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Cited by 67Healthcare Operations and Scheduling OptimizationHealthcare Quality and ManagementEmergency and Acute Care Studies

The DOI matches its Crossref record; 2 of the 2 references it cites were found in a registry or an index.

A Lean Six Sigma Quality Improvement Project Improves Timeliness of Discharge from the Hospital

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Molla, Mithu, Warren, Duncan S., Stewart, Susan Leroy, Stocking, Jacqueline, Johl, Hershan, Sinigayan, Voltaire·2018·The Joint Commission Journal on Quality and Patient Safety
DOI 10.1016/j.jcjq.2018.02.006
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Abstract

Background Hospital overcrowding has become a widespread problem, with constrained bed capacity and admission bottlenecks having far-reaching negative impacts on quality and safety. Focus on timing of discharge may be the least disruptive and most effective way to address constrained bed capacity, yet there may be significant institution-specific barriers to implementation. Methods With the creation of a "Value Team," a 627-bed, tertiary care academic medical center embarked on a quality improvement (QI) project using Lean Six Sigma process improvement methodology. After defining the problems around timeliness of discharge, the team went through the steps in the Define, Measure, Analyze, Improve, Control (DMAIC) framework. Interventions, which were implemented on the basis of an in-depth analysis of barriers to the discharge process, included geographic cohorts of internal medicine physicians on specific hospital units and multidisciplinary huddles one day before anticipated discharge. Results After accounting for the concurrent trends in the control group, the percentage of discharge orders released by 10:00 a.m. increased by 21.3 points (p < 0.001; adjusted odds ratio [OR] = 2.62; 95% confidence interval [CI] = 1.91-3.59), and the percentage of patients discharged by noon increased by 7.5 points (p = 0.001; adjusted OR = 1.70; 95% CI 1.15-2.51). There were no significant changes in the 30-day readmission rate or length of stay. Conclusion A QI program shaped by Lean Six Sigma principles and reinforced by clinician huddles and geographic cohorting was associated with earlier posting of discharge orders and physical discharge by noon.

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Citations

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Research works printed but not linked: 16

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Metadata

Authors
Molla, M., Warren, D. S., Stewart, S. L., Stocking, J., Johl, H., & Sinigayan, V.
Affiliations
  • University of California Davis Medical Center (US)
  • University of California, Davis (US)
Corresponding author
Molla, Mithu
ORCID
Venue
The Joint Commission Journal on Quality and Patient Safety
Publisher
Elsevier BV
Published
2018-07
Volume
44
Issue
7
Pages
401-412
ISSN
1553-7250 (ISSN-L)
DOI
10.1016/j.jcjq.2018.02.006
OpenAlex
W2807029137
Cited by
67
References
2
Citations by year
2026: 2 · 2025: 6 · 2024: 9 · 2023: 4 · 2022: 20 · 2021: 13 · 2020: 9 · 2019: 4
FWCI
9.64
Type
journal article
Language
en
Open access
Licence
Locations
  • The Joint Commission Journal on Quality and Patient Safety (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
University of California, Davis
Topics
  • Social Sciences › Decision Sciences › Management Science and Operations Research › Healthcare Operations and Scheduling Optimization
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Quality and Management
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
Keywords
Lean Six Sigma, hospital overcrowding, hospital bed capacity, discharge orders, internists, quality improvement, 30-day readmission, length of hospital stay
MeSH terms
Academic Medical Centers, Adult, Age Factors, Aged, Aged, 80 and over, Bed Occupancy, Continuity of Patient Care, Female, Humans, Length of Stay, Male, Middle Aged, Patient Discharge, Sex Factors, Socioeconomic Factors, Time Factors, Trauma Severity Indices, Efficiency, Organizational, Total Quality Management, Quality Improvement, Root Cause Analysis

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