LOS, Costs Decreased in VA Joint Replacement Initiative

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INDIANAPOLIS — Five years ago, an analysis of joint replacement surgical procedures at the Richard L. Roudebush Veterans Affairs Medical Center in Indianapolis revealed that $1.4 million in non-VA care costs had been spent for total hip and knee replacements in 2008, with an average length of stay of 6.1 days.

As a result, the Joint Replacement Program system redesign project was initiated to increase efficiency, decrease length of stay and reduce non-VA care costs. One of its goals was to determine the effectiveness of Lean Six Sigma process improvement methods applied in a VA hospital.

Results of the initiative were reported recently in JAMA Surgery.1

Perioperative processes for patients undergoing total joint replacement were redesigned following the VA Vision/Analyze, Team/Aim, Map, Measure, Change, Sustain(TAMMCS) model.

The multidisciplinary team, which included orthopedic surgeons, frontline staff and executive management, identified waste in the current processes and initiated changes to reduce waste and increase efficiency. Data collection included a one-year baseline period and a 20-month sustainment period, with the primary endpoint length of stay followed by reduction of non-VA care costs.

As a result of the intervention, length of stay decreased 36% overall, decreasing from 5.3 days during the pre-project period to 3.4 days during the 20-month sustainment period (P <0.001).

Non-VA care was completely eliminated for patients undergoing total hip and knee replacement, meanwhile, producing an estimated return on investment of $1 million annually, when compared with baseline cost and volumes. In addition, the volume of total joint replacements at the Roudebush VA increased during the data collection period.

“The success of the Joint Replacement Program demonstrates that VA-TAMMCS is an effective tool for Lean and Six Sigma process improvement initiatives in a surgical practice, producing a 36% sustained reduction in length of stay and completely eliminating non-VA care for total hip and knee replacements while increasing total joint replacement volume at this medical center,” the authors concluded.

1Gayed B, Black S, Daggy J, Munshi IA. Redesigning a joint replacement program using Lean Six Sigma in a Veterans Affairs hospital. JAMA Surg. 2013Nov;148(11):1050-6. doi: 10.1001/jamasurg.2013.3598. PubMed PMID: 24026166.

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