Carlo Ricciardi, Giovanni Balato, Maria Romano, Ida Santalucia, Mario Cesarelli and Giovanni Improta
The reduction of costs has a more and more relevant role in the healthcare context, therefore, a large effort is done by health providers to this aim, for example, by reducing the…
Abstract
Purpose
The reduction of costs has a more and more relevant role in the healthcare context, therefore, a large effort is done by health providers to this aim, for example, by reducing the length of hospital stay (LOS) of patients undergoing surgery. Fast track surgery fits perfectly this issue and was applied to patients undergoing knee replacement surgery due to Osteoarthritis, one of the most common diseases of aged population. The paper aims to discuss these issues.
Design/methodology/approach
Lean six sigma was applied to analyze the implementation of fast track surgery through the define, measure, analyze, improve, control roadmap, used as a typical problem-solving approach. It is characterized by five operational phases, which make possible the achievement of fixed goals through a rigorous process of defining, measuring, analyzing, improving and controlling business problems.
Findings
The corrective action, consisting in the application of fast track surgery, improved both effectiveness and efficiency of the process of care. The average length of hospital stay (LOS) was reduced from 8.34 to 6.68 days (–19.9 percent) and its standard deviation from 2.41 to 1.99 days (–17.1 percent). The statistical significance of this decrease was verified by means of proper tests. Moreover, some variables influencing the LOS were identified.
Research limitations/implications
The follow up and the satisfaction of patients were not analyzed and could be a future development of this study.
Practical implications
Patients will experience a faster recovery while the hospital will benefit from a rise of available beds. The effect is a general improvement of hospital management.
Originality/value
The introduction of fast track surgery for patients undergoing knee replacement surgery made significantly reduce LOS and, consequently, costs’ with a money saving of more than 50,000 euro per year.
Details
Keywords
Carlo Ricciardi, Alfonso Sorrentino, Giovanni Improta, Vincenzo Abbate, Imma Latessa, Antonietta Perrone, Maria Triassi and Giovanni Dell'aversana Orabona
Head and neck cancers are multi-factorial diseases that can affect many sides of people's life and are due to a lot of risk factors. According to their characteristics, the…
Abstract
Purpose
Head and neck cancers are multi-factorial diseases that can affect many sides of people's life and are due to a lot of risk factors. According to their characteristics, the treatment can be surgical, use of radiation or chemotherapy. The use of a surgical treatment can lead to surgical infections that are a main theme in medicine. At the University hospital of Naples “Federico II”, two antibiotics were employed to tackle the issue of the infections and they are compared in this paper to find which one implies the lowest length of hospital stay (LOS) and the reduction of infections.
Design/methodology/approach
The Six Sigma methodology and its problem-solving strategy DMAIC (define, measure, analyse, improve, control), already employed in the healthcare sector, were used as a tool of a health technology assessment between two drugs. In this paper the DMAIC roadmap is used to compare the Ceftriaxone (administered to a group of 48 patients) and the association of Cefazolin plus Clindamycin (administered to a group of 45 patients).
Findings
The results show that the LOS of patients treated with Ceftriaxone is lower than those who were treated with the association of Cefazolin plus Clindamycin, the difference is about 41%. Moreover, a lower number of complications and infections was found in patients who received Ceftriaxone. Finally, a greater number of antibiotic shifts was needed by patients treated with Cefazolin plus Clindamycin.
Research limitations/implications
While the paper enhances clearly the advantages for patients' outcomes regarding the LOS and the number of complications, it did not analyse the costs of the two antibiotics.
Practical implications
Employing the Ceftriaxone would allow the Department of Maxillofacial Surgery to obtain lower LOS and a limited number of complications/infections for recovered patients, consequently reducing the hospitalization costs.
Originality/value
There is a double value in this paper: first of all, the comparison between the two antibiotics gives an answer to one of the main issues in medicine that is the reduction of hospital-acquired infections; secondly, the Six Sigma through its DMAIC cycle can be employed also to compare two biomedical technologies as a tool of health technology assessment studies.
Details
Keywords
Antonella Fiorillo, Alfonso Sorrentino, Arianna Scala, Vincenzo Abbate and Giovanni Dell'aversana Orabona
The goal was to improve the quality of the hospitalization process and the management of patients, allowing the reduction of costs and the minimization of the preoperative Length…
Abstract
Purpose
The goal was to improve the quality of the hospitalization process and the management of patients, allowing the reduction of costs and the minimization of the preoperative Length of Hospital Stay (LOS).
Design/methodology/approach
The methodology used to improve the quality of the hospitalization process and patient management was Lean Thinking. Therefore, the Lean tools (Value stream map and Ishikawa diagram) were used to identify waste and inefficiencies, improving the process with the implementation of corrective actions. The data was collected through personal observations, patient interviews, brainstorming and from printed medical records of 151 patients undergoing oral cancer surgery in the period from 2006 to 2018.
Findings
The authors identified, through Value Stream Map, waste and inefficiencies during preoperative activities, consequently influencing preoperative LOS, considered the best performance indicator. The main causes were identified through the Ishikawa diagram, allowing reflection on possible solutions. The main corrective action was the introduction of the pre-hospitalization service. A comparative statistical analysis showed the significance of the solutions implemented. The average preoperative LOS decreased from 4.90 to 3.80 days (−22.40%) with a p-value of 0.001.
Originality/value
The methodology allowed to highlight the improvement of the patient hospitalization process with the introduction of the pre-hospitalization service. Therefore, by adopting the culture of continuous improvement, the flow of hospitalization was redrawn. The benefits of the solutions implemented are addressed to the patient in terms of lower LOS and greater service satisfaction and to the hospital for lower patient management costs and improved process quality. This article will be useful for those who need examples on how to apply Lean tools in healthcare.
Details
Keywords
Imma Latessa, Antonella Fiorillo, Ilaria Picone, Giovanni Balato, Teresa Angela Trunfio, Arianna Scala and Maria Triassi
One of the biggest challenges in the health sector is that of costs compared to economic resources and the quality of services. Hospitals register a progressive increase in…
Abstract
Purpose
One of the biggest challenges in the health sector is that of costs compared to economic resources and the quality of services. Hospitals register a progressive increase in expenditure due to the aging of the population. In fact, hip and knee arthroplasty surgery are mainly due to primary osteoarthritis that affects the elderly population. This study was carried out with the aim of analysing the introduction of the fast track surgery protocol, through the lean Six Sigma, on patients undergoing knee and hip prosthetic replacement surgery. The goal was to improve the arthroplasty surgery process by reducing the average length of stay (LOA) and hospital costs
Design/methodology/approach
Lean Six Sigma was applied to evaluate the arthroplasty surgery process through the DMAIC cycle (define, measure, analyse, improve and control) and the lean tools (value stream map), adopted to analyse the new protocol and improve process performance. The dataset consisted of two samples of patients: 54 patients before the introduction of the protocol and 111 patients after the improvement. Clinical and demographic variables were collected for each patient (gender, age, allergies, diabetes, cardiovascular diseases and American Society of Anaesthesiologists (ASA) score).
Findings
The results showed a 12.70% statistically significant decrease in LOS from an overall average of 8.72 to 7.61 days. Women patients without allergies, with a low ASA score not suffering from diabetes and cardiovascular disease showed a significant a reduction in hospital days with the implementation of the FTS protocol. Only the age variable was not statistically significant.
Originality/value
The introduction of the FTS in the orthopaedic field, analysed through the LSS, demonstrated to reduce LOS and, consequently, costs. For each individual patient, there was an economic saving of € 445.85. Since our study takes into consideration a dataset of 111 patients post-FTS, the overall economic saving brought by this study amounts to €49,489.35.