Fast track surgery for knee replacement surgery: a lean six sigma approach

PurposeThe reduction of costs has a more and more relevant role in the healthcare context, therefore, a large effort is done by health providers to this aim, for example, by reducing the length of hospital stay (LOS) of patients undergoing surgery. Fast track surgery fits perfectly this issue and was applied to patients undergoing knee replacement surgery due to Osteoarthritis, one of the most common diseases of aged population. The paper aims to discuss these issues.Design/methodology/approachLean six sigma was applied to analyze the implementation of fast track surgery through the define, measure, analyze, improve, control roadmap, used as a typical problem-solving approach. It is characterized by five operational phases, which make possible the achievement of fixed goals through a rigorous process of defining, measuring, analyzing, improving and controlling business problems.FindingsThe corrective action, consisting in the application of fast track surgery, improved both effectiveness and efficiency of the process of care. The average length of hospital stay (LOS) was reduced from 8.34 to 6.68 days (–19.9 percent) and its standard deviation from 2.41 to 1.99 days (–17.1 percent). The statistical significance of this decrease was verified by means of proper tests. Moreover, some variables influencing the LOS were identified.Research limitations/implicationsThe follow up and the satisfaction of patients were not analyzed and could be a future development of this study.Practical implicationsPatients will experience a faster recovery while the hospital will benefit from a rise of available beds. The effect is a general improvement of hospital management.Originality/valueThe introduction of fast track surgery for patients undergoing knee replacement surgery made significantly reduce LOS and, consequently, costs' with a money saving of more than 50,000 euro per year

A comparison of a SARS-CoV-2 rapid-test and serological-test in a Public Health Hospital

Nowadays, with the start of the vaccination campaign is very important to assess the extent of exposure of the population and identifying rapid, sensitive and accurate test to quickly identify new cases of SARS-CoV-2. The rapid test, cheap and easy to perform, is therefore very useful in developing countries, where the vaccination campaign has not yet reached adequate coverage

A Health Technology Assessment in Maxillofacial Cancer Surgery by Using the Six Sigma Methodology

Squamous cell carcinoma represents the most common cancer affecting the oral cavity. At the University of Naples “Federico II”, two different antibiotic protocols were used in patients undergoing oral mucosa cancer surgery from 2006 to 2018. From 2011, there was a shift; the combination of Cefazolin plus Clindamycin as a postoperative prophylactic protocol was chosen. In this paper, a health technology assessment (HTA) is performed by using the Six Sigma and DMAIC (Define, Measure, Analyse, Improve, Control) cycle in order to compare the performance of the antibiotic protocols according to the length of hospital stay (LOS). The data (13 variables) of two groups were collected and analysed; overall, 136 patients were involved. The American Society of Anaesthesiologist score, use of lymphadenectomy or tracheotomy and the presence of infections influenced LOS significantly (p-value < 0.05) in both groups. Then, the groups were compared: the overall difference between LOS of the groups was not statistically significant, but some insights were provided by comparing the LOS of the groups according to each variable. In conclusion, in light of the insights provided by this study regarding the comparison of two antibiotic protocols, the utilization of DMAIC cycle and Six Sigma tools to perform HTA studies could be considered in future research

Application of DMAIC Cycle and Modeling as Tools for Health Technology Assessment in a University Hospital

Background. The Health Technology Assessment (HTA) is used to evaluate health services, manage healthcare processes more efficiently, and compare medical technologies. The aim of this paper is to carry out an HTA study that compares two pharmacological therapies and provides the clinicians with two models to predict the length of hospital stay (LOS) of patients undergoing oral cavity cancer surgery on the bone tissue. Methods. The six Sigma method was used as a tool of HTA; it is a technique of quality management and process improvement that combines the use of statistics with a five-step procedure: “Define, Measure, Analyze, Improve, Control” referred to in the acronym DMAIC. Subsequently, multiple linear regression has been used to create two models. Two groups of patients were analyzed: 45 were treated with ceftriaxone while 48 were treated with the combination of cefazolin and clindamycin. Results. A reduction of the overall mean LOS of patients undergoing oral cavity cancer surgery on bone was observed of 40.9% in the group treated with ceftriaxone. Its reduction was observed in all the variables of the ceftriaxone group. The best results are obtained in younger patients (−54.1%) and in patients with low oral hygiene (−52.4%) treated. The regression results showed that the best LOS predictors for cefazolin/clindamycin are ASA score and flap while for ceftriaxone, in addition to these two, oral hygiene and lymphadenectomy are the best predictors. In addition, the adjusted R squared showed that the variables considered explain most of the variance of LOS. Conclusion. SS methodology, used as an HTA tool, allowed us to understand the performance of the antibiotics and provided variables that mostly influence postoperative LOS. The obtained models can improve the outcome of patients, reducing the postoperative LOS and the relative costs, consequently increasing patient safety, and improving the quality of care provided

Health technology assessment through Six Sigma Methodology to assess cemented and uncemented protheses in total hip arthroplasty.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadThe purpose of this study is to use Health Technology Assessment (HTA) through the Six Sigma (SS) and DMAIC (Define, Measure, Analyse, Improve, Control) problem-solving strategies for comparing cemented and uncemented prostheses in terms of the costs incurred for Total hip arthroplasty (THA) and the length of hospital stay (LOS). Multinomial logistic regression analysis for modelling the data was also performed. Quantitative parameters extracted from gait analysis, electromyography and computed tomography images were used to compare the approaches, but the analysis did not show statistical significance. The variables regarding costs were studied with the Mann-Whitney and Kruskal-Wallis tests. No statistically significant difference between cemented and uncemented prosthesis for the total cost of LOS was found, but the cost of the surgeon had an influence on the overall expenses, affecting the cemented prosthetic approach. The material costs of surgery for the uncemented prosthesis and the cost of theatre of surgery for the cemented prosthesis were the most influential. Multinomial logistic regression identified the Vastus Lateralis variable as statistically significant. The overall accuracy of the model is 93.0%. The use of SS and DMAIC cycle as tools of HTA proved that the cemented and uncemented approaches for THA have similar costs and LOSy.University of Reykjavik Icelandic National Hospital (Landspitali Scientific Fund) Rannis (Rannis Icelandic Research Fund (Rannsoknasjodur

Improving Prosthetic Selection and Predicting BMD from Biometric Measurements in Patients Receiving Total Hip Arthroplasty.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadThere are two surgical approaches to performing total hip arthroplasty (THA): a cemented or uncemented type of prosthesis. The choice is usually based on the experience of the orthopaedic surgeon and on parameters such as the age and gender of the patient. Using machine learning (ML) techniques on quantitative biomechanical and bone quality data extracted from computed tomography, electromyography and gait analysis, the aim of this paper was, firstly, to help clinicians use patient-specific biomarkers from diagnostic exams in the prosthetic decision-making process. The second aim was to evaluate patient long-term outcomes by predicting the bone mineral density (BMD) of the proximal and distal parts of the femur using advanced image processing analysis techniques and ML. The ML analyses were performed on diagnostic patient data extracted from a national database of 51 THA patients using the Knime analytics platform. The classification analysis achieved 93% accuracy in choosing the type of prosthesis; the regression analysis on the BMD data showed a coefficient of determination of about 0.6. The start and stop of the electromyographic signals were identified as the best predictors. This study shows a patient-specific approach could be helpful in the decision-making process and provide clinicians with information regarding the follow up of patients. Keywords: clinical decision making; database analyses; electromyography; machine learning; total hip arthroplasty.University of Reykjavik Icelandic National Hospital Rannis (Rannis Icelandic Research Fund (Rannsoknasjodur)) A&C M-C Foundation of Translational Myology, Padova, Ital

Planning and managing a seismic emergency: The INGV drill of November 26th, 2015 carried out in the framework of the activity line T5 "Seismic surveillance and post-earthquake operational procedures" | Pianificazione e gestione di un'emergenza sismica: Esercitazione INGV del 26 novembre 2015 effettuata nell'ambito della Linea di Attività T5 "Sorveglianza sismica e operatività post terremoto"

Nella Struttura Terremoti dell’INGV la Linea di Attività T5 “Sorveglianza sismica ed operatività postterremoto” si occupa delle attività di sviluppo di strumenti e procedure per la valutazione in tempo reale degli effetti di terremoti e tsunami e della gestione delle emergenze sismiche. Uno dei suoi obiettivi del 2015 era la formalizzazione dei protocolli di intervento di Gruppi d’Emergenza, avvenuta per Emergeo, Emersito, IES, QUEST e Sismiko con Decreto del Presidente nel luglio 2015. Altro obiettivo era l’elaborazione di un Protocollo di Ente per la gestione delle emergenze sismiche. La bozza preparata nel 2015 prevede l’importante novità dell’Unità di Crisi, mai formalizzata in precedenza. Attraverso questo Protocollo di Ente si auspica di migliorare la risposta logistico-operativa dell’INGV durante l’emergenza, di avere una più rapida conoscenza del fenomeno in corso e di realizzare un’efficace comunicazione verso Protezione Civile, media e pubblico. Per verificare il tutto è stata organizzata un’esercitazione in cui è stato simulato un terremoto di magnitudo 6.4 nel basso Lazio. Si sono così sperimentate l’efficacia del flusso azioni/informazioni durante un’emergenza, il funzionamento dell’Unità di Crisi, la funzionalità dei protocolli dei Gruppi d’Emergenza, l’efficienza delle attività in sede per gli aspetti tecnico-logistici, il flusso di comunicazione interno e le comunicazioni istituzionali esterne (queste ultime simulate). In questo articolo sono descritte le fasi di organizzazione ed attuazione dell’esercitazione. Inoltre, durante il suo svolgimento, la valutazione dell’efficacia dell’organizzazione e delle attività svolte dai gruppi coinvolti è stata affidata ad alcuni osservatori e qui è allegata l’elaborazione dei commenti riportati. Abbiamo fatto infine una sintesi dei risultati positivi e delle criticità emerse dall’esercitazione, attività così importante a nostro avviso da considerarne indispensabile la ripetizione con cadenza quanto meno annuale.Published1SR. TERREMOTI - Servizi e ricerca per la SocietàN/A or not JCRope

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p &lt; 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p &lt; 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p &lt; 0.0001) or urgent (20.4% vs. 38.5%; p &lt; 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p &lt; 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

Bollettino Sismico Italiano settembre – dicembre 2018

Gli analisti del BSI hanno revisionato tutti gli eventi di magnitudo M≥1.5, localizzati dal 1 settembre al 31 dicembre 2018. I parametri dei terremoti di magnitudo inferiore a tale soglia di revisione, sono quelli calcolati in tempo reale, nella sala di sorveglianza sismica di Roma.Istituto Nazionale di Geofisica e Vulcanologia - Dipartimento di Protezione CivilePublished4IT. Banche dat

Bollettino Sismico Italiano maggio – agosto 2017

I parametri dei terremoti registrati dalla Rete Sismica Nazionale Italiana, localizzati nelle sale di monitoraggio di Roma, Napoli e Catania, sono immediatamente disponibili sul web, alla pagina http://terremoti.ingv.it/, e nell’Italian Seismological Instrumental and parametric Data-base (ISIDe working group (2016) version 1.0, DOI: 10.13127/ISIDe). Gli analisti del Bollettino Sismico Italiano (BSI) ricontrollano i parametri dei terremoti localizzati, inserendo pesi e polarità degli arrivi delle onde sismiche e integrando, inoltre, i dati letti in sala con tutti quelli disponibili nel sistema di acquisizione. Dal 1985 i dati del bollettino sono consultabili nel data-base ISIDe.Istituto Nazionale di Geofisica - Dipartimento di Protezione CivilePublished4IT. Banche dat