title: Applying industrial process improvement techniques to increase efficiency in a surgical practice.
abstract: OBJECTIVE
  The goal of this study was to examine how industrial process improvement techniques could help streamline the preoperative workup.
  
  
  METHODS
  Lean process improvement was used to streamline patient workup at an endocrine surgery service at a tertiary medical center utilizing multidisciplinary collaboration. The program consisted of several major changes in how patients are processed in the department. The goal was to shorten the wait time between initial call and consult visit and between consult and surgery.
  
  
  RESULTS
  We enrolled 1,438 patients enrolled in the program. The wait time from the initial call until consult was reduced from 18.3 ± 0.7 to 15.4 ± 0.9 days. Wait time from consult until operation was reduced from 39.9 ± 1.5 to 33.9 ± 1.3 days for the overall practice and to 15.0 ± 4.8 days for low-risk patients. Patient cancellations were reduced from 27.9 ± 2.4% to 17.3 ± 2.5%. Overall patient flow increased from 30.9 ± 5.1 to 52.4 ± 5.8 consults per month (all P < .01).
  
  
  CONCLUSIONS
  Utilizing process improvement methodology, surgery patients can benefit from an improved, streamlined process with significant reduction in wait time from call to initial consult and initial consult to surgery, with reduced cancellations. This generalized process has resulted in increased practice throughput and efficiency and is applicable to any surgery practice.
authors.affiliation: Endocrine Surgery Department at the Cleveland Clinic, Cleveland, OH. Electronic address: reznicd@ccf.org.
authors.forename: David
authors.initials: D
authors.lastname: Reznick
authors.affiliation: Endocrine Surgery Department at the Cleveland Clinic, Cleveland, OH.
authors.forename: Lora
authors.initials: L
authors.lastname: Niazov
authors.affiliation: Endocrine Surgery Department at the Cleveland Clinic, Cleveland, OH.
authors.forename: Eric
authors.initials: E
authors.lastname: Holizna
authors.affiliation: Endocrine Surgery Department at the Cleveland Clinic, Cleveland, OH.
authors.forename: Allan
authors.initials: A
authors.lastname: Siperstein
mesh_terms: D017598:Efficiency, Organizational; D004704:Endocrinology / Q000458:organization & administration*; D006801:Humans; D009820:Ohio; D010043:Outcome and Process Assessment, Health Care; D011300:Preoperative Care / Q000379:methods / Q000592:standards; D058996:Quality Improvement / Q000458:organization & administration*; D013043:Specialties, Surgical / Q000458:organization & administration*; D062606:Tertiary Care Centers / Q000458:organization & administration*; D013997:Time Factors