The application of six sigma to reduce the pre-operative length of hospital stay at the hospital Antonio Cardarelli

Abstract

Purpose The best treatment for femur fractures is the surgical one within 48 h from the admission to the hospital. These fractures have serious consequences, both in terms of morbidity and socio-economic impact. In the hospital A.O.R.N. Cardarelli of Naples in Italy, the mean pre-operative length of hospital stay (LOS) was nine days and just 4 per cent of patients was operated within the suggested time. Therefore, a diagnostic-therapeutic-assistance path (DTAP) was implemented to improve the process. Design/methodology/approach This paper analyzes two groups of patients (534 and 562, respectively) before and after the introduction of DTAP, through six sigma (SS) based on define, measure, analyze, improve and control cycle. Age, gender, American Society of Anaesthesiologists (ASA) score, cardiovascular diseases, diabetes and allergies were used as independent subgrouping variables. The t-tests and chi-square were performed to compare the groups, tools of SS were used. Findings The analyses were conducted considering overall patients and some subgroups. The overall reduction in LOS was about 54 per cent, patients without cardiovascular diseases and with a low ASA score had the highest reduction, more than 60 per cent. All the p-values proved a high statistically significant difference between the two groups. Research limitations/implications The influence of the Italian health-care system is a minor limitation while, unfortunately, the lack of a follow-up did not allow quantifying the real gain in health of patients. A lean thinking analysis would suit this context. Practical implications There are practical advantages for both hospital and patients: the hospital will have an increase in admissions and more beds available, while patients will benefit of a faster intervention and a shorter wait. Originality/value This is the first analysis through SS of DTAP showing its positive influences in terms of both socio-economic impact and patients’ outcome. Policy leaders could use this study as an example to evaluate the introduction of the same clinical pathway in other health facilities.

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

“…“A. Cardarelli”, as described in [ 30 ]. Among them, the presence of a protocol for the rapid transfer of the patient from the emergency department to the orthopedic ward, timely multi-professional (orthopedic, internal medicine, anesthesiology and nursing) assessment, and, not least, early rehabilitation care, are common points for both the pathways implemented at the hospital Cardarelli of Naples and the hospital Ruggi of Salerno, respectively.…”

“…Finally, the study discusses a comparison between the presented results and those obtained by implementing analogous clinical pathways, with particular focus on the pathway developed at the Italian national hospital A.O.R.N. Cardarelli of Naples, as reported in [ 30 ].…”

Factors Influencing Private Hospitals’ Participation in the Innovation of Biomedical Engineering Industry: A Perspective of Evolutionary Game Theory

“…Some scholars conducted research on the optimization of patient treatment procedures in hospitals. For example, Ricciardi, C. et al [ 33 ] and Giovanni, I. et al [ 34 , 35 ] applied the Six Sigma method to the patient hospital service, and their research results proved that the service mode combined with the Six Sigma method can improve the efficiency of health management personnel for patients.…”

Evaluation of System Modelling Techniques for Waste Identification in Lean Healthcare Applications

“…2 Lean has gained significant attention in the healthcare industry to develop safe, efficient and wastefree operational processes. [3][4][5] Recent studies reported positive results in various healthcare applications, such as reducing patient waiting time and length of hospital stay, 6,7 improved resource utilization and staff satisfaction. 8,9 An important aspect of lean is the waste identification to reduce non-valueadded activities and provide standardized solutions for better performance and operational excellence.…”