title: Lean Six Sigma to Reduce Intensive Care Unit Length of Stay and Costs in Prolonged Mechanical Ventilation.
abstract: Patients with prolonged mechanical ventilation (PMV) represent important "outliers" of hospital length of stay (LOS) and costs (∼$26 billion annually in the United States). We tested the hypothesis that a Lean Six Sigma (LSS) approach for process improvement could reduce hospital LOS and the associated costs of care for patients with PMV.
  
  
  
  Before-and-after cohort study.
  
  
  
  Multidisciplinary intensive care unit (ICU) in an academic medical center.
  
  
  
  Adult patients admitted to the ICU and treated with PMV, as defined by diagnosis-related group (DRG).
  
  
  
  We implemented a clinical redesign intervention based on LSS principles. We identified eight distinct processes in preparing patients with PMV for post-acute care. Our clinical redesign included reengineering daily patient care rounds ("Lean ICU rounds") to reduce variation and waste in these processes. We compared hospital LOS and direct cost per case in patients with PMV before (2013) and after (2014) our LSS intervention.
  
  
  
  Among 259 patients with PMV (131 preintervention; 128 postintervention), median hospital LOS decreased by 24% during the intervention period (29 vs. 22 days, p < .001). Accordingly, median hospital direct cost per case decreased by 27% ($66,335 vs. $48,370, p < .001).
  
  
  
  We found that a LSS-based clinical redesign reduced hospital LOS and the costs of care for patients with PMV.
authors.forename: Stephen
authors.initials: S
authors.lastname: Trzeciak
authors.forename: Michael
authors.initials: M
authors.lastname: Mercincavage
authors.forename: Cory
authors.initials: C
authors.lastname: Angelini
authors.forename: William
authors.initials: W
authors.lastname: Cogliano
authors.forename: Emily
authors.initials: E
authors.lastname: Damuth
authors.forename: Brian W
authors.initials: BW
authors.lastname: Roberts
authors.forename: Sergio
authors.initials: S
authors.lastname: Zanotti
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Mazzarelli
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003953:Diagnosis-Related Groups; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000191:economics* / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000191:economics* / Q000706:statistics & numerical data*; D017749:Total Quality Management / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States