Reducing Respiratory Length of Stay Via Lean Six Sigma
Medical Center Project Overview
Not-for-Profit Medical Center
Juran Lean Six Sigma – Rapid Improvement Event and DMAIC
In-house data analysis from January through October showed that the Respiratory (DRGs 079, 088, 475) Medicare average length of stay was 9.1 days compared to the Medicare mean of 6.2 days.
Overall, an increased length of
stay above the target mean, and across all Diagnosis Related Groups hospital-wide costs the organization approximately $4 million annually.
Reduced LOS will not only improve profitability on the patient load currently served but will enable improved Emergency Department throughput and increased overall hospital revenue.
Reduce Respiratory LOS from a current baseline of 7.7 days to 6.2 days within a 6 month period. (Actual project result was 6.3 days.)
- Data analysis shows the current average YTD LOS hospital-wide is 4.28 days versus the organization’s target of 3.85 days.
- Reducing YTD LOS to 4.1 days could reduce cost per adjusted discharge
- Reducing YTD LOS to 3.85 days could reduce our cost per adjusted
discharge by $950.
- Decreasing LOS for Medicare patients reduces expense without reducing net revenue.
- Decreasing LOS will reduce denials for unapproved days.
- Decreasing LOS can have a positive impact on salary costs for both Nursing and Ancillary Services.
- Ability to respond to varying patient and customer needs.
- Doctors and employees are friendly to and considerate of patients.
- Safe, high-quality care is consistently provided to patients.
- An atmosphere of partnership and trust exists between the hospital and
- Clear, complete orders, charts, and treatment notes.
- Timely, clear planning of patient care.
- Test orders and results that are obtained quickly, easily, and accurately.
- Minimal waiting time for patients.
Value Added Analysis
The targeted Value Stream was the in-patient care process from admission until discharge for Respiration Medicare Patients. The team walked through the process and determined the actual length of time it took to complete each admission process step. They calculated that only 35% was the actual value-added process time, and the non-value-added process time was 63%. The non-value-added but necessary time made up for the remainder.
Non-Value Added Analysis
The team identified the non-value-added activities adding to the overall time.
Some of the issues that clearly needed to be addressed were:
- Unit secretaries ordering the wrong test for Barium Swallow
- Transportation delays resulting in the rescheduling of tests
- Labs not available for MDs when rounding
- Chest X-ray reports not available to MDs when rounding
- Decline in function due to failure to ambulate patients
Measurable Improvements Made After Implementing Lean Six Sigma
- Real-time pending lab results log display in Lab Department – alerts staff when results are due (color coded) for STATs, etc.
- Added new PT screening process so the Case Manager or Nurse can
order screening without MD order earlier inpatient stay to evaluate
conditioning level of patient
- Added 6-track criteria for Ventilation Weaning protocol
- Updated Physician Resuscitation orders
- Palliative care program approved and implemented
- Daily huddle with Hospitalists and Case Managers to identify appropriate patient care level, anticipated discharge date, medical management plan, and barriers to patient progress
Implementation is being tracked against the plan at bi-weekly team meetings. A control chart with key measurements has been developed and is updated after every meeting to sustain the gains.
The lessons learned from this project are repeatable and reproducible to impact more than the Respiratory Diagnoses Related Group. The team will address Cardiology as the second of seven value streams on their improvement journey.
- Reduced Specified Respiratory Diagnoses Related Group’s LOS by 1.4 days from 7.7 to 6.3 days.
- Savings of $495,600 over the six month time period following implementation.
- Reductions in ALOS were not only experienced by those patients in Medicare
- Respiratory and Cardiac, but also by all patients in those Diagnostic Related Groups.
- When all patients affected are considered, the total six-month savings rises to $636,900.
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