Lean Six Sigma Approach to Improve the Management of Patients Undergoing Laparoscopic Cholecystectomy
Abstract
:1. Introduction
2. Materials and Methods
- Gender (Male/Female);
- Age (0–29, 30–49, 50–59, 60–69, 70–79, ≥80);
- Hypertension (Yes/No);
- Diabetes (Yes/No);
- Cardiovascular disease (Yes/No);
- Respiratory disease (Yes/No);
- Obesity (Yes/No);
- Liver disease (Yes/No);
- Date and time of admission;
- Date and time of an LC procedure;
- Date and time of discharge.
2.1. DMAIC Cycle
2.1.1. Define
- Project title: Lean Six Sigma approach to improve the management of patients undergoing laparoscopic cholecystectomy.
- Question: prolonged post-operative LOS.
- CTQ: post-operative LOS (days).
- Target: Improve the quality process to reduce the CTQ for all patients who undergo LC according to the indication of the Italian government.
- Deliverables: increase in the turnover; decrease in post-operative LOS.
- Timeline:
- ○
- Define: January–March 2015;
- ○
- Measure: April–August 2015;
- ○
- Analyze: September–October 2015;
- ○
- Improve: November–December 2015;
- ○
- Control: January 2016–December 2020.
- In scope: laparoscopic cholecystectomy; transversal to surgery department of “San Giovanni di Dio e Ruggi d’Aragona” of Salerno (Italy).
- Out scope: the departments not enclosed in the process.
- Financial: no financial assistance is required.
- Business need: speeding up the discharge process.
2.1.2. Measure
2.1.3. Analyze
2.1.4. Improve
- Post-operative hematochemical examinations: the time for performing and receiving the result has been reduced thanks to a defined pathway with the laboratories.
- Light feeding after gas canalization.
- Discharge on the first or second day depending on clinical evolution.
- Outpatient surgical check-up 7 days after discharge.
2.2. Control
3. Results
4. Discussions
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Category | Post-Operative LOS * (Mean ± Std Dev **) | N | p-Value |
---|---|---|---|---|
Age | 0–29 | 10.000 ± 20.008 | 13 | 0.382 |
30–49 | 6.655 ± 9.913 | 55 | ||
50–59 | 6.250 ± 12.128 | 68 | ||
60–69 | 6.592 ± 13.681 | 71 | ||
70–79 | 6.122 ± 8.838 | 41 | ||
over 80 | 4.833 ± 4.535 | 6 | ||
Gender | Man | 6.780 ± 12.910 | 104 | 0.886 |
Women | 6.430 ± 11.380 | 150 | ||
Hypertension | No | 6.727 ± 11.063 | 143 | 0.527 |
Yes | 6.369 ± 13.174 | 111 | ||
Diabetes | No | 6.638 ± 11.953 | 213 | 0.540 |
Yes | 6.220 ± 12.433 | 41 | ||
Cardiovascular disease | No | 6.694 ± 12.935 | 180 | 0.426 |
Yes | 6.270 ± 9.453 | 74 | ||
Respiratory disease | No | 6.242 ± 11.174 | 231 | 0.283 |
Yes | 9.870 ± 18.450 | 23 | ||
Obesity | No | 6.634 ± 12.368 | 227 | 0.386 |
Yes | 6.037 ± 8.555 | 27 | ||
Liver disease | No | 6.304 ± 11.414 | 227 | 0.516 |
Yes | 8.815 ± 16.272 | 27 |
Variable | Category | Pre-Improvement (Mean ± Std Dev *) | Post-Improvement (Mean ± Std Dev *) | Difference of the Mean (%) | p-Value |
---|---|---|---|---|---|
All | All | 134 | 23.80 | 5 | 262 |
Age | 0–29 | 10.000 ± 20.008 | 1.750 ± 0.500 | −82.50 | 0.008 |
30–49 | 6.655 ± 9.913 | 7.159 ± 17.430 | +7.57 | 0.002 | |
50–59 | 6.250 ± 12.128 | 4.235 ± 6.752 | −32.24 | 0.193 | |
60–69 | 6.592 ± 13.681 | 2.950 ± 3.730 | −55.25 | 0.0001 | |
70–79 | 6.122 ± 8.838 | 4.038 ± 7.082 | −34.04 | 0.086 | |
over 80 | 4.833 ± 4.535 | 5.307 ± 5.907 | +9.80 | 0.858 | |
Gender | Man | 6.780 ± 12.910 | 3.906 ± 7.049 | −42.39 | 0.001 |
Women | 6.430 ± 11.380 | 4.836 ± 10.825 | −24.79 | 0.0007 | |
Hypertension | No | 6.727 ± 11.063 | 4.396 ± 9.134 | −34.65 | 0.0001 |
Yes | 6.369 ± 13.174 | 4.504 ± 9.731 | −29.28 | 0.017 | |
Diabetes | No | 6.638 ± 11.953 | 4.511 ± 9.846 | −32.04 | 0.0001 |
Yes | 6.220 ± 12.433 | 9.900 ± 15.933 | −16.48 | 0.044 | |
Cardiovascular disease | No | 6.694 ± 12.935 | 4.380 ± 8.381 | −34.56 | 0.0001 |
Yes | 6.270 ± 9.453 | 4.000 ± 8.367 | −36.20 | 0.012 | |
Respiratory disease | No | 6.242 ± 11.174 | 4.513 ± 9.984 | −27.69 | 0.0001 |
Cardiological Disorders | Yes | 9.870 ± 18.450 | 4.269 ± 5.204 | −56.74 | 0.119 |
Obesity | No | 6.634 ± 12.368 | 4.465 ± 9.490 | −32.69 | 0.0001 |
Yes | 6.037 ± 8.555 | 4.522 ± 9.686 | −28.30 | 0.125 | |
Liver disease | No | 6.304 ± 11.414 | 4.432 ± 9.644 | −29.69 | 0.0001 |
Yes | 8.815 ± 16.272 | 5.700 ± 7.718 | −35.33 | 0.245 | |
Hypertension | No | 6.727 ± 11.063 | 4.396 ± 9.134 | −34.65 | 0.0001 |
Yes | 6.369 ± 13.174 | 4.504 ± 9.731 | −29.28 | 0.017 |
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Scala, A.; Improta, G. Lean Six Sigma Approach to Improve the Management of Patients Undergoing Laparoscopic Cholecystectomy. Healthcare 2024, 12, 292. https://doi.org/10.3390/healthcare12030292
Scala A, Improta G. Lean Six Sigma Approach to Improve the Management of Patients Undergoing Laparoscopic Cholecystectomy. Healthcare. 2024; 12(3):292. https://doi.org/10.3390/healthcare12030292
Chicago/Turabian StyleScala, Arianna, and Giovanni Improta. 2024. "Lean Six Sigma Approach to Improve the Management of Patients Undergoing Laparoscopic Cholecystectomy" Healthcare 12, no. 3: 292. https://doi.org/10.3390/healthcare12030292