Redesigning a Joint Replacement Program Using Lean Six Sigma in a Veterans Affairs Hospital
Redesigning a Joint Replacement Program Using Lean Six Sigma in a Veterans Affairs Hospital
复制标题
DOI：
10.1001/jamasurg.2013.3598
复制
发表时间：
2013-11-01
期刊：
影响因子：
16.9
通讯作者：
Munshi, Imtiaz A.
中科院分区：
文献类型：
--
作者：
Gayed, Benjamin;Black, Stephen;Munshi, Imtiaz A.
2009年4月，印第安纳州印第安纳波利斯Richard L. Roudebush退伍军人医疗中心对关节置换手术的分析显示，2008财政年度，全髋关节和膝关节置换术的非退伍军人事务（VA）护理费用为140万美元，平均住院时间为6.1天。联合置换计划系统重新设计项目是根据视力-分析-团队-目标-地图-测量-改变-维持（VA-TAMMCS）模型启动的，以提高效率，缩短住院时间，减少非va护理成本。目的探讨精益六西格玛流程改进方法在某VA医院的应用效果。设计、设置和参与者全关节置换术患者的围手术期流程按照VA- tammcs模型（VA的官方品牌精益六西格玛流程改进方法）重新设计。包括骨科医生、一线员工和行政管理人员在内的多学科团队确定了当前流程中的浪费，并发起了减少浪费和提高效率的变革。数据收集包括1年基线期和20个月维持期。主要结局和测量：主要终点为住院时间；第二项分析考虑了非退伍军人事务部护理成本的降低。结果住院时间总体减少了36%，从项目前期的5.3天减少到20个月维持期的3.4天（P < 0.001）。在Richard L. Roudebush退伍军人事务医疗中心接受全髋关节和膝关节置换术的患者完全取消了非va护理，与基线成本和数量相比，估计每年产生100万美元的投资回报。此外，在数据收集期间，该中心的全关节置换术量有所增加。结论和相关性关节置换项目的成功表明，VA-TAMMCS是外科实践中精益和六西格玛流程改进的有效工具，在该医疗中心持续减少36%的住院时间，完全消除全髋关节和膝关节置换术的非va护理，同时增加了全关节置换术的量。
IMPORTANCE In April 2009, an analysis of joint replacement surgical procedures at the Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, revealed that total hip and knee replacements incurred $1.4 million in non-Veterans Affairs (VA) care costs with an average length of stay of 6.1 days during fiscal year 2008. The Joint Replacement Program system redesign project was initiated following the Vision-Analysis-Team-Aim-Map-Measure-Change-Sustain (VA-TAMMCS) model to increase efficiency, decrease length of stay, and reduce non-VA care costs.OBJECTIVE To determine the effectiveness of Lean Six Sigma process improvement methods applied in a VA hospital.DESIGN, SETTING, AND PARTICIPANTS Perioperative processes for patients undergoing total joint replacement were redesigned following the VA-TAMMCS model-the VA's official, branded method of Lean Six Sigma process improvement. A multidisciplinary team including the orthopedic surgeons, frontline staff, and executive management identified waste in the current processes and initiated changes to reduce waste and increase efficiency. Data collection included a 1-year baseline period and a 20-month sustainment period.MAIN OUTCOMES AND MEASURES The primary endpoint was length of stay; a secondary analysis considered non-VA care cost reductions.RESULTS Length of stay decreased 36% overall, decreasing from 5.3 days during the preproject period to 3.4 days during the 20-month sustainment period (P < .001). Non-VA care was completely eliminated for patients undergoing total hip and knee replacement at the Richard L. Roudebush Veterans Affairs Medical Center, producing an estimated return on investment of $1 million annually when compared with baseline cost and volumes. In addition, the volume of total joint replacements at this center increased during the data collection period.CONCLUSIONS AND RELEVANCE The success of the Joint Replacement Program demonstrates that VA-TAMMCS is an effective tool for Lean and Six Sigma process improvement initiatives in a surgical practice, producing a 36% sustained reduction in length of stay and completely eliminating non-VA care for total hip and knee replacements while increasing total joint replacement volume at this medical center.