title: Improving operating room efficiency in academic children's hospital using Lean Six Sigma methodology.
abstract: OBJECTIVE
  Lean Six Sigma (LSS) is a process improvement methodology that utilizes a collaborative team effort to improve performance by systematically identifying root causes of problems. Our objective was to determine whether application of LSS could improve efficiency when applied simultaneously to all services of an academic children's hospital.
  
  
  METHODS
  In our tertiary academic medical center, a multidisciplinary committee was formed, and the entire perioperative process was mapped, using fishbone diagrams, Pareto analysis, and other process improvement tools. Results for Children's Hospital scheduled main operating room (OR) cases were analyzed, where the surgical attending followed themselves.
  
  
  RESULTS
  Six hundred twelve cases were included in the seven Children's Hospital operating rooms (OR) over a 6-month period. Turnover Time (interval between patient OR departure and arrival of the subsequent patient) decreased from a median 41min in the baseline period to 32min in the intervention period (p<0.0001). Turnaround Time (interval between surgical dressing application and subsequent surgical incision) decreased from a median 81.5min in the baseline period to 71min in the intervention period (p<0.0001).
  
  
  CONCLUSIONS
  These results demonstrate that a coordinated multidisciplinary process improvement redesign can significantly improve efficiency in an academic Children's Hospital without preselecting specific services, removing surgical residents, or incorporating new personnel or technology.
  
  
  METHODS
  Prospective comparative study, Level II.
authors.affiliation: Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA. Electronic address: etagge@llu.edu.
authors.forename: Edward P
authors.initials: EP
authors.lastname: Tagge
authors.affiliation: Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA.
authors.forename: Arul S
authors.initials: AS
authors.lastname: Thirumoorthi
authors.affiliation: Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA.
authors.forename: John
authors.initials: J
authors.lastname: Lenart
authors.affiliation: Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Garberoglio
authors.affiliation: Department of Process Improvement, Loma Linda University Medical Center, Loma Linda, CA.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Mitchell
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D002140:California; D002648:Child; D017598:Efficiency, Organizational / Q000592:standards*; D006776:Hospitals, Pediatric / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D009873:Operating Rooms / Q000458:organization & administration* / Q000706:statistics & numerical data; D019990:Perioperative Care / Q000592:standards* / Q000706:statistics & numerical data; D017064:Process Assessment, Health Care; D011446:Prospective Studies; D058996:Quality Improvement / Q000458:organization & administration* / Q000706:statistics & numerical data; D013997:Time Factors; D017749:Total Quality Management
keywords: Efficiency; Lean Six Sigma; Operating room; Process mapping; Total quality improvement