Faculty Collaboration Database

Quality Improvement to Address Surgical Burden of Disease at a Large Tertiary Public Hospital in Peru. World J Surg 2021 Aug;45(8):2357-2369

Date

04/27/2021

Pubmed ID

33900420

DOI

10.1007/s00268-021-06118-z

Scopus ID

2-s2.0-85105280170 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

BACKGROUND: In resource-limited settings, there is a unique opportunity for using process improvement strategies to address the lack of access to surgical care. By implementing organizational changes in the surgical admission process, we aimed to decrease wait times, increase surgical volume, and improve patient satisfaction for elective general surgery procedures at a public tertiary hospital in Lima, Peru.

METHODS: During the first phase of the intervention, Plan-Do-Study-Act (PDSA) cycles were performed to ensure the surgery waitlist included up-to-date clinical information. In the second phase, Lean Six Sigma methodology was used to adapt the admission and scheduling process for elective general surgery patients. After six months, outcomes were compared to baseline data using Wilcoxon rank-sum test.

RESULTS: At the conclusion of phase one, 87.0% (488/561) of patients on the new waitlist had all relevant clinical data documented, improved from 13.3% (2/15) for the pre-existing list. Time from admission to discharge for all surgeries improved from 5 to 4 days (p<0.05) after the intervention. Median wait times from admission to operation for elective surgeries were unchanged at 4 days (p=0.076) pre- and post-intervention. There was a trend toward increased weekly elective surgical volume from a median of 9 to 13 cases (p=0.24) and increased patient satisfaction rates for elective surgery from 80.5 to 83.8% (p=0.62), although these were not statistically significant.

CONCLUSION: The process for scheduling and admitting elective surgical patients became more efficient after our intervention. Time from admission to discharge for all surgical patients improved significantly. Other measured outcomes improved, though not with statistical significance. Main challenges included gaining buy-in from all participants and disruptions in surgical services from bed shortages.

Author List

Iverson KR, Roa L, Shu S, Wong M, Rubenstein S, Zavala P, Caddell L, Graham C, Colina J, Leon SR, Lecca L, Mody GN

Author

Katie Iverson MD, MPH Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Cost of Illness
Elective Surgical Procedures
Hospitals, Public
Humans
Peru
Quality Improvement