title: Impact of lean six sigma process improvement methodology on cardiac catheterization laboratory efficiency.
abstract: BACKGROUND
  Operational inefficiencies are ubiquitous in several healthcare processes. To improve the operational efficiency of our catheterization laboratory (Cath Lab), we implemented a lean six sigma process improvement initiative, starting in June 2010. We aimed to study the impact of lean six sigma implementation on improving the efficiency and the patient throughput in our Cath Lab.
  
  
  METHODS
  All elective and urgent cardiac catheterization procedures including diagnostic coronary angiography, percutaneous coronary interventions, structural interventions and peripheral interventions performed between June 2009 and December 2012 were included in the study. Performance metrics utilized for analysis included turn-time, physician downtime, on-time patient arrival, on-time physician arrival, on-time start and manual sheath-pulls inside the Cath Lab.
  
  
  RESULTS
  After implementation of lean six sigma in the Cath Lab, we observed a significant improvement in turn-time, physician downtime, on-time patient arrival, on-time physician arrival, on-time start as well as sheath-pulls inside the Cath Lab. The percentage of cases with optimal turn-time increased from 43.6% in 2009 to 56.6% in 2012 (p-trend<0.001). Similarly, the percentage of cases with an aggregate on-time start increased from 41.7% in 2009 to 62.8% in 2012 (p-trend<0.001). In addition, the percentage of manual sheath-pulls performed in the Cath Lab decreased from 60.7% in 2009 to 22.7% in 2012 (p-trend<0.001).
  
  
  CONCLUSIONS
  The current longitudinal study illustrates the impact of successful implementation of a well-known process improvement initiative, lean six sigma, on improving and sustaining efficiency of our Cath Lab operation. After the successful implementation of this continuous quality improvement initiative, there was a significant improvement in the selected performance metrics namely turn-time, physician downtime, on-time patient arrival, on-time physician arrival, on-time start as well as sheath-pulls inside the Cath Lab.
authors.affiliation: Sones Cardiac Catheterization Laboratories, Department of Cardiovascular Medicine, J2-3, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195.
authors.forename: Shikhar
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Sones Cardiac Catheterization Laboratories, Department of Cardiovascular Medicine, J2-3, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195.
authors.forename: Justin J
authors.initials: JJ
authors.lastname: Gallo
authors.affiliation: Sones Cardiac Catheterization Laboratories, Department of Cardiovascular Medicine, J2-3, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195.
authors.forename: Akhil
authors.initials: A
authors.lastname: Parashar
authors.affiliation: Sones Cardiac Catheterization Laboratories, Department of Cardiovascular Medicine, J2-3, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195.
authors.forename: Kanika K
authors.initials: KK
authors.lastname: Agarwal
authors.affiliation: Sones Cardiac Catheterization Laboratories, Department of Cardiovascular Medicine, J2-3, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195.
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Ellis
authors.affiliation: Sones Cardiac Catheterization Laboratories, Department of Cardiovascular Medicine, J2-3, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195.
authors.forename: Umesh N
authors.initials: UN
authors.lastname: Khot
authors.affiliation: Sones Cardiac Catheterization Laboratories, Department of Cardiovascular Medicine, J2-3, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195.
authors.forename: Robin
authors.initials: R
authors.lastname: Spooner
authors.affiliation: Sones Cardiac Catheterization Laboratories, Department of Cardiovascular Medicine, J2-3, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195.
authors.forename: Emin
authors.initials: E
authors.lastname: Murat Tuzcu
authors.affiliation: Sones Cardiac Catheterization Laboratories, Department of Cardiovascular Medicine, J2-3, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195. Electronic address: kapadis@ccf.org.
authors.forename: Samir R
authors.initials: SR
authors.lastname: Kapadia
mesh_terms: D006328:Cardiac Catheterization; D002406:Catheterization, Peripheral; D017023:Coronary Angiography; D003695:Delivery of Health Care / Q000458:organization & administration*; D004526:Efficiency; D017598:Efficiency, Organizational; D057510:Endovascular Procedures; D006801:Humans; D017146:Models, Organizational; D009937:Organizational Objectives; D062645:Percutaneous Coronary Intervention; D017064:Process Assessment, Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration*; D019984:Quality Indicators, Health Care / Q000458:organization & administration*; D013997:Time Factors; D061665:Time-to-Treatment / Q000458:organization & administration; D017749:Total Quality Management / Q000458:organization & administration*; D057188:Workflow
keywords: Catheterization laboratory; Lean six sigma; Operational efficiency