Lean Six Sigma Approach for Reducing Length of Hospital Stay for Patients with Femur Fracture in a University Hospital

Arianna Scala  1 , Alfonso Maria Ponsiglione  2 , Ilaria Loperto  1 , Antonio Della Vecchia  3 , Anna Borrelli  3 , Giuseppe Russo  4 , Maria Triassi  1   5 , Giovanni Improta  1   5
Affiliations

Lean Six Sigma Approach for Reducing Length of Hospital Stay for Patients with Femur Fracture in a University Hospital

Arianna Scala et al. Int J Environ Res Public Health. .

Abstract

Surgical intervention within 48 h of hospital admission is the gold standard procedure for the management of elderly patients with femur fractures, since the increase in preoperative waiting time is correlated with the onset of complications and longer overall length of stay (LOS) in the hospital. However, national evidence demonstrates that there is still the need to provide timely intervention for this type of patient, especially in some regions of central southern Italy. Here we discuss the introduction of a diagnostic-therapeutic assistance pathway (DTAP) to reduce the preoperative LOS for patients undergoing femur fracture surgery in a university hospital. A Lean Six Sigma methodology, based on the DMAIC cycle (Define, Measure, Analyze, Improve, Control), is implemented to evaluate the effectiveness of the DTAP. Data were retrospectively collected and analyzed from two groups of patients before and after the implementation of DTAP over a period of 10 years. The statistics of the process measured before the DTAP showed an average preoperative LOS of 5.6 days (standard deviation of 3.2), thus confirming the need for corrective actions to reduce the LOS in compliance with the national guidelines. The influence of demographic and anamnestic variables on the LOS was evaluated, and the impact of the DTAP was measured and discussed, demonstrating the effectiveness of the improvement actions implemented over the years and leading to a significant reduction in the preoperative LOS, which decreased to an average of 3.5 days (standard deviation of 3.60). The obtained reduction of 39% in the average LOS proved to be in good agreement with previously developed DTAPs for femur fracture available in the literature.

Keywords: Lean Six Sigma; healthcare quality; length of stay; process improvement; public health.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Run chart of preoperative LOS before improvement. The red line indicates the average value of 5.6.
Figure 2
Figure 2
Ishikawa fishbone diagram.
Figure 3
Figure 3
The three main phases of the implemented DTAP.
Figure 4
Figure 4
Run chart of preoperative LOS after improvement. Red line indicates the average value of 3.5.
Figure 5
Figure 5
Boxplot of preoperative LOS before and after DTAP.
See this image and copyright information in PMC

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References

    1. Rossini M., Piscitelli P., Fitto F., Camboa P., Angeli A., Guida G., Adami S. Incidence and socioeconomic burden of hip fractures in Italy. Reumatismo. 2005;57:97–102. doi: 10.4081/reumatismo.2005.97. - DOI - PubMed
    1. Kim S.-M., Yeom J.-W., Song H.K., Hwang K.-T., Hwang J.-H., Yoo J.-H. Lateral Locked Plating for Distal Femur Fractures by Low-Energy Trauma: What Makes a Difference in Healing? Int. Orthop. 2018;42:2907–2914. doi: 10.1007/s00264-018-3881-3. - DOI - PubMed
    1. Johnell O. The Socioeconomic Burden of Fractures: Today and in the 21st Century. Am. J. Med. 1997;103:S20–S26. doi: 10.1016/S0002-9343(97)90023-1. - DOI - PubMed
    1. Lippuner K., von Overbeck J., Perrelet R., Bosshard H., Jaeger P. Incidence and Direct Medical Costs of Hospitalizations Due to Osteoporotic Fractures in Switzerland. Osteoporos. Int. 1997;7:414–425. doi: 10.1007/PL00004149. - DOI - PubMed
    1. Chen F.-P., Fu T.-S., Lin Y.-C., Fan C.-M. Risk Factors and Quality of Life for the Occurrence of Hip Fracture in Postmenopausal Women. Biomed. J. 2018;41:202–208. doi: 10.1016/j.bj.2018.04.001. - DOI - PMC - PubMed

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