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The application of six sigma to reduce the pre-operative length of hospital stay at the hospital Antonio Cardarelli

Giovanni Improta (Dipartimento di Sanità Pubblica, University of Naples Federico II, Napoli, Italy)
Carlo Ricciardi (Dipartimento di Scienze Biomediche Avanzate, University of Naples Federico II, Napoli, Italy)
Anna Borrelli (Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, Napoli, Italy)
Alessia D’alessandro (Dipartimento di medicina sperimentale, Università degli Studi della Campania Luigi Vanvitelli, Caserta, Italy)
Ciro Verdoliva (Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, Napoli, Italy)
Mario Cesarelli (DIETI, University of Naples Federico II, Napoli, Italy)

International Journal of Lean Six Sigma

ISSN: 2040-4166

Article publication date: 2 September 2019

Issue publication date: 14 May 2020

Abstract

Purpose

The best treatment for femur fractures is the surgical one within 48 h from the admission to the hospital. These fractures have serious consequences, both in terms of morbidity and socio-economic impact. In the hospital A.O.R.N. Cardarelli of Naples in Italy, the mean pre-operative length of hospital stay (LOS) was nine days and just 4 per cent of patients was operated within the suggested time. Therefore, a diagnostic-therapeutic-assistance path (DTAP) was implemented to improve the process.

Design/methodology/approach

This paper analyzes two groups of patients (534 and 562, respectively) before and after the introduction of DTAP, through six sigma (SS) based on define, measure, analyze, improve and control cycle. Age, gender, American Society of Anaesthesiologists (ASA) score, cardiovascular diseases, diabetes and allergies were used as independent subgrouping variables. The t-tests and chi-square were performed to compare the groups, tools of SS were used.

Findings

The analyses were conducted considering overall patients and some subgroups. The overall reduction in LOS was about 54 per cent, patients without cardiovascular diseases and with a low ASA score had the highest reduction, more than 60 per cent. All the p-values proved a high statistically significant difference between the two groups.

Research limitations/implications

The influence of the Italian health-care system is a minor limitation while, unfortunately, the lack of a follow-up did not allow quantifying the real gain in health of patients. A lean thinking analysis would suit this context.

Practical implications

There are practical advantages for both hospital and patients: the hospital will have an increase in admissions and more beds available, while patients will benefit of a faster intervention and a shorter wait.

Originality/value

This is the first analysis through SS of DTAP showing its positive influences in terms of both socio-economic impact and patients’ outcome. Policy leaders could use this study as an example to evaluate the introduction of the same clinical pathway in other health facilities.

Keywords

Acknowledgements

Funding: the authors received no funding.

Conflict of interests: the authors declare they have no conflict of interests.

Citation

Improta, G., Ricciardi, C., Borrelli, A., D’alessandro, A., Verdoliva, C. and Cesarelli, M. (2020), "The application of six sigma to reduce the pre-operative length of hospital stay at the hospital Antonio Cardarelli", International Journal of Lean Six Sigma, Vol. 11 No. 3, pp. 555-576. https://doi.org/10.1108/IJLSS-02-2019-0014

Publisher

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Emerald Publishing Limited

Copyright © 2019, Emerald Publishing Limited