A Lean Six Sigma Quality Improvement Project to Increase Discharge Paperwork Completeness for Admission to a Comprehensive Integrated Inpatient Rehabilitation Program
1Johns Hopkins University School of Medicine, Baltimore, MD.American Journal of Medical Quality (Impact Factor: 1.25). 01/2013; 28(4). DOI: 10.1177/1062860612470486
Lean Six Sigma (LSS) process analysis can be used to increase completeness of discharge summary reports used as a critical communication tool when a patient transitions between levels of care. The authors used the LSS methodology as an intervention to improve systems process. Over the course of the project, 8 required elements were analyzed in the discharge paperwork. The authors analyzed the discharge paperwork of patients (42 patients preintervention and 143 patients postintervention) of a comprehensive integrated inpatient rehabilitation program (CIIRP). Prior to this LSS project, 61.8% of required discharge elements were present. The intervention improved the completeness to 94.2% of the required elements. The percentage of charts that were 100% complete increased from 11.9% to 67.8%. LSS is a well-established process improvement methodology that can be used to make significant improvements in complex health care workflow issues. Specifically, the completeness of discharge documentation required for transition of care to CIIRP can be improved.
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ABSTRACT: Data suggest that delays in discharges from inpatient units affect hospital throughput and contribute to emergency department crowding. Lean/Six Sigma (LSS) has been shown to improve inefficiencies in other industries. There are no published data on what impact LSS can have on advancing and sustaining earlier patient discharges. Determine the impact LSS has on advancing times of placement of discharge order and patient discharge compared to control. Secondary outcomes were length of stay (LOS) and readmission rates. Prospective quality study with concurrent controls. Academic medical center. Hospitalized pediatric patients compared to remainder of the children's hospital services. Staff reallocation, creation of standard workflow, multidisciplinary predischarge planning, and creation of a discharge checklist. Median time of discharge order entry and median time of actual patient discharge, proportion of patients discharged before noon and 2 pm, and LOS and readmission rates. The median time of order entry was 10:45 compared to 14:05, and the median time of discharge was 14:15 compared to 15:48. The LOS and the readmission rates remained the same in both cohorts. The control group had faster baseline discharge order entry and patient discharge, but discharge performance did not improve, despite a significantly lower average daily census. We determined that Lean approaches can have an immediate and sustained impact on advancing patient discharges, with no negative affect on LOS or readmission rates. Our intervention generated consistent results independent of personnel during the busiest months of the year at a tertiary care children's hospital. Journal of Hospital Medicine 2014; © 2014 Society of Hospital Medicine. © 2014 Society of Hospital Medicine.
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ABSTRACT: School safety is critical to education, but is rarely managed effectively. In Thailand, school safety is lower priority than other educational issues, lacking effective policy, and with schools struggling to justify safety costs. This paper outlines a novel application of lean thinking, which aims to control costs, bureaucracy and waste associated with managing school safety. A Thai primary school is the case study, where current safety is reviewed with regard to key aspects of management, including people, finance and operations. Lean thinking is applied to improve safety management and results show significant potential, along with management implications and future recommendations.
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