Page 205 - Lean six sigma demystified

Chapter 5 Redu C ing d efe C t S with Six Sigm a 183

The following year they further reduced outages from 22,000 minutes down
to 11,000 minutes. This project avoided most of the Six Sigma tar pits.

Hospital Case Study

The Institute for Healthcare Improvement (ihi.org) estimates that prevent-
able physical harm to patients occurs 40,000 times a day in U.S. hospitals.
The Center for Disease Control and Prevention estimates that 2 million
people are affected by surgical site infections, drug reactions, and bedsores.
A total of 99,000 people die as a result of hospital-acquired infections.
Dr. Peter Pronovost at Johns Hopkins Hospital came up with a five-item
checklist that reduced catheter infections to zero in 77 Michigan hospitals.
The checklist included simple solutions like washing hands before touching
patients, clean patient’s skin with antiseptic, wear masks, caps and gowns,
and so on.
While infections are a problem, misuse of antibiotics can lead to other
problems.
Providence Saint Joseph Medical Center (PSJMC) found that nursing units
often failed to discontinue antibiotics within 24 hours of surgery end-time for
up to 1,000 patients per year. Failure to stop antibiotics can lead to adverse
reactions and increased medical costs.
PSJMC found that average stop time for antibiotics was 39 hours after sur-
gery. Only 25% of cases were compliant with guidelines. And there was no
standard process or protocol used in the nursing units. They also found that
orthopedic and colon surgeons had the highest noncompliance rates.

Countermeasures

• Revise order sets with support from surgeons.
• Identify applicable cases in the operating room.
• Automate discontinuation of antibiotics by the pharmacy at the 24th hour
for applicable cases.
• Add orange stickers to patient charts to visually identify the patients.
• Monitor compliance daily.

In a few months, compliance rose to 90% from 36% which generated $35,000
in savings.