Study: Lean Six Sigma model decreases length of stay for patients after TJR

Gayed B. J Am Med Assoc. 2013;doi:10.1001/jamasurg.2013.3598.

  • September 25, 2013

A Veterans Affairs hospital applying the Lean Six Sigma model for their total joint replacement program found the process significantly decreased length of stay for patients and increased return on investment for the program.

“The [Joint Replacement Program] JRP demonstrates that [Lean Six Sigma] LSS process methods can be used to improve patient care efficiency, substantially enhancing outcomes while reducing costs in a [Veterans Affairs] VA facility’s orthopedic surgery department,” Benjamin Gayed, MD, and colleagues wrote in the study. “Process changes reduced waste and were sustained, directly contributing to the complete elimination of non-VA care costs for patients undergoing [total hip arthroplasty] THA and [total knee arthroplasty] TKA, a 36% reduction in [length of stay] LOS, and a $1 million [return on investment] ROI while increasing total joint replacement volume.”

Gayed and colleagues applied the LSS process, known as the Vision-Analysis-Team-Aim-Map-Measure-Change-Sustain (VA-TAMMCS) model into the Richard L. Roudebush Veterans Affairs Medical Center with a 1-year baseline period and 20-month sustainment period.

Prior to the study, the total joint replacement program cost the medical center $1.4 million in 2008 and patients had an average LOS of 6.1 days. At baseline, the LOS decreased to 5.3 days and after the study and the sustainment period, LOS further decreased to 3.4 days. Compared to baseline cost and volumes, the VA-TAMMCS model yielded an annual $1 million ROI, according to the abstract.

Disclosure: The authors have no relevant financial disclosures.

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