Toledo Alexander H, Carroll Tracy, Arnold Emily, Tulu Zeynep, Caffey Tom, Kearns Lauren E, Gerber David A
University of North Carolina Health Care, Chapel Hill.
Prog Transplant. 2013 Dec;23(4):350-64. doi: 10.7182/pit2013226.
Organ transplant centers are under increasing scrutiny to maintain outcomes while controlling cost in a challenging population of patients. Throughout health care and transplant specifically, length of stay is used as a benchmark for both quality and resource utilization.
To decrease our length of stay for liver transplant by using Lean Six Sigma methods.
The Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) method was used to systematically analyze our process from transplant listing to hospital discharge after transplant, identifying many factors affecting length of stay.
Adult, single-organ, primary liver transplant recipients between July 2008 and June 2012 were included in the study. Recipients with living donors or fulminant liver failure were excluded.
INTERVENTION(S): Multiple interventions, including a clinical pathway and enhanced communication, were implemented.
MAIN OUTCOME MEASURE(S): Length of stay after liver transplant and readmission after liver transplant.R ESULTS: Median length of stay decreased significantly from 11 days before the intervention to 8 days after the intervention. Readmission rate did not change throughout the study. The improved length of stay was maintained for 24 months after the study.
Using a Lean Six Sigma approach, we were able to significantly decrease the length of stay of liver transplant patients. These results brought our center's outcomes in accordance with our goal and industry benchmark of 8 days. Clear expectations, improved teamwork, and a multidisciplinary clinical pathway were key elements in achieving and maintaining these gains.
器官移植中心在面临挑战的患者群体中，为了在控制成本的同时维持治疗效果，正受到越来越多的审视。在整个医疗保健领域，尤其是移植领域，住院时间被用作质量和资源利用的基准。
通过运用精益六西格玛方法来缩短我们肝移植患者的住院时间。
采用六西格玛DMAIC（定义、测量、分析、改进、控制）方法，系统地分析从移植登记到移植后出院的整个过程，识别出许多影响住院时间的因素。
纳入了2008年7月至2012年6月期间的成年单器官原发性肝移植受者。排除活体供者或暴发性肝衰竭的受者。
实施了多种干预措施，包括临床路径和加强沟通。
肝移植后的住院时间和肝移植后的再入院情况。
住院时间中位数从干预前的11天显著降至干预后的8天。在整个研究过程中，再入院率没有变化。研究结束后，缩短的住院时间持续了24个月。
通过采用精益六西格玛方法，我们能够显著缩短肝移植患者的住院时间。这些结果使我们中心的治疗效果达到了我们设定的目标以及8天的行业基准。明确的期望、改进的团队合作以及多学科临床路径是实现并维持这些成果的关键因素。
