Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Deployment of Lean Six Sigma in Care Coordination: An Improved Discharge Process

Breslin, Susan Ellen DNP, RN, NE-BC; Hamilton, Karen Marie PhD, RN; Paynter, Jacquelyn MPH, RN

doi: 10.1097/NCM.0000000000000016

Purpose/Objectives: This article presents a quality improvement project to reduce readmissions in the Medicare population related to heart failure, acute myocardial infarction, and pneumonia. The article describes a systematic approach to the discharge process aimed at improving transitions of care from hospital to post–acute care, utilizing Lean Six Sigma methodology.

Primary Practice Setting: Inpatient acute care hospital.

Findings/Conclusions: A coordinated discharge process, which includes postdischarge follow-up, can reduce avoidable readmissions.

Implications for Case Management: The quality improvement project demonstrated the significant role case management plays in preventing costly readmissions and improving outcomes for patients through better transitions of care from the hospital to the community. By utilizing Lean Six Sigma methodology, hospitals can focus on eliminating waste in their current processes and build more sustainable improvements to deliver a safe, quality, discharge process for their patients. Case managers are leading this effort to improve care transitions and assure a smoother transition into the community postdischarge.

Susan Ellen Breslin, DNP, RN, NE-BC, is a health care professional and Nurse Executive with greater than 25 years of experience in operations and patient care. Dr. Breslin has her master of science in nursing from University of Cincinnati, her bachelor of science in nursing from George Mason University and has her Doctor of Nursing Practice from University of South Alabama. Susan is Board Certified in Nursing Administration with the American Nurses Association.

Karen Marie Hamilton, PhD, RN, is Clinical Associate Professor at the University of South Alabama College of Nursing. Dr. Hamilton's role includes Doctor of Nursing Practice advisor in the public health track and instructor in the Public Health Nursing Administration graduate program. Other areas of specialty include research and school health. She is an active member of the nursing Honor Society, Sigma Theta Tau International, and served as President of Zeta Gamma Chapter 2010–2012.

Jacquelyn Paynter, MPH, RN, Executive Director of Care Management at DeKalb Medical, oversees utilization management, discharge planning, and population-based programs. As a Certified Lean Six Sigma Green Belt, Jackie has facilitated throughput and care coordination Lean projects.

Address correspondence to Susan Ellen Breslin, DNP, RN, NE-BC, Patient Care Services & CNO, DeKalb Regional Health System, 2701 North Decatur Road, Decatur, GA 30033 (

The authors report no conflicts of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.