Improving efficiency in a total hip arthroplasty program

Objective

To evaluate the application of Lean Six Sigma methodology to increase efficiency in a morning total hip arthroplasty program and analyze the challenges in improving operating room efficiency.

Methods

A quasi-experimental study with pre-post intervention analysis was conducted in a public university hospital. Multidisciplinary meetings and a retrospective analysis of the previous year were carried out to define improvement points. Study period: June–December 2023, with 24 planned sessions in Monday and Thursday morning modules. Measures implemented included selection of low-complexity cases, early start of surgeries, optimization of changeover times, and use of efficiency-facilitating systems.

Results

The feasibility of performing three procedures in one morning was confirmed, with 72% of cases having surgery times under 90 min. 67% of the proposed target was achieved, despite the loss of an operating room module for four months. The average start time of the first surgery improved from 9:23 ± 54 min to 8:32 ± 22 min. The average number of procedures per module increased from 1.76 to 2.79. The average changeover time reduced from 29 ± 12 min to 18 ± 12 min.

Conclusions

The Lean Six Sigma methodology has improved operating room efficiency for hip arthroplasty by 50%. Identifying easily modifiable stoppers is crucial for successful implementation of improvements in the clinical process. Additional studies are required to address the challenges identified in post-surgery clinical process and to ensure continuous process optimization.