Implementation of Six Sigma Method To Improve Hospital Discharge Process: A Before-And- After Study With The Control Group In A Large Hospital

Abstract Background: Delayed hospital discharge is a complex process that can impact hospital and service delivery capacity. The improvement of this process requires structural reforms and coordination with different wards, individuals, and the hospital.The present study aimed to use the Six Sigma method to reduce hospital discharge time. Methods: This pre-post study was conducted based on an experimental design from 2016 to 2020. A series of Six Sigma-driven interventions based on the Define-Measure-Analyze-Improve-Control (DMAIC) cycle was employed in a 1,000 bed tertiary care hospital to decrease discharge waiting time. Two wards in the hospital were allocated to the intervention and control groups. Three months of pre-intervention data were compared with 16 months of post-intervention in each group. The data were analyzed in Stata software (version 14.1). The level of statistical significance was set at 0.000.Results: There was a significant difference (P<0.000) between pre and post-intervention, as well as experimental and control groups. The discharge time points in the intervention and control groups before the intervention were reported as 438 and 411 min, respectively. After the intervention, the discharge time reached 246 min (3.20 h decrease) in the intervention group (P<0.000) and 475 min in the control group (P<0.574). The waiting time in stations 2, 3, and 4 reached zero after the intervention(P<0.000). The trend of discharge time after the intervention from October 2017 to March 2020 demonstrated that the changes were stable (184±25.56 min).Conclusions: As evidenced by the obtained results, the Six Sigma methodology can be an effective change management tool for the improvement of discharge time. The findings suggested that the use of electronic discharge and focusing on physician readiness for writing a discharge order would have the greatest impact.

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Implementation of Electronic Patient Discharge: A Successful Strategy to Increase Hospital Bed Capacity During the COVID-19 Pandemic

10.32592/ircmj.2021.23.12.1505 ◽

2021 ◽

Keyword(s):

Six Sigma ◽

Patient Discharge ◽

Management Tool ◽

Discharge Process ◽

Care Hospital ◽

Discharge Time ◽

Post Intervention ◽

Hospital Bed Capacity ◽

Hospital Bed ◽

Bed Capacity

Background: The ongoing COVID-19 pandemic increased the need for inpatient beds, indicating the need for hospitals to increase the efficiency of beds. Objectives: This study aimed to increase hospital bed capacity using the implementation of Electronic Patient Discharge (EPD). Methods: This qualitative-quantitative study was conducted in a tertiary care hospital using the pre-and post-intervention designs, and the main outcome was patient discharge time. By applying the Six Sigma model, including definition, measurement, analysis, improvement, and control, the patient discharge process was assessed and improved by some interventions such as EPD. All hospitalized patients with COVID-19 from 21 March 2020 to 22 July 2021 were examined for the post-intervention. In addition, data were collected from the hospital information system (HIS). Results: By the use of EPD, patient discharge time decreased to 47.70% (from 10.19 h to 5.33 h) (P < 0.000). According to the Sigma level, the yield and defects per million opportunities of the discharge process also increased to 55%. Conclusion: Six Sigma methodology can be an effective change management tool to improve discharge time to cover the demand created during pandemics. According to the results of the present study and the obtained saved time, one bed is added to the hospital capacity for every five discharges.

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Strengthening Hospital Capacity for the COVID-19 Pandemic: Implementation of Electronic Patient Discharge

Journal of Research and Health ◽

10.32598/jrh.11.5.1802.1 ◽

2021 ◽

Vol 11 (5) ◽

pp. 305-312

Author(s):

Mohaddeseh Sabethosseini Dokht ◽

◽

Mehdi Yousefi ◽

Hamid Hedarian Miri ◽

Somayeh Fazaeli ◽

...

Keyword(s):

Six Sigma ◽

Sigma Model ◽

Low Cost ◽

Patient Discharge ◽

Discharge Process ◽

Discharge Time ◽

Post Intervention ◽

Hospital Capacity ◽

Sigma Level ◽

And Control

Background: Increasing hospital capacity to cover the service demands is an important priority during an epidemic or a pandemic. The aim of this study was to increase hospital capacity using the Six Sigma method to improve the patient discharge process. Methods: This was a quantitative study. The Pre- and post-intervention study was conducted in a big hospital designated for COVID-19 patients. The patient discharge process was evaluated and improved based on seven sub-processes and following the Six Sigma model, including defining the problem, measuring time in each of the discharge stations, analysis times and process, improvement process, and control. Results: Implementation of the electronic patient discharge led to a 51.9% decrease in discharge time from 7.3 h during the pre-intervention period to 3.8 h post-intervention (P< 0.0001). According to the Sigma level, the yield and defects per million opportunities of the discharge process also improved to 55%. Conclusion: Increasing hospital capacity by improving the discharge time is a quick action to cover the demand created during pandemics. Also, about 32 beds can be obtained by applying the Six Sigma model to improve the discharge process in a short time and at a very low cost.

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Challenges and results of a school-based intervention to manage excess weight among school children in Tunisia 2012–2014

International Journal of Adolescent Medicine and Health ◽

10.1515/ijamh-2015-0035 ◽

2017 ◽

Vol 29 (2) ◽

Cited By ~ 3

Author(s):

Jihen Maatoug ◽

Sihem Ben Fredj ◽

Zeineb Msakni ◽

Emna Dendana ◽

Jihene Sahli ◽

...

Keyword(s):

School Children ◽

The Body ◽

Calorie Intake ◽

Control Group ◽

Control Groups ◽

Post Intervention ◽

School Based ◽

Increased Risk ◽

And Control

Abstract Background: Obesity is a serious health issue and predisposes individuals to an increased risk of morbidity and mortality. Its prevalence in children has increased worldwide. Objective: To demonstrate the feasibility and effectiveness of a school-based management program based on healthy lifestyle promotion for obese and overweight adolescents in Sousse, Tunisia. Methods: We conducted a quasi-experimental study among overweight and obese school children enrolled in 7th and 8th grades in Sousse, Tunisia with two groups, intervention and control. The 1-year intervention was based on promoting healthy eating and physical activity through a collective intervention for all recruited children and an individual intervention only for obese children who require intensive managing. Data collection was done before, at the end and at a 4-month follow up of the intervention, both in intervention and control groups. Results: The body mass index Z score decreased significantly from pre-intervention to post-intervention (1.89±0.57 to 1.76±0.63, p<0.001) and from post-intervention to the follow-up (1.76±0.63 to 1.55±0.68, p<0.001) in the intervention group. In the control group, it decreased significantly from pre-intervention to post-intervention but not significantly from post-intervention to follow-up assessment. Calorie intake decreased significantly both in intervention and control groups. Conclusion: This project began with introducing a new culture of health management in schools on one side and with increasing awareness of the importance of obesity prevention and treatment. The support of authorities for this type of action is very important to guarantee its sustainability.

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Effects of vibration on chronic leg edema in chair-bound older adults: A randomized pilot trial

10.21203/rs.3.rs-54743/v1 ◽

2020 ◽

Author(s):

Sayumi Tsuchiya ◽

Aya Sato ◽

Terumi Ueda ◽

Misako Dai ◽

Mayumi Okuwa ◽

...

Keyword(s):

Pilot Trial ◽

Intervention Group ◽

Nursing Home Residents ◽

Interquartile Range ◽

Control Group ◽

Control Groups ◽

Post Intervention ◽

Leg Edema ◽

Clinical Trials Registry ◽

And Control

Abstract BackgroundElderly individuals can easily develop leg edema that can become chronic, which may result in various problems. Therefore, appropriate care for the edema should be provided. In some cases, chronic leg edema among elderly individuals cannot be controlled by the standard care such as leg elevation or compression. A previous study reported that vibration benefited upper limb lymphedema; however, its effects on chronic leg edema are not yet clarified. Therefore, this study aimed to clarify the effects of vibration for reducing chronic leg edema among chair-bound elderly individuals.MethodsFor participant allocation, a computer-generated list of random numbers was used. Nursing home residents aged ≥65 years with chronic leg edema who spent more time sitting than standing or lying during the day were randomly assigned to the intervention (n = 7) or control group (n = 7). The intervention group underwent vibration therapy three times a day for 2 weeks at 47 Hz and 1.78 m/s2 frequency and horizontal vibration acceleration, respectively. The pitting test was performed at 22 sites, and participants’ pitting scores were calculated based on the pitting depth. Pitting score changes at pre- and post-intervention were compared between the intervention and control groups. Both participants and investigators were not blinded to group assignment.ResultsThe median age of the intervention and control groups was 86 and 84 years, respectively. Participants’ characteristics and edema severity at baseline were not significantly different. The median total pitting score change in the intervention group was −0.4 (interquartile range: −5.3–1.8), which was significantly lower than that of the control group (2.0 [interquartile range: 1.0－5.3], P = 0.01). The intervention group was more likely to have controlled edema (64.3%) than the control group (21.4%) (χ2 (1) = 5.25, P = 0.02).ConclusionsThe intervention group was more likely to have controlled edema than the control group, suggesting that vibration could prevent the worsening of chronic leg edema in chair-bound elderly individuals.Trial registration: UMIN Clinical Trials Registry, UMIN000017716. Registered 1 July 2015, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000020522

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A pilot study to determine the feasibility of a cluster randomised controlled trial of an intervention to change peer attitudes towards children who stutter

South African Journal of Communication Disorders ◽

10.4102/sajcd.v65i1.583 ◽

2018 ◽

Vol 65 (1) ◽

Author(s):

Rizwana B. Mallick ◽

Lehana Thabane ◽

A.S.M. Borhan ◽

Harsha Kathard

Keyword(s):

Pilot Study ◽

Treatment Effect ◽

Dropout Rate ◽

Control Group ◽

Control Groups ◽

Post Intervention ◽

Peer Attitudes ◽

Significant Difference ◽

Randomised Controlled ◽

And Control

Background: While randomised controlled trials (RCTs) are considered the gold standard of research, prior study is needed to determine the feasibility of a future large-scale RCT study. Objectives: This pilot study, therefore, aimed to determine feasibility of an RCT by exploring: (1) procedural issues and (2) treatment effect of the Classroom Communication Resource (CCR), an intervention for changing peer attitudes towards children who stutter. Method: A pilot cluster stratified RCT design was employed whereby the recruitment took place first at school-level and then at individual level. The dropout rate was reported at baseline, 1 and 6 months post-intervention. For treatment effect, schools were the unit of randomisation and were randomised to receive either the CCR intervention administered by teachers or usual practice, using a 1:1 allocation ratio. The stuttering resource outcomes measure (SROM) measured treatment effect at baseline, 1 and 6 months post-intervention overall and within the constructs (positive social distance, social pressure and verbal interaction). Results: For school recruitment, 11 schools were invited to participate and 82% (n = 9) were recruited. Based on the school recruitment, N = 610 participants were eligible for this study while only n = 449 were recruited, where there was n = 183 in the intervention group and n = 266 in the control group. The dropout rate from recruitment to baseline was as follows: intervention, 23% (n = 34), and control, 6% (n = 15). At 1 month a dropout rate of 7% (n = 10) was noted in the intervention and 6% (n = 15) in the control group, whereas at 6 months, dropout rates of 7% (n = 10) and 17% (n = 44) were found in the intervention and control groups, respectively. For treatment effect on the SROM, the estimated mean differences between intervention and control groups were (95% Confidence Interval (CI): -1.07, 5.11) at 1 month and 3.01 (95% CI: -0.69, 6.69) at 6 months. A statistically significant difference was observed at 6 months on the VI subscale of the SROM, with 1.35 (95% CI: 0.58, 2.13). Conclusion: A high recruitment rate of schools and participants was observed with a high dropout rate of participants. Significant differences were only noted at 6 months post-intervention within one of the constructs of the SROM. These findings suggest that a future RCT study is warranted and feasible.

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The Effect of Lymphoedema Exercises and Foot Elevation on the Quality of Life of Patients with Elephantiasis

Journal of Tropical Medicine ◽

10.1155/2020/6309630 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Emirensiana Watu ◽

Supargiyono ◽

Haryani

Keyword(s):

Quality Of Life ◽

Intervention Group ◽

Control Group ◽

Cluster Sampling ◽

Control Groups ◽

Post Intervention ◽

Before And After ◽

And Control ◽

Pitting Edema

Filariasis is a chronic infectious disease caused by filarial worms. Swelling in the legs in patients with filariasis can result in a significantly lower quality of life. The recommended treatments for patients who experience swelling or lymphoedema are lymphoedema exercises and foot elevation. This research is a quantitative study with a quasi-experimental design including pre- and posttreatment tests with a control group. This study used a cluster sampling method, which is a nonprobability sampling technique. The samples in this study were 48 respondents divided into two groups: 24 respondents from the Nebe Village comprising the intervention group and 24 respondents from the Bangkoor Village comprising the control group. The intervention group conducted lymphoedema exercises and foot elevation three times a week for 15–20 min for 1 month and measured their quality of life using the LFSQQ questionnaire. Measurements of pitting edema and ankle diameter were also carried out. Paired t-test revealed an improvement in the quality of life between pretest and posttest in the intervention and control groups (p=0.001). The quality of life in the pre-post intervention group improved from 67.42 to 81.58. In addition, the quality of life in the pre-post control group only improved from 62.50 to 72.58. The level of pitting edema decreased from severe (+++) to moderate (++) and from mild (+) to normal (0), and there was no difference in ankle diameter in each group (p=1.000). The quality of life improved before and after the administration of lymphoedema exercises and foot elevation for each group. Pitting edema decreased before and after lymphoedema exercises and foot elevation for each group. There was no decrease in ankle diameter after lymphoedema exercises and foot elevation in the intervention and control groups.

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Effectiveness of a virtual-reality anti-stigma application to reduce the stigma of depression: a randomized controlled trial (Preprint)

10.2196/preprints.28072 ◽

2021 ◽

Author(s):

Wey Guan Lem ◽

Ayako Kohyama-Koganeya ◽

Toki Saito ◽

Hiroshi Oyama

Keyword(s):

Virtual Reality ◽

Medical Information ◽

Intervention Group ◽

University Hospital ◽

Control Group ◽

Public Stigma ◽

Control Groups ◽

Post Intervention ◽

Significant Difference ◽

And Control

BACKGROUND Public stigma against depression contributes to low employment rates among individuals with depression and self-stigmatization of people with depression. Contact-based educational (CBE) interventions, either using in-person contact or video-based contact, have been shown to reduce stigma against mental illness effectively. In-person contacts can stimulate empathy in participants but are challenging to arrange, while video-based contact is cost-effective but encounters difficulty stimulating empathy towards the patient. In this paper, we examined the usefulness of the virtual-reality anti-stigma (VRAS) application to reduce public stigma. OBJECTIVE To develop and evaluate a VRAS application that could provide CBE intervention without using real patients. METHODS Sixteen medical students were recruited and randomized 1:1 to intervention and control groups. Participants in the intervention group (VRAS group) used the VRAS application, while those in the control group watched video material on depression. Participants' depression stigma score was assessed using the Depression Stigma Scale (DSS) and Attitudinal Social Distance (ASD), both pre-and post-intervention. The feasibility of both the VRAS application and video, and the utility of the VRAS application was also evaluated post-intervention. RESULTS Feasibility score was significantly higher in the intervention group (mean 5.63, SD 0.74) than in the control group (mean 3.88, SD 1.73; P=.03). This result indicates that the VRAS application promoted an understanding of stigma in participants. However, no significant differences were apparent between the intervention and control groups for DSS (intervention: mean 35.13, SD 5.30; control: mean 35.38, SD 4.50; P=.92) or ASD (intervention: mean 12.25, SD 3.33; control: mean 11.25, SD 1.91; P=.92). Stigma scores tended to decrease, but the stigma-reducing effects of the VRAS application were not statistically significant for either DSS (pre: mean 33.00, SD 4.44; post: mean 35.13, SD 5.30; P=.12) or ASD (pre: mean 13.25, SD 3.92; post: mean 12.25, SD 3.33; P=.12). CONCLUSIONS No significant differences in mean DSS or ASD were seen between VRAS and control groups. However, one item in the feasibility score showed a significant difference, and feedback comments suggested that VRAS was effective in educating about the stigma of depression. CLINICALTRIAL University hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) UMIN000043020; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000049109

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Convalescent plasma for patients with severe COVID-19: a matched cohort study

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1548 ◽

2020 ◽

Cited By ~ 3

Author(s):

Ralph Rogers ◽

Fadi Shehadeh ◽

Evangelia K Mylona ◽

Josiah Rich ◽

Marguerite Neill ◽

...

Keyword(s):

Hospital Mortality ◽

Hospital Discharge ◽

Cohort Analysis ◽

Cox Proportional Hazards ◽

Control Group ◽

Matched Cohort ◽

Control Groups ◽

Significant Difference ◽

And Control ◽

The Impact

Abstract Background The efficacy of convalescent plasma (CP) for the treatment of COVID-19 remains unclear. Methods In a matched cohort analysis of hospitalized patients with severe COVID-19, the impact of CP treatment on in-hospital mortality was evaluated using univariate and multivariate Cox proportional-hazards models, and the impact of CP treatment on time to hospital discharge was assessed using a stratified log-rank analysis. Results 64 patients who received CP a median of 7 days after symptom onset were compared to a matched control group of 177 patients. The incidence of in-hospital mortality was 12.5% and 15.8% in the CP and control groups, respectively (p = 0.52). There was no significant difference in the risk of in-hospital mortality between the two groups (adjusted hazard ratio [aHR] 0.93, 95% confidence interval [CI] 0.39 – 2.20). The overall rate of hospital discharge was not significantly different between the two groups (rate ratio [RR] 1.28, 95% CI 0.91 – 1.81), although there was a significantly increased rate of hospital discharge among patients 65-years-old or greater who received CP (RR 1.86, 95% CI 1.03 – 3.36). There was a greater than expected frequency of transfusion reactions in the CP group (2.8% reaction rate observed per unit transfused). Conclusions We did not demonstrate a significant difference in risk of mortality or rate of hospital discharge between the CP and control groups. There was a signal for improved outcomes among the elderly, and further adequately powered randomized studies should target this subgroup when assessing the efficacy of CP treatment.

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A Dance Movement Psychotherapy Intervention for the Wellbeing of Children With an Autism Spectrum Disorder: A Pilot Intervention Study

Frontiers in Psychology ◽

10.3389/fpsyg.2021.588418 ◽

2021 ◽

Vol 12 ◽

Author(s):

Supritha Aithal ◽

Vicky Karkou ◽

Stergios Makris ◽

Themis Karaminis ◽

Joanne Powell

Keyword(s):

Autism Spectrum Disorder ◽

Intervention Group ◽

Autism Spectrum ◽

Control Group ◽

Control Groups ◽

Post Intervention ◽

Dance Movement ◽

Children With Asd ◽

The Social ◽

And Control

BackgroundSustaining the wellbeing for children with an autism spectrum disorder (ASD) can be highly demanding. Dance Movement Psychotherapy (DMP), a form of psychotherapy with a non-verbal character, may present as a relevant intervention option for this group of children.MethodsA protocol-based group DMP intervention was developed and implemented in two special educational needs schools in the North West of England. We aimed to investigate the effects of DMP on children with ASD using the Social Communication Questionnaire (SCQ) and Strengths and Difficulties Questionnaire (SDQ). Twenty-six children aged between 8 and 13 years (mean age = 10.65 years) with ASD were randomly allocated to DMP and a control group with standard care, following a crossover research design.ResultsResults showed no significant carryover or period effects for either the SCQ or SDQ (p > 0.05). A significant intervention effect was found only for SCQ (p = 0.005) but not for SDQ (p > 0.05). ANCOVAs were performed on the data before the crossover to test for differences in SCQ and SDQ scores between the DMP intervention and control groups while controlling for pre-intervention scores. Those in the DMP intervention group presented significantly lower SCQ scores following the intervention period than those in the control group (p = 0.001). No significant differences in post-intervention SDQ scores were found between DMP intervention and control groups (p = 0.2). However, minimal clinically important differences (MCID) were reached for both SCQ and SDQ measures before crossover for those in the DMP intervention group. Moreover, repeated measures ANOVAs performed on SCQ and SDQ measures following crossover were significant, with the change in both SCQ (p = 0.001) and SDQ (p = 0.009) pre-and post-intervention being significantly greater for those in the DMP intervention than the control group.ConclusionThe pilot DMP intervention has shown promising results on the social and emotional wellbeing of children with ASD irrespective of whether they preferred verbal or non-verbal mode of communication. Limitations and appropriateness of the research methods implemented in this study for their use in a large RCT are discussed in detail. Overall, our findings highlight the value of creative therapies for improving the lives of young vulnerable groups.

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Conjugated Linoleic Acid Causes a Marked Increase in Liver α-Tocopherol and Liver α-Tocopherol Transfer Protein in C57BL/6 J Mice

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000007 ◽

2010 ◽

Vol 80 (1) ◽

pp. 65-73 ◽

Cited By ~ 10

Author(s):

Pei-Min Chao ◽

Wan-Hsuan Chen ◽

Chun-Huei Liao ◽

Huey-Mei Shaw

Keyword(s):

Antioxidant Enzymes ◽

Linoleic Acid ◽

Conjugated Linoleic Acid ◽

Thiobarbituric Acid ◽

Control Group ◽

Thiobarbituric Acid Reactive Substances ◽

Control Groups ◽

Protein Levels ◽

Transfer Protein ◽

And Control

Conjugated linoleic acid (CLA) is a collective term for the positional and geometric isomers of a conjugated diene of linoleic acid (C18:2, n-6). The aims of the present study were to evaluate whether levels of hepatic α-tocopherol, α-tocopherol transfer protein (α-TTP), and antioxidant enzymes in mice were affected by a CLA-supplemented diet. C57BL/6 J mice were divided into the CLA and control groups, which were fed, respectively, a 5 % fat diet with or without 1 g/100 g of CLA (1:1 mixture of cis-9, trans-11 and trans-10, cis-12) for four weeks. α-Tocopherol levels in plasma and liver were significantly higher in the CLA group than in the control group. Liver α-TTP levels were also significantly increased in the CLA group, the α-TTP/β-actin ratio being 2.5-fold higher than that in control mice (p<0.01). Thiobarbituric acid-reactive substances were significantly decreased in the CLA group (p<0.01). There were no significant differences between the two groups in levels of three antioxidant enzymes (superoxide dismutase, glutathione peroxidase, and catalase). The accumulation of liver α-tocopherol seen with the CLA diet can be attributed to the antioxidant potential of CLA and the ability of α-TTP induction. The lack of changes in antioxidant enzyme protein levels and the reduced lipid peroxidation in the liver of CLA mice are due to α-tocopherol accumulation.

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