Lean Six Sigma to reduce the acute myocardial infarction mortality rate: a single center study

IF 3.8 Q2 MANAGEMENT
A. Rosa, Teresa Angela Trunfio, Giuliano Marolla, A. Costantino, Davide Nardella, Olivia McDermott
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引用次数: 6

Abstract

PurposeCardiovascular diseases are the leading cause of death worldwide. In Italy, acute myocardial infarction (AMI) is a major cause of hospitalization and healthcare costs. AMI is a myocardial necrosis event caused by an unstable ischemic syndrome. The Italian government has defined an indicator called “AMI: 30-day mortality” to assess the quality of the overall care pathway of the heart attacked patient. In order to guarantee high standards, all hospitals had to implement techniques to increase the quality of care pathway. The aim of the paper is to identify the root cause and understand the mortality rate for AMI and redesign the patient management process in order to improve it.Design/methodology/approachA Lean Six Sigma (LSS) approach was used in this study to analyze the patient flow in order to reduce 30-days mortality rate from AMI registered by Complex Operative Unit (COU) of Cardiology of an Italian hospital. Value stream mapping (VSM) and Ishikawa diagrams were implemented as tools of analysis.FindingsProcess improvement using LSS methodology made it possible to reduce the overall times from 115 minutes to 75 minutes, with a reduction of 35%. In addition, the corrective actions such as the activation of a post-discharge outpatient clinic and telephone contacts allowed the 30-day mortality rate to be lowered from 16% before the project to 8% after the project. In this way, the limit value set by the Italian government was reached.Research limitations/implicationsThe limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.Practical implicationsThe LSS approach has brought significant benefits to the process of managing patients with AMI. Corrective actions such as the activation of an effective shared protocol or telephone interview with checklist can become the gold standard in reducing mortality. The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.Originality/valueLSS, applied for the first time to the management of cardiovascular diseases in Italy, is a methodology which has proved to be strategic for the improvement of healthcare process. The simple solutions implemented could serve as a guide for other hospitals to pursue the national AMI mortality target.
精益六西格玛降低急性心肌梗死死亡率:单中心研究
目的心血管疾病是世界范围内死亡的主要原因。在意大利,急性心肌梗死(AMI)是住院和医疗费用的主要原因。AMI是一种由不稳定缺血性综合征引起的心肌坏死事件。意大利政府定义了一个名为“AMI:30天死亡率”的指标,以评估心脏病发作患者的整体护理途径的质量。为了保证高标准,所有医院都必须实施提高护理质量的技术。本文的目的是确定AMI的根本原因并了解其死亡率,并重新设计患者管理流程以改进其。设计/方法/方法本研究采用精益六西格玛(LSS)方法分析患者流量,以降低意大利心脏病综合手术室(COU)登记的AMI 30天死亡率医院价值流映射(VSM)和石川图被实现为分析工具。Findings使用LSS方法对流程进行改进,可以将总时间从115分钟减少到75分钟,减少35%。此外,通过启动出院后门诊和电话联系等纠正措施,30天死亡率从项目前的16%降至项目后的8%。通过这种方式,达到了意大利政府设定的极限值。研究局限性/含义该研究的局限性在于它是单中心的,并且应用于病例数量有限的设施。实际意义LSS方法为AMI患者的管理过程带来了显著的好处。纠正措施,如激活有效的共享协议或电话访谈检查表,可以成为降低死亡率的黄金标准。该研究的局限性在于,它是单中心的,适用于病例数量有限的设施。独创性/价值LSS是意大利首次应用于心血管疾病管理的一种方法,已被证明对改善医疗保健流程具有战略意义。实施的简单解决方案可以作为其他医院追求全国AMI死亡率目标的指南。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
TQM Journal
TQM Journal Business, Management and Accounting-Business, Management and Accounting (all)
CiteScore
9.10
自引率
0.00%
发文量
114
期刊介绍: Commitment to quality is essential if companies are to succeed in a commercial environment which will be virtually unrecognizable in less than a decade. Changing attitudes, changing perspectives and changing priorities will revolutionise the structure and philosophy of future business practice - and TQM will be at the heart of that metamorphosis. All aspects of preparing for, developing, introducing, managing and evaluating TQM initiatives.
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