title: Quality in trauma care: improving the discharge procedure of patients by means of Lean Six Sigma.
abstract: BACKGROUND
  The University Medical Center Groningen is a level I trauma center in the northern part of the Netherlands. Sixty-three percent of all the patients admitted at the Trauma Nursing Department (TND) are acute patients who are admitted directly after trauma. In 2006 and 2007, the University Medical Center Groningen was not always capable of admitting all trauma patients to the TND due to the relatively high-bed occupation. Therefore, the reduction of the average length of stay (LOS) formed the objective of the project described in this study.
  
  
  METHODS
  We used the process-focused method of Lean Six Sigma to reduce hospital stay by improving the discharge procedure of patients in the care processes and eliminating waste and waiting time. We used the "Dutch Appropriateness Evaluation Protocol" to identify the possible causes of inappropriate hospital stay. The average LOS of trauma patients at the TND at the beginning of the project was 10.4 days.
  
  
  RESULTS
  Thirty percent of the LOS was unnecessary. The main causes of the inappropriate hospital stay were delays in several areas. The implementation of the improvement plan reduced almost 50% of the inappropriate hospital stay, enabling the trauma center to admit almost all trauma patients to the TND. After the implementation of the improvements, the average LOS was 8.5 days.
  
  
  CONCLUSIONS
  Our study shows that Lean Six Sigma is an effective method to reduce inappropriate hospital stay, thereby improving the quality and financial efficiency of trauma care.
authors.affiliation: Department of Traumatology, University Medical Center Groningen, Groningen, The Netherlands. g.c.niemeijer@chir.umcg.nl
authors.forename: Gerard C
authors.initials: GC
authors.lastname: Niemeijer
authors.forename: Albert
authors.initials: A
authors.lastname: Trip
authors.forename: Kees T B
authors.initials: KT
authors.lastname: Ahaus
authors.forename: Ronald J M M
authors.initials: RJ
authors.lastname: Does
authors.forename: Klaus W
authors.initials: KW
authors.lastname: Wendt
mesh_terms: D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care / Q000592:standards / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000592:standards*; D011787:Quality of Health Care / Q000458:organization & administration; D014193:Trauma Centers / Q000592:standards*