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

Bibliographic Data

ID15474366
AuthorsArianna Scala (0000-0001-9735-5227, University of Naples Federico II), Alfonso Maria Ponsiglione (0000-0003-1346-515X, University of Naples Federico II, corresponding author), Ilaria Loperto (0000-0003-4943-6780, University of Naples Federico II), Antonio Della Vecchia (Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona), Anna Borrelli (0000-0002-2633-8507, Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona), Giuseppe Russo (0000-0003-1646-9607, Ospedale Antonio Cardarelli), Maria Triassi (0000-0002-9420-9571, University of Naples Federico II), Giovanni Improta (0000-0002-9485-1687, University of Naples Federico II)
Year2021
Volume18
Issue6
Pages2843-2843
Publication date2021-03-11
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueInternational Journal of Environmental Research and Public Health (JOURNAL)
Journal identifiersISSN: 1661-7827 • E-ISSN: 1660-4601
PublisherMultidisciplinary Digital Publishing Institute (PUBLISHER • CH)
DOI10.3390/ijerph18062843
PMID33799518
OpenAlexW3133957411
LanguageEN
Citations received7
References cited30

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

DMAIC · Femur · Gold standard (test · Lean manufacturing · Lean Six Sigma · Operations management · Six Sigma · Standard deviation · Cardiac, Anesthesia and Surgical Outcomes · Clinical practice guidelines implementation · Healthcare Quality and Management · Medicine · Emergency Medicine · Internal Medicine · Surgery

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