Cross-functional Program: Improving Anti-Embolism Stocking Application in Neurosurgical Unit with Lean and Six Sigma Framework

Introduction

Lean and Six Sigma is widely used in healthcare system to improve quality of care. Proper Anti-Embolism Stocking (TED) application is crucial to avoid patients suffering from deep vein thrombosis as a result of immobility. The author adopted Lean and Six Sigma framework to enhance effective application of TED in Neurosurgical Unit, PWH.

Objectives

(1) To Identify the root causes of inappropriate application of TED (2) To make a sustainable improvement of TED application in Neurosurgical Unit.

Methodology

The Lean and Six Sigma framework included: (1) Define phase, a multidisciplinary team included neurosurgical nurses and physiotherapists was formed in Neurosurgical Unit, PWH. A project charter was created to set the goal and scope of the program. Literature review about updated TED usage and monitoring was done. (2) Measure phase, for assessing staff performance, physiotherapists were invited to conduct pre-audit in collaboration with a Six Sigma Leader (Author). Moreover, nurses' and supporting staff knowledge was assessed with questionnaire. (3) Analyze phase, members performed data and graphical analysis to identify the root causes which were inadequate training and staff knowledge. (4) Improve phase, training sessions on proper TED application were held by nurses and physiotherapists. The video of training session was shared on electronic mobile platform for easy retrieval. In addition, the post-audit of TED application and staff knowledge assessment were conducted. (5) Control phase, a control plan included new staff orientation, regular internal audits were established. To make the improvement more sustainable, signage was designed and posted up to increase staff and relatives' awareness. A video was produced for educating relatives on the usage and care of TED, which would be broadcasted during visiting hours.

Results & Outcome

200 samples were collected in pre-& post-audits respectively. “Toe stick out of inspection hole” and “wrinkles” were the two most common problems. The number of improper TED wearing dropped from 148 to 69 after staff sharing sessions (95%CI, p-value< 0.001, Chi-square test). The Overall Effectiveness improved from 0.26 to 0.65 (95%CI, p-Value< 0.001, paired t-test). The SIGMA level increased from 2.4 σ to 3 σ. Staff knowledge also increased significantly, with mean score increased from 5.9 to 8.8 (95% CI, p-value< 0.001, paired t-test).