El-Eid Ghada R, Kaddoum Roland, Tamim Hani, Hitti Eveline A
From the Executive Hospital Administrator (GRE-D); Assistant Professor of Clinical Anesthesiology (RK); Associate Professor Department of Internal Medicine (HT); and Assistant Professor of Clinical Emergency Medicine, Department of Emergency Medicine, American University of Beirut Faculty of Medicine, Beirut, Lebanon (EAH).
Medicine (Baltimore). 2015 Mar;94(12):e633. doi: 10.1097/MD.0000000000000633.
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.
患者出院延迟会影响医院及急诊科的工作效率。出院流程复杂，存在一些特定挑战，这限制了相关解决方案的通用性。本研究旨在评估运用六西格玛方法改善患者出院流程的效果。这是一项干预前后的定量研究。研究对象为一家拥有386张床位的三级护理医院。在10个月的时间里实施了一系列由六西格玛驱动的干预措施。主要结局指标为出院时间（从下达出院医嘱到患者离开病房的时间）。次要结局指标包括出院医嘱在中午前开具的患者百分比、中午前离开病房的患者百分比、住院时长以及急诊科收治患者的住院时长。出院时间从干预前的2.2小时减少了22.7%，降至干预后的1.7小时（P<0.001）。干预后有更大比例的患者在中午前离开病房（P<0.001），不过中午前出院情况无统计学差异。干预后住院时长从3.4天降至3.1天（P<0.001）。干预后收治入院的急诊科患者平均住院时长显著缩短（6.9±7.8小时 vs 5.9±7.7小时；P<0.001）。六西格玛方法可以成为改善出院时间的有效变革管理工具。有志于解决出院流程延迟问题的机构应关注采用六西格玛的核心原则，而非可能因机构而异的特定干预措施。
