title: Structured syncope care pathways based on lean six sigma methodology optimises resource use with shorter time to diagnosis and increased diagnostic yield.
abstract: OBJECTIVE
  To conduct a pilot study on the potential to optimise care pathways in syncope/Transient Loss of Consciousness management by using Lean Six Sigma methodology while maintaining compliance with ESC and/or NICE guidelines.
  
  
  METHODS
  Five hospitals in four European countries took part. The Lean Six Sigma methodology consisted of 3 phases: 1) Assessment phase, in which baseline performance was mapped in each centre, processes were evaluated and a new operational model was developed with an improvement plan that included best practices and change management; 2) Improvement phase, in which optimisation pathways and standardised best practice tools and forms were developed and implemented. Staff were trained on new processes and change-management support provided; 3) Sustaining phase, which included support, refinement of tools and metrics. The impact of the implementation of new pathways was evaluated on number of tests performed, diagnostic yield, time to diagnosis and compliance with guidelines. One hospital with focus on geriatric populations was analysed separately from the other four.
  
  
  RESULTS
  With the new pathways, there was a 59% reduction in the average time to diagnosis (p = 0.048) and a 75% increase in diagnostic yield (p = 0.007). There was a marked reduction in repetitions of diagnostic tests and improved prioritisation of indicated tests.
  
  
  CONCLUSIONS
  Applying a structured Lean Six Sigma based methodology to pathways for syncope management has the potential to improve time to diagnosis and diagnostic yield.
authors.affiliation: Medtronic Hospital Solutions, Heerlen, The Netherlands.
authors.forename: Leon
authors.initials: L
authors.lastname: Martens
authors.affiliation: Blackpool Victoria Hospital, Blackpool, United Kingdom.
authors.forename: Grahame
authors.initials: G
authors.lastname: Goode
authors.affiliation: Medical Center Alkmaar, Alkmaar, The Netherlands.
authors.forename: Johan F H
authors.initials: JF
authors.lastname: Wold
authors.affiliation: Centre Hospitalier Universitaire Carémeau, Nîmes, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Beck
authors.affiliation: Northern General/Royal Hallamshire Hospital, Sheffield, United Kingdom.
authors.forename: Georgina
authors.initials: G
authors.lastname: Martin
authors.affiliation: St. Marien Hospital, Lünen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Perings
authors.affiliation: MagliaRotta, Basel, Switzerland.
authors.forename: Pelle
authors.initials: P
authors.lastname: Stolt
authors.affiliation: Medtronic Hospital Solutions, Heerlen, The Netherlands.
authors.forename: Lucas
authors.initials: L
authors.lastname: Baggerman
mesh_terms: D003422:Critical Care / Q000379:methods / Q000458:organization & administration / Q000592:standards; D019091:Critical Pathways / Q000458:organization & administration* / Q000592:standards; D042241:Early Diagnosis; D017598:Efficiency, Organizational; D005060:Europe; D019983:Guideline Adherence / Q000592:standards; D006295:Health Resources / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D033183:Interdisciplinary Communication; D010865:Pilot Projects; D058996:Quality Improvement / Q000458:organization & administration* / Q000592:standards; D013575:Syncope / Q000175:diagnosis / Q000628:therapy*; D013997:Time Factors