Using Lean Six Sigma to improve rates of day of surgery admission in a national thoracic surgery department

Abstract

Abstract Objective The aim of this study is to improve rates of day of surgery admission (DOSA) for all suitable elective thoracic surgery patients. Design Lean Six Sigma (LSS) methods were used to enable improvements to both the operational process and the organizational working of the department over a period of 19 months. Setting A national thoracic surgery department in a large teaching hospital in Ireland. Participants Thoracic surgery staff, patients and quality improvement staff at the hospital. Intervention(s) LSS methods were employed to identify and remove the non-value-add in the patient’s journey and achieve higher levels of DOSA. A pre-surgery checklist and Thoracic Planning Meeting were introduced to support a multidisciplinary approach to enhanced recovery after surgery (ERAS), reduce rework, improve list efficiency and optimize bed management. Main Outcome Measure(s) To achieve DOSA for all suitable elective thoracic surgery patients in line with the National Key Performance Indicator of 75%. A secondary outcome would be to further decrease overall length of stay by 1 day. Results Over a 19 month period, DOSA has increased from 10 to 75%. Duplication of preoperative tests reduced from 83 to <2%. Staff and patient surveys show increased satisfaction and improved understanding of ERAS. Conclusions Using LSS methods to improve both operational process efficiency and organizational clinical processes led to the successful achievement of increasing rates of DOSA in line with national targets.