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

Author

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  • Arianna Scala

    (Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy)

  • Alfonso Maria Ponsiglione

    (Department of Electrical Engineering and Information Technology, University of Naples “Federico II”, 80125 Naples, Italy)

  • Ilaria Loperto

    (Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy)

  • Antonio Della Vecchia

    (Hospital Directorate, “San Giovanni di Dio e Ruggi d’Aragona” University Hospital of Salerno, 84125 Salerno, Italy)

  • Anna Borrelli

    (Hospital Directorate, “San Giovanni di Dio e Ruggi d’Aragona” University Hospital of Salerno, 84125 Salerno, Italy)

  • Giuseppe Russo

    (Hospital Directorate, National Hospital A.O.R.N. “Antonio Cardarelli” of Naples, 80131 Naples, Italy)

  • Maria Triassi

    (Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy
    Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), University of Naples “Federico II”, 80131 Naples, Italy)

  • Giovanni Improta

    (Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy
    Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), University of Naples “Federico II”, 80131 Naples, Italy)

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.

Suggested Citation

  • Arianna Scala & Alfonso Maria Ponsiglione & Ilaria Loperto & Antonio Della Vecchia & Anna Borrelli & Giuseppe Russo & Maria Triassi & Giovanni Improta, 2021. "Lean Six Sigma Approach for Reducing Length of Hospital Stay for Patients with Femur Fracture in a University Hospital," IJERPH, MDPI, vol. 18(6), pages 1-13, March.
  • Handle: RePEc:gam:jijerp:v:18:y:2021:i:6:p:2843-:d:514712
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    References listed on IDEAS

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    1. Robinson, Stewart & Radnor, Zoe J. & Burgess, Nicola & Worthington, Claire, 2012. "SimLean: Utilising simulation in the implementation of lean in healthcare," European Journal of Operational Research, Elsevier, vol. 219(1), pages 188-197.
    2. Giovanni Improta & Guido Guizzi & Carlo Ricciardi & Vincenzo Giordano & Alfonso Maria Ponsiglione & Giuseppe Converso & Maria Triassi, 2020. "Agile Six Sigma in Healthcare: Case Study at Santobono Pediatric Hospital," IJERPH, MDPI, vol. 17(3), pages 1-17, February.
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    Cited by:

    1. Emma Montella & Antonino Ferraro & Giancarlo Sperlì & Maria Triassi & Stefania Santini & Giovanni Improta, 2022. "Predictive Analysis of Healthcare-Associated Blood Stream Infections in the Neonatal Intensive Care Unit Using Artificial Intelligence: A Single Center Study," IJERPH, MDPI, vol. 19(5), pages 1-9, February.
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    3. Arianna Scala & Teresa Angela Trunfio & Lucia De Coppi & Giovanni Rossi & Anna Borrelli & Maria Triassi & Giovanni Improta, 2022. "Regression Models to Study the Total LOS Related to Valvuloplasty," IJERPH, MDPI, vol. 19(5), pages 1-13, March.
    4. Nicola Wolfe & Seán Paul Teeling & Marie Ward & Martin McNamara & Liby Koshy, 2021. "Operation Note Transformation: The Application of Lean Six Sigma to Improve the Process of Documenting the Operation Note in a Private Hospital Setting," IJERPH, MDPI, vol. 18(22), pages 1-16, November.
    5. Giovanni Improta & Anna Borrelli & Maria Triassi, 2022. "Machine Learning and Lean Six Sigma to Assess How COVID-19 Has Changed the Patient Management of the Complex Operative Unit of Neurology and Stroke Unit: A Single Center Study," IJERPH, MDPI, vol. 19(9), pages 1-19, April.
    6. Sinead Moffatt & Catherine Garry & Hannah McCann & Sean Paul Teeling & Marie Ward & Martin McNamara, 2022. "The Use of Lean Six Sigma Methodology in the Reduction of Patient Length of Stay Following Anterior Cruciate Ligament Reconstruction Surgery," IJERPH, MDPI, vol. 19(3), pages 1-18, January.
    7. Agnieszka Zdęba-Mozoła & Remigiusz Kozłowski & Anna Rybarczyk-Szwajkowska & Tomasz Czapla & Michał Marczak, 2023. "Implementation of Lean Management Tools Using an Example of Analysis of Prolonged Stays of Patients in a Multi-Specialist Hospital in Poland," IJERPH, MDPI, vol. 20(2), pages 1-23, January.
    8. Sandeep Jadhav & Ahmed Imran & Marjia Haque, 2023. "Application of six sigma and the system thinking approach in COVID-19 operation management: a case study of the victorian aged care response centre (VACRC) in Australia," Operations Management Research, Springer, vol. 16(1), pages 531-553, March.
    9. Ana-Beatriz Hernández-Lara & Maria-Victoria Sánchez-Rebull & Angels Niñerola, 2021. "Six Sigma in Health Literature, What Matters?," IJERPH, MDPI, vol. 18(16), pages 1-13, August.
    10. Arianna Scala & Antonio D’Amore & Maria Pia Mannelli & Mario Mensorio & Giovanni Improta, 2024. "Management of Patients with Colorectal Cancer through Fast-Track Surgery," IJERPH, MDPI, vol. 21(9), pages 1-16, September.

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