Impact of lean six sigma process improvement methodology on cardiac catheterization laboratory efficiency

Shikhar Agarwal; Justin J Gallo; Akhil Parashar; Kanika K Agarwal; Stephen G Ellis; Umesh N Khot; Robin Spooner; Emin Murat Tuzcu; Samir R Kapadia

doi:10.1016/j.carrev.2015.12.011

Impact of lean six sigma process improvement methodology on cardiac catheterization laboratory efficiency

Cardiovasc Revasc Med. 2016 Mar;17(2):95-101. doi: 10.1016/j.carrev.2015.12.011. Epub 2015 Dec 28.

Authors

Shikhar Agarwal¹, Justin J Gallo¹, Akhil Parashar¹, Kanika K Agarwal¹, Stephen G Ellis¹, Umesh N Khot¹, Robin Spooner¹, Emin Murat Tuzcu¹, Samir R Kapadia²

Affiliations

¹ Sones Cardiac Catheterization Laboratories, Department of Cardiovascular Medicine, J2-3, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195.
² 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.

PMID: 26905051
DOI: 10.1016/j.carrev.2015.12.011

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.

Keywords: Catheterization laboratory; Lean six sigma; Operational efficiency.

MeSH terms

Cardiac Catheterization*
Catheterization, Peripheral*
Coronary Angiography
Delivery of Health Care / organization & administration*
Efficiency
Efficiency, Organizational*
Endovascular Procedures*
Humans
Models, Organizational
Organizational Objectives
Percutaneous Coronary Intervention
Process Assessment, Health Care / organization & administration*
Program Evaluation
Quality Improvement / organization & administration*
Quality Indicators, Health Care / organization & administration*
Time Factors
Time-to-Treatment / organization & administration
Total Quality Management / organization & administration*
Workflow