دورية أكاديمية
Lean Six Sigma to Reduce Intensive Care Unit Length of Stay and Costs in Prolonged Mechanical Ventilation.
| العنوان: | Lean Six Sigma to Reduce Intensive Care Unit Length of Stay and Costs in Prolonged Mechanical Ventilation. |
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| المؤلفون: | Trzeciak S, Mercincavage M, Angelini C, Cogliano W, Damuth E, Roberts BW, Zanotti S, Mazzarelli AJ |
| المصدر: | Journal for healthcare quality : official publication of the National Association for Healthcare Quality [J Healthc Qual] 2018 Jan/Feb; Vol. 40 (1), pp. 36-43. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: National Association For Healthcare Quality Country of Publication: United States NLM ID: 9202994 Publication Model: Print Cited Medium: Internet ISSN: 1945-1474 (Electronic) Linking ISSN: 10622551 NLM ISO Abbreviation: J Healthc Qual |
| أسماء مطبوعة: | Original Publication: Skokie Il : National Association For Healthcare Quality |
| مواضيع طبية MeSH: | Intensive Care Units/*economics , Intensive Care Units/*statistics & numerical data , Length of Stay/*economics , Length of Stay/*statistics & numerical data , Respiration, Artificial/*economics , Respiration, Artificial/*statistics & numerical data , Total Quality Management/*economics, Academic Medical Centers/economics ; Academic Medical Centers/statistics & numerical data ; Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Diagnosis-Related Groups ; Female ; Hospitalization/economics ; Hospitalization/statistics & numerical data ; Humans ; Male ; Middle Aged ; Total Quality Management/statistics & numerical data ; United States |
| مستخلص: | Objective: Patients with prolonged mechanical ventilation (PMV) represent important "outliers" of hospital length of stay (LOS) and costs (∼$26 billion annually in the United States). We tested the hypothesis that a Lean Six Sigma (LSS) approach for process improvement could reduce hospital LOS and the associated costs of care for patients with PMV. Design: Before-and-after cohort study. Setting: Multidisciplinary intensive care unit (ICU) in an academic medical center. Patients: Adult patients admitted to the ICU and treated with PMV, as defined by diagnosis-related group (DRG). Methods: We implemented a clinical redesign intervention based on LSS principles. We identified eight distinct processes in preparing patients with PMV for post-acute care. Our clinical redesign included reengineering daily patient care rounds ("Lean ICU rounds") to reduce variation and waste in these processes. We compared hospital LOS and direct cost per case in patients with PMV before (2013) and after (2014) our LSS intervention. Results: Among 259 patients with PMV (131 preintervention; 128 postintervention), median hospital LOS decreased by 24% during the intervention period (29 vs. 22 days, p < .001). Accordingly, median hospital direct cost per case decreased by 27% ($66,335 vs. $48,370, p < .001). Conclusion: We found that a LSS-based clinical redesign reduced hospital LOS and the costs of care for patients with PMV. |
| تواريخ الأحداث: | Date Created: 20161201 Date Completed: 20190917 Latest Revision: 20190917 |
| رمز التحديث: | 20221213 |
| DOI: | 10.1097/JHQ.0000000000000075 |
| PMID: | 27902532 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1945-1474 |
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| DOI: | 10.1097/JHQ.0000000000000075 |