title: Reducing liver transplant length of stay: a Lean Six Sigma approach.
abstract: BACKGROUND
  Organ transplant centers are under increasing scrutiny to maintain outcomes while controlling cost in a challenging population of patients. Throughout health care and transplant specifically, length of stay is used as a benchmark for both quality and resource utilization.
  
  
  OBJECTIVE
  To decrease our length of stay for liver transplant by using Lean Six Sigma methods.
  
  
  METHODS
  The Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) method was used to systematically analyze our process from transplant listing to hospital discharge after transplant, identifying many factors affecting length of stay.
  
  
  METHODS
  Adult, single-organ, primary liver transplant recipients between July 2008 and June 2012 were included in the study. Recipients with living donors or fulminant liver failure were excluded.
  
  
  METHODS
  Multiple interventions, including a clinical pathway and enhanced communication, were implemented.
  
  
  METHODS
  Length of stay after liver transplant and readmission after liver transplant.R ESULTS: Median length of stay decreased significantly from 11 days before the intervention to 8 days after the intervention. Readmission rate did not change throughout the study. The improved length of stay was maintained for 24 months after the study.
  
  
  CONCLUSIONS
  Using a Lean Six Sigma approach, we were able to significantly decrease the length of stay of liver transplant patients. These results brought our center's outcomes in accordance with our goal and industry benchmark of 8 days. Clear expectations, improved teamwork, and a multidisciplinary clinical pathway were key elements in achieving and maintaining these gains.
authors: University of North Carolina Health Care, Chapel Hill.
authors: Alexander H
authors: AH
authors: Toledo
authors: Tracy
authors: T
authors: Carroll
authors: Emily
authors: E
authors: Arnold
authors: Zeynep
authors: Z
authors: Tulu
authors: Tom
authors: T
authors: Caffey
authors: Lauren E
authors: LE
authors: Kearns
authors: David A
authors: DA
authors: Gerber
mesh_terms: D000328:Adult; D019985:Benchmarking; D003363:Cost Control; D019091:Critical Pathways; D006801:Humans; D007902:Length of Stay; D016031:Liver Transplantation; D010865:Pilot Projects; D011182:Postoperative Care / Q000191:economics / Q000379:methods*; D017064:Process Assessment, Health Care / Q000379:methods*; D011446:Prospective Studies; D014481:United States