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

Arianna Scala, Alfonso Maria Ponsiglione, Ilaria Loperto, Antonio Della Vecchia, Anna Borrelli, Giuseppe Russo, Maria Triassi and Giovanni Improta
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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
Giovanni Improta: Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy

IJERPH, 2021, vol. 18, issue 6, 1-13

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; public health; healthcare quality; process improvement; length of stay (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (10)

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