Reducing liver transplant length of stay: a Lean Six Sigma approach

Context-Organ transplant centers are under increasing scrutiny to maintain outcomes while controlling cost in a challenging population of patients. Throughout health care and transplant specifically, length of stay is used as a benchmark for both quality and resource utilization. Objective-To decrease our length of stay for liver transplant by using Lean Six Sigma methods. Design-The Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) method was used to systematically analyze our process from transplant listing to hospital discharge after transplant, identifying many factors affecting length of stay. Patients or Other Participants-Adult, single-organ, primary liver transplant recipients between July 2008 and June 2012 were included in the study. Recipients with living donors or fulminant liver failure were excluded. Intervention(s)-Multiple interventions, including a clinical pathway and enhanced communication, were implemented. Main Outcome Measure(s)-Length of stay after liver transplant and readmission after liver transplant. Results-Median length of stay decreased significantly from 11 days before the intervention to 8 days after the intervention. Readmission rate did not change throughout the study. The improved length of stay was maintained for 24 months after the study. Conclusion-Using a Lean Six Sigma approach, we were able to significantly decrease the length of stay of liver transplant patients. These results brought our center's outcomes in accordance with our goal and industry benchmark of 8 days. Clear expectations, improved teamwork, and a multidisciplinary clinical pathway were key elements in achieving and maintaining these gains. (C)2013 NATCO, The Organization for Transplant Professionals