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six sigma

David H Rothstein, Mehul V Raval
The operating room is the financial hub of any hospital, and maximizing operating room efficiency has important implications for cost savings, patient satisfaction, and medical team morale. Over the past decade, manufacturing principles and processes such as Lean and Six Sigma have been applied to various aspects of healthcare including the operating room. Although time consuming, process mapping and deep examinations of each step of the patient journey from pre-operative visit to post-operative discharge can have multiplicative benefits that extend from cost savings to maintaining the focus on improving quality and patient safety...
April 2018: Seminars in Pediatric Surgery
Michelle M Valdez, Maureen Liwanag, Charles Mount, Rechell Rodriguez, Elisea Avalos-Reyes, Andrew Smith, David Collette, Michael Starsiak, Richard Green
Introduction: Inefficiencies in the command approval process for publications and/or presentations negatively impact DoD Graduate Medical Education (GME) residency programs' ability to meet ACGME scholarly activity requirements. A preliminary review of the authored works approval process at Naval Medical Center San Diego (NMCSD) disclosed significant inefficiency, variation in process, and a low level of customer satisfaction. In order to facilitate and encourage scholarly activity at NMCSD, and meet ACGME requirements, the Executive Steering Council (ESC) chartered an interprofessional team to lead a Lean Six Sigma (LSS) Rapid Improvement Event (RIE) project...
March 14, 2018: Military Medicine
Pietro Mancosu, Giorgia Nicolini, Giulia Goretti, Fiorenza De Rose, Davide Franceschini, Chiara Ferrari, Giacomo Reggiori, Stefano Tomatis, Marta Scorsetti
BACKGROUND & PURPOSE: Lean Six Sigma Methodology (LSSM) was introduced in industry to provide near-perfect services to large processes, by reducing improbable occurrence. LSSM has been applied to redesign the 2D-2D breast repositioning process (Lean) by the retrospective analysis of the database (Six Sigma). MATERIALS & METHODS: Breast patients with daily 2D-2D matching before RT were considered. The five DMAIC (define, measure, analyze, improve, and control) LSSM steps were applied...
March 6, 2018: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Edward W Randell, Garry Short, Natasha Lee, Allison Beresford, Margaret Spencer, Marina Kennel, Zoë Moores, David Parry
OBJECTIVE: This study examines effectiveness of a project to enhance an autoverification (AV) system through application of Six Sigma (DMAIC) process improvement strategies. DESIGN AND METHODS: Similar AV systems set up at three sites underwent examination and modification to produce improved systems while monitoring proportions of samples autoverified, the time required for manual review and verification, sample processing time, and examining characteristics of tests not autoverified...
March 5, 2018: Clinical Biochemistry
Devon M Fitzgerald, Carol Smith, Pascal Lapierre, Joseph T Wade
In Escherichia coli, one Sigma factor recognizes the majority of promoters, and six "alternative" Sigma factors recognize specific subsets of promoters. The alternative Sigma factor FliA (σ28 ) recognizes promoters upstream of many flagellar genes. We previously showed that most E. coli FliA binding sites are located inside genes. However, it was unclear whether these intragenic binding sites represent active promoters. Here, we construct and assay transcriptional promoter-lacZ fusions for all 52 putative FliA promoters previously identified by ChIP-seq...
February 24, 2018: Molecular Microbiology
Ahmed Farouk, Ahmed Tawfick, Mohamed Shoeb, Mahmoud A Mahmoud, Diaa Eldin Mostafa, Mohamed Hasan, Hany M Abdalla
PURPOSE: The extracorporeal shockwave lithotripsy (ESWL) remains the most common first line of treatment for renal stones in the pediatric population. The purpose of this study is to evaluate and compare the outcomes of the ESWL and mini-percutaneous nephrolithotomy (mini-PCNL). PATIENTS AND METHODS: A total of 108 patients younger than 12 years of age with 1-2 cm single renal stone (pelvic or calyceal) were randomized into two groups, each containing 54 patients...
February 15, 2018: World Journal of Urology
Sweta Kulkarni, R Ramesh, A R Srinivasan, C R Wilma Delphine Silvia
Preanalytical steps are the major sources of error in clinical laboratory. The analytical errors can be corrected by quality control procedures but there is a need for stringent quality checks in preanalytical area as these processes are done outside the laboratory. Sigma value depicts the performance of laboratory and its quality measures. Hence in the present study six sigma and Pareto principle was applied to preanalytical quality indicators to evaluate the clinical biochemistry laboratory performance. This observational study was carried out for a period of 1 year from November 2015-2016...
January 2018: Indian Journal of Clinical Biochemistry: IJCB
Anthony D Kuner, Andrew J Schemmel, B Dustin Pooler, John-Paul J Yu
Background The diagnosis and treatment of acute stroke requires timed and coordinated effort across multiple clinical teams. Purpose To analyze the frequency and temporal distribution of emergent stroke evaluations (ESEs) to identify potential contributory workflow factors that may delay the initiation and subsequent evaluation of emergency department stroke patients. Material and Methods A total of 719 sentinel ESEs with concurrent neuroimaging were identified over a 22-month retrospective time period. Frequency data were tabulated and odds ratios calculated...
January 1, 2018: Acta Radiologica
Nitat Sookrung, Onrapak Reamtong, Rojana Poolphol, Nitaya Indrawattana, Watee Seesuay, Nawannaporn Saelim, Pongsakorn Tantilipikorn, Chaweewan Bunnag, Wanpen Chaicumpa, Anchalee Tungtrongchitr
Insect glutathione S-transferases (GSTs) play important roles in insecticide/drug resistance and stress response. Medically, GSTs of house dust mites (Dermatophagoides pteronyssinus and Blomia tropicalis) and German cockroach (Blattella germanica) are human allergens. In this study, classes, isoforms and B-cell and allergenic epitopes of GST of American cockroach, Periplaneta americana, the predominant species in the tropics and subtropics were investigated for the first time. Enzymatically active native and recombinant P...
January 11, 2018: Scientific Reports
Gareth J Morgan, David H Burkhardt, Jeffery W Kelly, Evan T Powers
Cellular protein levels are dictated by the balance between gene transcription, mRNA translation, and protein degradation, among other factors. Translation requires the interplay of several RNA hybridization processes, which are expected to be temperature-sensitive. We used ribosome profiling to monitor translation in Escherichia coli at 30 °C and to investigate how this changes after 10-20 min of heat shock at 42 °C. Translation efficiencies are robustly maintained after thermal heat shock and after mimicking the heat-shock response transcriptional program at 30 °C by overexpressing the heat shock σ factor encoded by the rpoH gene...
January 19, 2018: Journal of Biological Chemistry
Su Liu, Yu-Xing Zhang, Wen-Long Wang, Bang-Xian Zhang, Shi-Guang Li
Insect glutathione S-transferases (GSTs) play essential roles in the detoxification of insecticides and other xenobiotic compounds. The cabbage white butterfly, Pieris rapae, is an economically important agricultural pest. In this study, 17 cDNA sequences encoding putative GSTs were identified in P. rapae. All cDNAs include a complete open reading frame and were designated PrGSTd1-PrGSTz2. Based on phylogenetic analysis, PrGSTs were divided into six classes (delta, epsilon, omega, sigma, theta and zeta). The exon-intron organizations of these PrGSTs were also analysed...
November 2017: Pesticide Biochemistry and Physiology
Hna Al Nahedh, N S Sibai
OBJECTIVES: To investigate the efficacy of X-ray micro-computed tomography (μCT) in the detection and quantification of interfacial gap formation in standardized Class I and Class II resin composite restorations, to compare the interfacial gaps for two low-shrinkage resin composites with a methacrylate composite material, and to determine any correlation between the cavity configuration factor (C-factor) and the volume of gaps formed. METHODS AND MATERIALS: Sixty standardized Class I and Class II cavities were prepared and divided into six groups...
November 2017: Operative Dentistry
Rebecca J Maners, Eric Bakow, Michael D Parkinson, Gary S Fischer, Geoffrey R Camp
Addressing patient health and care behaviors that underlie much of chronic disease continues to challenge providers, medical practices, health systems, and insurers. Improving health and care as described by the Quadruple Aim requires innovation at the front lines of clinical care: the doctor-patient interaction and office practice. This article describes the use of Lean Six Sigma in a quality improvement (QI) effort to design an effective and scalable method for physicians to prescribe health coaching for healthy behaviors in a primary care medical home within a large integrated delivery and financing system...
November 1, 2017: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
Pamela Maree Ramirez, Barry Peterson, Christine Holtshopple, Kristina Borja, Vincent Torres, Lucille Valdivia-Peppers, Julio Harriague, Melanie D Joe
PURPOSE: Four incident reports involving missed doses of myeloid growth factors (MGFs) triggered the need for an outcome-driven initiative. From March 1, 2015, to February 29, 2016, at University of California Irvine Health Chao Infusion Center, 116 of 3,300 MGF doses were missed (3.52%), including pegfilgrastim, filgrastim, and sargramostim. We hypothesized that with the application of Lean Six Sigma methodology, we would achieve our primary objective of reducing the number of missed MGF doses to < 0...
December 2017: Journal of Oncology Practice
Giovanni Improta, Mario Cesarelli, Paolo Montuori, Liberatina Carmela Santillo, Maria Triassi
RATIONALE, AIMS, AND OBJECTIVES: Lean Six Sigma (LSS) has been recognized as an effective management tool for improving healthcare performance. Here, LSS was adopted to reduce the risk of healthcare-associated infections (HAIs), a critical quality parameter in the healthcare sector. METHODS: Lean Six Sigma was applied to the areas of clinical medicine (including general medicine, pulmonology, oncology, nephrology, cardiology, neurology, gastroenterology, rheumatology, and diabetology), and data regarding HAIs were collected for 28,000 patients hospitalized between January 2011 and December 2016...
November 3, 2017: Journal of Evaluation in Clinical Practice
Gabriele Arcidiacono, Dominik T. Matt, Erwin Rauch
Lean Management and Six Sigma are nowadays applied not only to the manufacturing industry but also to service industry and public administration. The manifold variables affecting the Health Care system minimize the effect of a narrow Lean intervention. Therefore, this paper aims to discuss a comprehensive, system-based approach to achieve a factual holistic optimization of patient flows. This paper debates the efficacy of Lean principles applied to the optimization of patient flows and related activities, structures, and resources, developing a theoretical framework based on the principles of the Axiomatic Design...
2017: Journal of Healthcare Engineering
Gabriele Arcidiacono, Dominik T Matt, Erwin Rauch
Lean Management and Six Sigma are nowadays applied not only to the manufacturing industry but also to service industry and public administration. The manifold variables affecting the Health Care system minimize the effect of a narrow Lean intervention. Therefore, this paper aims to discuss a comprehensive, system-based approach to achieve a factual holistic optimization of patient flows. This paper debates the efficacy of Lean principles applied to the optimization of patient flows and related activities, structures, and resources, developing a theoretical framework based on the principles of the Axiomatic Design...
2017: Journal of Healthcare Engineering
Cristiano Ialongo, Sergio Bernardini
BACKGROUND: The International Federation of Clinical Chemistry and Laboratory Medicine has introduced in recent times the turnaround time (TAT) as mandatory quality indicator for the postanalytical phase. Classic TAT indicators, namely, average, median, 90th percentile and proportion of acceptable test (PAT), are in use since almost 40 years and to date represent the mainstay for gauging the laboratory timeliness. In this study, we investigated the performance of the Six Sigma Z-score, which was previously introduced as a device for the quantitative assessment of timeliness...
October 17, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
Maríosa Kieran, Mary Cleary, Aoife De Brún, Aileen Igoe
Objective: To improve efficiency, reduce interruptions and reduce the time taken to complete oral drug rounds. Design: Lean Six Sigma methods were applied to improve drug round efficiency using a pre- and post-intervention design. Setting: A 20-bed orthopaedic ward in a large teaching hospital in Ireland. Participants: Pharmacy, nursing and quality improvement staff. Intervention(s): A multifaceted intervention was designed which included changes in processes related to drug trolley organization and drug supply planning...
August 19, 2017: International Journal for Quality in Health Care
Elena Itzcovich, Massimo Riani, Walter G Sannita
We verified whether a stochastic resonance paradigm (SR), with random interference ("noise") added in optimal amounts, improves the detection of sub-threshold visual information by subjects with retinal disorder and impaired vision as it does in the normally sighted. Six levels of dynamic, zero-mean Gaussian noise were added to each pixel of images (13 contrast levels) in which alphabet characters were displayed against a uniform gray background. Images were presented with contrast below the subjective threshold to 14 visually impaired subjects (age: 22-53 yrs...
October 9, 2017: Scientific Reports
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