Research Article

Implementation of a Hip Fracture Care Pathway Using Lean Six Sigma Methodology in a Level I Trauma Center

Sayeed, Zain MD, MHA; Anoushiravani, Afshin MD; El-Othmani, Mouhanad MD; Barinaga, Gonzalo MD; Sayeed, Yousuf MD; Cagle, Paul Jr MD; Saleh, Khaled J. BSc, MD, MSc, FRCS (C), MHCM, CPE

Author Information

From the Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI (Dr. Z. Sayeed), Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, IL (Dr. Z. Sayeed), Resident Research Partnership–Division of Orthopaedics, John D. Dingle Veteran Affairs Medical Center, Detroit, MI (Dr. Z. Sayeed), Department of Orthopaedics, Albany Medical College, Albany, NY (Dr. Anoushiravani), New York University NYU Langone Medical Center, New York, NY (Dr. Anoushiravani), Department of Orthopaedics, Detroit Medical Center, Detroit, MI (Dr. El-Othmani), Division of Orthopaedics, Southern Illinois University, Carbondale, IL (Dr. Barinaga), New York Medical College, Department of Emergency Medicine, Metropolitan Hospital, New York, NY (Dr. Y. Sayeed), St. Luke's West and Mt. Sinai West, St Luke's Hospital, New York, NY (Dr. Cagle), and Division of Orthopaedics, John Dingle Veteran Affairs Medical Center, Detroit, MI, and College of Medicine, Michigan State University, East Lansing, MI and Saleh Medical Innovations, PLLC, Northville, MI (Dr. Saleh).

Correspondence to Dr. Saleh: [email protected]

Dr. Saleh or an immediate family member has received royalties from and is a member of a speakers' bureau or has made paid presentations on behalf of Aesculap/B.Braun; serves as a paid consultant to Aesculap/B.Braun and CareFusion; and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons and the American Orthopaedic Association. None of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Z. Sayeed, Dr. Anoushiravani, Dr. El-Othmani, Dr. Barinaga, Dr. Y. Sayeed, and Dr. Cagle.

Journal of the American Academy of Orthopaedic Surgeons 26(24):p 881-893, December 15, 2018. | DOI: 10.5435/JAAOS-D-16-00947

SDC

Abstract

Introduction:

The application of Lean Six Sigma (LSS) methodology with regard to hip fracture care remains unexamined. The aim of this study is to illustrate the application of LSS principles in the implementation of a hip fracture integrated care pathway (ICP).

Methods:

A multidisciplinary team at a level I trauma center formed a hip fracture ICP using LSS principles. An ICP aimed toward decreasing time to surgery to <48 hours was implemented in April 2012.

Results:

A total of 505 hip fracture patients met inclusion criteria. A total of 221 patients entered the preimplementation cohort, and 284 were incorporated in the postimplementation cohort. The percentage of patients who received surgical fixation beyond 48 hours significantly decreased (9.50% versus 4.23%; P = 0.01). Significantly more complications were detected in the postimplementation cohort (62.44% versus 80.10%; P < 0.01). The postimplementation cohort showed a significantly shorter length of stay (P = 0.02) and decreased hospital cost (P = 0.016).

Conclusion:

Our findings suggest that using LSS methods in an ICP at our institution resulted in markedly greater percentage of patients receiving surgical care within 48 hours, greater detection of complication, and reduced resource consumption.