Improving VTE prophylaxis in ward and ICU surgical urology patients: a Six-Sigma DMAIC methodology improvement project

IF 3.8 Q2 MANAGEMENT TQM Journal Pub Date : 2023-04-11 DOI:10.1108/tqm-09-2022-0281
Hesham Metwalli Mousli, I. El Sayed, Adel Zaki, Sherif Abdelmonem
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Post-intervention sample included all patients meeting the inclusion criteria over a period of six months. The improvement areas included both the VTE risk assessment as well as the VTE prophylaxis prescription.FindingsDMAIC methodology has achieved a substantial sustained improvement in surgical urology VTE prophylaxis practices with an average of 70% on both levels; VTE risk assessment practices and VTE prophylaxis prescribing practices were statistically significant. The post-intervention results also showed a statistically controlled process with no special cause variations. Based on the study results, the Six-Sigma DMAIC methodology can be considered of high value when applied in healthcare clinical practice improvement projects.Research limitations/implicationsThe project study includes some pitfalls that can be addressed as follows: 1. The lack of VTE rate incidence tracking. This limitation can be partly refuted when the authors conduct a literature review and explore that the VTE prophylaxis effectiveness had been proven with sufficient evidence to an extent that pushed several scientific societies to develop their own guidelines to support VTE prophylaxis. (Algattas et al., 2018). 2. Another limitation of this study can be that it handled only surgical patients and more specifically surgical urology patients. Of course, VTE prophylaxis is a crucial life-threatening problem not only for the surgical admitted patients but also for all the medical admitted patients either in hospital wards or ICUs. However, the prediction that surgical patients especially surgical urology patients are more prone to VTE development risk as they have -in several cases-two or three main additive risk factors which are age, procedure duration and malignancy in elderly men. (Tikkinen et al., 2014). So, the authors consider the study project to be a prototype that hopefully can be utilized for future study projects that will manage both other surgical specialty patients and medical patients on the national level and can track accurately and effectively report the VTE incidence rates.Practical implicationsSeveral recommendations can be extracted from the research project that is summarized in the following points: Paying focused attention to continuous healthcare quality improvement initiatives and projects as a main approach for healthcare improvement especially for the public health-related problems. This might be achieved through periodic region-specific or specialty-specific focus groups from which public health problems could be addressed and prioritized to be considered as a part of country healthcare campaigns regarding cost-utility and feasibility studies. The adoption of a system thinking approach in dealing with the improvement strategies; all efforts and resources are to be employed to achieve a common objective. This includes the generation of a national-wide electronic health information system that can aid in healthcare resource allocation and direct the healthcare efforts towards the most important, high-priority public health problems. Electronic national-wide health record is really an effort, and resources consuming activity, but actually, it's worth exerting efforts, and its valuable outcomes may be seen several years later. 3. Development of unified national specialized VTE prophylaxis pathways to standardize the patient-specific VTE prophylaxis plans. Standardization of healthcare pathways enables healthcare professionals to follow an evidence-based practice which will be reflected on the improvement of healthcare quality level, cost-effectiveness enhancement, and timely patient care on all levels especially in high critical areas like ER and ICU. 4. Incorporation of VTE prophylaxis costs in the universal health insurance diagnosis-related group (DRG) insurance packages and service pricing. Universal health insurance is a nationwide strategy that is aiming to cover all Egypt residents by the year 2030. Universal health insurance is being following the DRG reimbursement policy that is thought to control all the healthcare-associated costs so, the VTE prophylaxis costs shall be added as the main cost item to encourage all healthcare facilities to follow an evidence-based VTE prophylaxis pathway taking into consideration the high-risk patient categories who will definitely represent a high-cost burden on the long run if they suffer a VTE event.Originality/valueDMAIC improvement methodology applications in healthcare are still relatively limited, especially on the clinical level. 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引用次数: 1

Abstract

PurposeThis study intends to improve the quality of venous thromboembolism (VTE) prophylaxis practices including proper VTE risk assessment and the appropriate prophylaxis measures for surgical urology patients.Design/methodology/approachThe authors applied the Six-Sigma define, measure, analyze, improve and control (DMAIC) improvement methodology in a pre–post interventional study that involved all adult patients above 18 years old indicated and scheduled for urology surgical interventions including endoscopic urological surgeries in a urology specialized 60-bed hospital. The pre-intervention sample included all patients meeting the inclusion criteria over a period of six months. Post-intervention sample included all patients meeting the inclusion criteria over a period of six months. The improvement areas included both the VTE risk assessment as well as the VTE prophylaxis prescription.FindingsDMAIC methodology has achieved a substantial sustained improvement in surgical urology VTE prophylaxis practices with an average of 70% on both levels; VTE risk assessment practices and VTE prophylaxis prescribing practices were statistically significant. The post-intervention results also showed a statistically controlled process with no special cause variations. Based on the study results, the Six-Sigma DMAIC methodology can be considered of high value when applied in healthcare clinical practice improvement projects.Research limitations/implicationsThe project study includes some pitfalls that can be addressed as follows: 1. The lack of VTE rate incidence tracking. This limitation can be partly refuted when the authors conduct a literature review and explore that the VTE prophylaxis effectiveness had been proven with sufficient evidence to an extent that pushed several scientific societies to develop their own guidelines to support VTE prophylaxis. (Algattas et al., 2018). 2. Another limitation of this study can be that it handled only surgical patients and more specifically surgical urology patients. Of course, VTE prophylaxis is a crucial life-threatening problem not only for the surgical admitted patients but also for all the medical admitted patients either in hospital wards or ICUs. However, the prediction that surgical patients especially surgical urology patients are more prone to VTE development risk as they have -in several cases-two or three main additive risk factors which are age, procedure duration and malignancy in elderly men. (Tikkinen et al., 2014). So, the authors consider the study project to be a prototype that hopefully can be utilized for future study projects that will manage both other surgical specialty patients and medical patients on the national level and can track accurately and effectively report the VTE incidence rates.Practical implicationsSeveral recommendations can be extracted from the research project that is summarized in the following points: Paying focused attention to continuous healthcare quality improvement initiatives and projects as a main approach for healthcare improvement especially for the public health-related problems. This might be achieved through periodic region-specific or specialty-specific focus groups from which public health problems could be addressed and prioritized to be considered as a part of country healthcare campaigns regarding cost-utility and feasibility studies. The adoption of a system thinking approach in dealing with the improvement strategies; all efforts and resources are to be employed to achieve a common objective. This includes the generation of a national-wide electronic health information system that can aid in healthcare resource allocation and direct the healthcare efforts towards the most important, high-priority public health problems. Electronic national-wide health record is really an effort, and resources consuming activity, but actually, it's worth exerting efforts, and its valuable outcomes may be seen several years later. 3. Development of unified national specialized VTE prophylaxis pathways to standardize the patient-specific VTE prophylaxis plans. Standardization of healthcare pathways enables healthcare professionals to follow an evidence-based practice which will be reflected on the improvement of healthcare quality level, cost-effectiveness enhancement, and timely patient care on all levels especially in high critical areas like ER and ICU. 4. Incorporation of VTE prophylaxis costs in the universal health insurance diagnosis-related group (DRG) insurance packages and service pricing. Universal health insurance is a nationwide strategy that is aiming to cover all Egypt residents by the year 2030. Universal health insurance is being following the DRG reimbursement policy that is thought to control all the healthcare-associated costs so, the VTE prophylaxis costs shall be added as the main cost item to encourage all healthcare facilities to follow an evidence-based VTE prophylaxis pathway taking into consideration the high-risk patient categories who will definitely represent a high-cost burden on the long run if they suffer a VTE event.Originality/valueDMAIC improvement methodology applications in healthcare are still relatively limited, especially on the clinical level. The study can be considered one of a kind in Egypt dealing with a comprehensive DMAIC methodology application on the clinical level.
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改进病房和ICU泌尿外科患者的VTE预防:六西格玛DMAIC方法改进项目
目的本研究旨在提高静脉血栓栓塞症(VTE)预防实践的质量,包括对外科泌尿外科患者进行适当的VTE风险评估和采取适当的预防措施。设计/方法/方法作者在一项介入前后研究中应用了六西格玛定义、测量、分析、改进和控制(DMAIC)改进方法,该研究涉及所有18岁以上的成年患者,这些患者在一家拥有60张床位的泌尿外科专科医院接受了泌尿外科手术干预,包括内窥镜泌尿外科手术。干预前样本包括六个月内符合纳入标准的所有患者。干预后样本包括六个月内符合纳入标准的所有患者。改善领域包括VTE风险评估和VTE预防处方。FindingsDMAIC方法在泌尿外科VTE预防实践中取得了显著的持续改进,两个水平的平均改进率均为70%;VTE风险评估实践和VTE预防处方实践具有统计学意义。干预后的结果也显示了一个统计控制的过程,没有特殊原因的变化。根据研究结果,六西格玛DMAIC方法在医疗保健临床实践改进项目中具有较高的应用价值。研究局限性/含义项目研究包括一些陷阱,可以通过以下方式解决:1。VTE发病率缺乏跟踪。当作者进行文献综述并探索VTE预防的有效性已被足够的证据证明时,这种局限性可以被部分反驳,这在一定程度上推动了几个科学协会制定自己的指南来支持VTE预防。(Algattas等人,2018)。2.本研究的另一个局限性可能是,它只处理外科患者,更具体地说,是泌尿外科患者。当然,VTE预防是一个至关重要的危及生命的问题,不仅对外科住院患者,而且对医院病房或重症监护室的所有内科住院患者都是如此。然而,预测外科患者,尤其是泌尿外科患者,更容易出现VTE发展风险,因为在某些情况下,有两到三个主要的附加风险因素,即年龄、手术持续时间和老年男性的恶性肿瘤。(Tikkinen等人,2014)。因此,作者认为该研究项目是一个原型,有望用于未来的研究项目,该项目将在国家层面管理其他外科专科患者和医疗患者,并能够准确有效地跟踪VTE发病率。实际含义可以从研究项目中提取一些建议,总结如下:关注持续的医疗质量改进举措和项目,将其作为医疗保健改进的主要方法,特别是针对公共健康相关问题。这可以通过定期针对特定地区或特定专业的重点小组来实现,从这些小组中可以解决公共卫生问题,并将其作为国家医疗保健运动中关于成本效用和可行性研究的一部分加以优先考虑。在处理改进战略时采用系统思维方法;所有的努力和资源都将用于实现一个共同的目标。这包括生成一个全国范围的电子健康信息系统,该系统可以帮助医疗资源分配,并将医疗工作引向最重要、最优先的公共卫生问题。全国范围内的电子健康记录确实是一项努力,也是一项消耗资源的活动,但实际上,它值得付出努力,几年后可能会看到它的宝贵成果。3.制定统一的国家专业VTE预防途径,以规范针对患者的VTE预防计划。医疗保健途径的标准化使医疗保健专业人员能够遵循循证实践,这将反映在医疗保健质量水平的提高、成本效益的提高以及各个层面的及时患者护理上,尤其是在急诊室和重症监护室等高危险领域。4.将VTE预防费用纳入全民健康保险诊断相关群体(DRG)保险包和服务定价。全民健康保险是一项全国性战略,旨在到2030年覆盖所有埃及居民。
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来源期刊
TQM Journal
TQM Journal Business, Management and Accounting-Business, Management and Accounting (all)
CiteScore
9.10
自引率
0.00%
发文量
114
期刊介绍: Commitment to quality is essential if companies are to succeed in a commercial environment which will be virtually unrecognizable in less than a decade. Changing attitudes, changing perspectives and changing priorities will revolutionise the structure and philosophy of future business practice - and TQM will be at the heart of that metamorphosis. All aspects of preparing for, developing, introducing, managing and evaluating TQM initiatives.
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