Improving Hospital Discharge Time A successful Implementation of Six Sigma Methodology
Improving Hospital Discharge Time A successful Implementation of Six Sigma Methodology
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DOI：
10.1097/md.0000000000000633
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发表时间：
2015-03-01
期刊：
影响因子：
1.6
通讯作者：
Hitti, Eveline A.
中科院分区：
文献类型：
--
作者：
El-Eid, Ghada R.;Kaddoum, Roland;Hitti, Eveline A.
延迟患者出院可能会影响医院和急诊科（艾德）的吞吐量。出院过程是复杂的，涉及设置特定的挑战，限制了解决方案的普遍性。本研究的目的是评估使用六西格玛方法改善患者出院过程的有效性。这是一项定量的干预前后研究。386张床位的三级护理医院。一系列六西格玛驱动的干预措施超过10个月。主要结局是出院时间（从出院令到患者离开房间的时间）。次要指标包括中午前写好出院单的患者百分比、中午前离开病房的患者百分比、住院时间（LOS）和入院艾德患者的LOS。出院时间从干预前的2.2小时减少到干预后的1.7小时，减少了22.7%（P< 0.001）。在干预后的一段时间里，有更大比例的患者在中午前离开他们的房间（P< 0.001），尽管在中午前离开没有统计学差异。住院时间从干预前的3.4天下降到干预后的3.1天（P< 0.001）。干预后入院患者的艾德平均LOS显著降低（6.9 +/- 7.8 vs 5.9 +/- 7.7小时; P< 0.001）。希望解决出院过程中的延迟问题的机构的重点应该是采用六西格玛的核心原则，而不是可能针对机构的具体干预措施。
Delays in discharging patients can impact hospital and emergency department (ED) throughput. The discharge process is complex and involves setting specific challenges that limit generalizability of solutions.The aim of this study was to assess the effectiveness of using Six Sigma methods to improve the patient discharge process.This is a quantitative pre and post-intervention study.Three hundred and eighty-six bed tertiary care hospital.A series of Six Sigma driven interventions over a 10-month period.The primary outcome was discharge time (time from discharge order to patient leaving the room). Secondary outcome measures included percent of patients whose discharge order was written before noon, percent of patients leaving the room by noon, hospital length of stay (LOS), and LOS of admitted ED patients.Discharge time decreased by 22.7% from 2.2 hours during the preintervention period to 1.7 hours post-intervention (P< 0.001). A greater proportion of patients left their room before noon in the postintervention period (P< 0.001), though there was no statistical difference in before noon discharge. Hospital LOS dropped from 3.4 to 3.1 days postintervention (P< 0.001). ED mean LOS of patients admitted to the hospital was significantly lower in the postintervention period (6.9 +/- 7.8 vs 5.9 +/- 7.7 hours; P< 0.001).Six Sigma methodology can be an effective change management tool to improve discharge time. The focus of institutions aspiring to tackle delays in the discharge process should be on adopting the core principles of Six Sigma rather than specific interventions that may be institution-specific.