Katherine R Iverson1,2, Lina Roa3,4, Sebastian Shu3,5, Milagros Wong6, Shayna Rubenstein7, Paloma Zavala6, Luke Caddell3, Cole Graham6, Jorge Colina8, Segundo R Leon6,9, Leonid Lecca6, Gita N Mody10. 1. Department of Surgery, Medical Center, University of California, Davis, 2335 Stockton Blvd, North Addition 5th floor, Sacramento, CA, 95817, USA. katie.r.iverson@gmail.com. 2. Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA. katie.r.iverson@gmail.com. 3. Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA. 4. Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Canada. 5. School of Medicine Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru. 6. Socios En Salud, Lima, Peru. 7. Tufts University School of Medicine, Boston, MA, USA. 8. Department of Surgery, Sergio E. Bernales National Hospital, Lima, Peru. 9. School of Medical Technology, Universidad Privada San Juan Bautista, Lima, Peru. 10. Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.
Abstract
BACKGROUND: In resource-limited settings, there is a unique opportunity for using process improvement strategies to address the lack of access to surgical care. By implementing organizational changes in the surgical admission process, we aimed to decrease wait times, increase surgical volume, and improve patient satisfaction for elective general surgery procedures at a public tertiary hospital in Lima, Peru. METHODS: During the first phase of the intervention, Plan-Do-Study-Act (PDSA) cycles were performed to ensure the surgery waitlist included up-to-date clinical information. In the second phase, Lean Six Sigma methodology was used to adapt the admission and scheduling process for elective general surgery patients. After six months, outcomes were compared to baseline data using Wilcoxon rank-sum test. RESULTS: At the conclusion of phase one, 87.0% (488/561) of patients on the new waitlist had all relevant clinical data documented, improved from 13.3% (2/15) for the pre-existing list. Time from admission to discharge for all surgeries improved from 5 to 4 days (p<0.05) after the intervention. Median wait times from admission to operation for elective surgeries were unchanged at 4 days (p=0.076) pre- and post-intervention. There was a trend toward increased weekly elective surgical volume from a median of 9 to 13 cases (p=0.24) and increased patient satisfaction rates for elective surgery from 80.5 to 83.8% (p=0.62), although these were not statistically significant. CONCLUSION: The process for scheduling and admitting elective surgical patients became more efficient after our intervention. Time from admission to discharge for all surgical patients improved significantly. Other measured outcomes improved, though not with statistical significance. Main challenges included gaining buy-in from all participants and disruptions in surgical services from bed shortages.
BACKGROUND: In resource-limited settings, there is a unique opportunity for using process improvement strategies to address the lack of access to surgical care. By implementing organizational changes in the surgical admission process, we aimed to decrease wait times, increase surgical volume, and improve patient satisfaction for elective general surgery procedures at a public tertiary hospital in Lima, Peru. METHODS: During the first phase of the intervention, Plan-Do-Study-Act (PDSA) cycles were performed to ensure the surgery waitlist included up-to-date clinical information. In the second phase, Lean Six Sigma methodology was used to adapt the admission and scheduling process for elective general surgery patients. After six months, outcomes were compared to baseline data using Wilcoxon rank-sum test. RESULTS: At the conclusion of phase one, 87.0% (488/561) of patients on the new waitlist had all relevant clinical data documented, improved from 13.3% (2/15) for the pre-existing list. Time from admission to discharge for all surgeries improved from 5 to 4 days (p<0.05) after the intervention. Median wait times from admission to operation for elective surgeries were unchanged at 4 days (p=0.076) pre- and post-intervention. There was a trend toward increased weekly elective surgical volume from a median of 9 to 13 cases (p=0.24) and increased patient satisfaction rates for elective surgery from 80.5 to 83.8% (p=0.62), although these were not statistically significant. CONCLUSION: The process for scheduling and admitting elective surgical patients became more efficient after our intervention. Time from admission to discharge for all surgical patients improved significantly. Other measured outcomes improved, though not with statistical significance. Main challenges included gaining buy-in from all participants and disruptions in surgical services from bed shortages.
Authors: Lacey N LaGrone; Amy K Fuhs; Eduardo Huaman Egoavil; Manuel J A Rodriguez Castro; Roberto Valderrama; Leah N Isquith-Dicker; Jaime Herrera-Matta; Charles N Mock Journal: World J Surg Date: 2017-04 Impact factor: 3.352
Authors: Henry Thomas Stelfox; Manjul Joshipura; Witaya Chadbunchachai; Ranjith N Ellawala; Gerard O'Reilly; Thai Son Nguyen; Russell L Gruen Journal: World J Surg Date: 2012-08 Impact factor: 3.352
Authors: Nakul P Raykar; Joshua S Ng-Kamstra; Stephen Bickler; Justine Davies; Sarah L M Greenberg; Lars Hagander; Walt Johnson; Andrew J M Leather; K A Kelly McQueen; Swagoto Mukhopadhyay; Emi Suzuki; Thomas Weiser; Mark G Shrime; John G Meara Journal: BMJ Glob Health Date: 2017-05-24