Reducing discharge delays: using DMAIC approach in a tertiary care hospital
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20252848Keywords:
Discharge time, DMAIC, Healthcare efficiency, Patient satisfaction, Quality improvementAbstract
Background: Efficient hospital discharge processes are crucial for enhancing patient satisfaction, ensuring bed availability, and reducing healthcare costs. However, the complexity of discharge procedures often leads to delays that frustrate patients and hinder overall hospital efficiency. This study aimed to improve discharge time in a tertiary care hospital by applying the define, measure, analyze, improve, and control (DMAIC) technique.
Methods: A cross-sectional study was conducted on 1000 patients discharged from a tertiary care hospital in north India. Data was collected using a researcher-developed questionnaire validated through a pilot study. The DMAIC approach was applied to analyze the discharge process, identify bottlenecks, and implement targeted interventions. Pre- and post-intervention discharge times were compared to assess the effectiveness of the improvements.
Results: Pre-intervention analysis revealed significant delays in receiving discharge summaries (235.29±78.36 minutes) and obtaining clearances under various healthcare financing schemes, particularly Ayushman Bharat (436.46±451.30 minutes). Post-intervention, the average time to receive discharge summaries reduced to 72.55±42.46 minutes, and Ayushman clearances improved to 162.65±95.162 minutes. The total discharge time decreased from a mean of 329.16±389.31 minutes to 208.11±122.87 minutes. Patient satisfaction with the discharge process increased, with 88.8% rating their experience as either “excellent” or “good” post-intervention.
Conclusions: The application of the DMAIC technique led to significant improvements in hospital discharge time and patient satisfaction. The study demonstrated the effectiveness of systematic process improvement approaches in healthcare settings. Continuous monitoring and improvement efforts are necessary to sustain and further enhance these gains.
Metrics
References
Institute for Healthcare Improvement. Reducing Patient Flow Delays. Boston: IHI; 2020.
Joint Commission on Accreditation of Healthcare Organizations. Improving Patient Flow and Reducing Emergency Department Crowding. Oakbrook Terrace: JCAHO; 2019.
McKenna P, Heslin SM, Viccellio P, Mallon WK, Hernandez C, Morley EJ. Emergency department and hospital crowding: causes, consequences, and cures. Clin Exp Emerg Med. 2019;6(3):189. DOI: https://doi.org/10.15441/ceem.18.022
Albliwi SA, Antony J, Lim SA. A systematic review of Lean Six Sigma for the manufacturing industry. Business Process Manage J. 2015;21(3):665-91. DOI: https://doi.org/10.1108/BPMJ-03-2014-0019
Vijay S. Reducing and optimizing the cycle time of patients discharge process in a hospital using six sigma DMAIC approach. Int J Qual Res. 2014;8(2):169-82.
Improta G, Balato G, Romano M, Carpentieri F, Bifulco P, Alessandro Russo M, et al. L ean S ix S igma: a new approach to the management of patients undergoing prosthetic hip replacement surgery. J Eval Clin Pract. 2015;21(4):662-72. DOI: https://doi.org/10.1111/jep.12361
Fazaeli S, Yousefi M, Dokht MS, Heidarian H. Implementation of six sigma method to improve hospital discharge process: a before-and-after study with the control group in a large hospital. Res Square. 2021. DOI: https://doi.org/10.21203/rs.3.rs-731820/v1
DelliFraine JL, Langabeer JR 2nd, Nembhard IM. Assessing the evidence of Six Sigma and Lean in the health care industry. Qual Manag Health Care. 2010;19(3):211-25. DOI: https://doi.org/10.1097/QMH.0b013e3181eb140e
National Health Authority. Ayushman Bharat Digital Mission: Strategy Overview. New Delhi: Government of India; 2021.
Garg P, Gupta A, Sharma K. Application of lean six sigma in indian healthcare: a critical review. Int J Healthc Manag. 2021;14(4):1204-14.
Sunder MV, Mahalingam S, Krishna MS. Improving patients’ satisfaction in a mobile hospital using lean six sigma- a design-thinking intervention. Prod Plan Control. 2020;31(6):512-26. DOI: https://doi.org/10.1080/09537287.2019.1654628
Angell BJ, Prinja S, Gupt A, Jha V, Jan S. The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana and the path to universal health coverage in India: overcoming the challenges of stewardship and governance. PLoS Med. 2019;16(3):e1002759. DOI: https://doi.org/10.1371/journal.pmed.1002759
Keller AC, Bergman MM, Heinzmann C, Todorov A, Weber H, Heberer M. The relationship between hospital patients rating of quality care and communication. Int J Qual Health Care. 2014;26(1):26-33. DOI: https://doi.org/10.1093/intqhc/mzt083
Arafeh M, Barghash MA, Sallam E, AlSamhouri AJ. Six sigma applied to reduce patients’ waiting time in a cancer pharmacy. Int J Six Sigma Compet Advan. 2014;8(2):105-24. DOI: https://doi.org/10.1504/IJSSCA.2014.064256
Ricciardi C, Fiorillo A, Valente AS, Borrelli A, Verdoliva C, Triassi M, et al. Lean six sigma approach to reduce LOS through a diagnostic-therapeutic-assistance path at AORNA Cardarelli. TQM J. 2019;31(5):657-72. DOI: https://doi.org/10.1108/TQM-02-2019-0065
Inal TC, Goruroglu Ozturk O, Kibar F, Cetiner S, Matyar S, Daglioglu G, et al. Lean six sigma methodologies improve clinical laboratory efficiency and reduce turnaround times. J Clin Lab Anal. 2018;32(1):e22180. DOI: https://doi.org/10.1002/jcla.22180
D’Andreamatteo A, Ianni L, Lega F, Sargiacomo M. Lean in healthcare: a comprehensive review. Health Polic. 2015;119(9):1197-209. DOI: https://doi.org/10.1016/j.healthpol.2015.02.002
Vest JR, Gamm LD. A critical review of the research literature on six sigma, lean and StuderGroup’s hardwiring excellence in the United States: the need to demonstrate and communicate the effectiveness of transformation strategies in healthcare. Implement Sci. 2009;4:35. DOI: https://doi.org/10.1186/1748-5908-4-35
Scott Kruse C, Karem P, Shifflett K, Vegi L, Ravi K, Brooks M. Evaluating barriers to adopting telemedicine worldwide: a systematic review. Journal of telemedicine and telecare. 2018;24(1):4-12. DOI: https://doi.org/10.1177/1357633X16674087
Prinja S, Chauhan AS, Karan A, Kaur G, Kumar R. Impact of publicly financed health insurance schemes on healthcare utilization and financial risk protection in India: a systematic review. PloS One. 2017;12(2):e0170996. DOI: https://doi.org/10.1371/journal.pone.0170996
National Sample Survey Office. Key Indicators of Social Consumption in India: Health, NSS 75th Round. New Delhi: Government of India; 2019.
Hooda SK. Out-of-pocket payments for healthcare in India: who pays, who does not and why? J Health Manag. 2020;22(1):1-16. DOI: https://doi.org/10.1177/0972063416682535
Powell AA, White KM, Partin MR, Halek K, Christianson JB, Neil B, et al. Unintended consequences of implementing a national performance measurement system into local practice. J Gen Intern Med. 2012;27(4):405-12. DOI: https://doi.org/10.1007/s11606-011-1906-3
Campanella P, Lovato E, Marone C, Fallacara L, Mancuso A, Ricciardi W, et al. The impact of electronic health records on healthcare quality: a systematic review and meta-analysis. Eur J Public Health. 2016;26(1):60-4. DOI: https://doi.org/10.1093/eurpub/ckv122
Singh K, Drotz E, Eriksson H. Improvement work in healthcare: understanding the concepts. Int J Health Care Qual Assur. 2021;34(1):1-12. DOI: https://doi.org/10.1108/IJHCQA-03-2021-0054
Reed JE, Card AJ. The problem with plan-do-study-act cycles. BMJ Qual Saf. 2016;25(3):147-52. DOI: https://doi.org/10.1136/bmjqs-2015-005076