LOS, Costs Decreased in VA Joint Replacement Initiative

INDIANAPOLIS β€” 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.

β€œThe 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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