Lean Six Sigma methodology to improve the discharge process in a Brazilian intensive care unit.
Guilherme Dos Santos Zimmermann, Elena Bohomol
PMID 37436235WHAT IT FOUND
Applying Lean Six Sigma to ICU discharge reduced mean transfer time from 189 to 75.7 minutes.
The process remained unstable, with points outside control limits linked to missing family members and workload, so gains may not hold without continued monitoring.
Key findings
01Mean time for a patient to leave the ICU for the inpatient unit dropped from 189 minutes at baseline to 75.7 minutes after the intervention.
02Setting a goal to refer patients within 90 minutes resulted in a mean of 74 minutes, compared to 237 minutes in the group that received no intervention.
03Control charts showed the process was not stable, with outliers caused by absent family members, work overload, and unexplained delays.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study did not investigate all possible causes of delay. Statistical control could not be maintained long-term due to time constraints, so the sustainability of the improvement is unknown. Financial impacts were not quantified. The process was shown to be unstable in the control phase, meaning individual discharge times varied significantly despite the improved mean.
The easy way to misread this
Do not assume the discharge process is now predictable or stable. Although the mean time improved, control charts showed significant variability and points outside the limits, driven by factors like absent family members and workload that the intervention did not fully resolve.