The usefulness of lean six sigma to the development of a clinical pathway for hip fractures

J Eval Clin Pract. 2013 Oct;19(5):909-14. doi: 10.1111/j.1365-2753.2012.01875.x. Epub 2012 Jul 11.


Aims and objectives: The objective of this study was to show the usefulness of lean six sigma (LSS) for the development of a multidisciplinary clinical pathway.

Methods: A single centre, both retrospective and prospective, non-randomized controlled study design was used to identify the variables of a prolonged length of stay (LOS) for hip fractures in the elderly and to measure the effect of the process improvements--with the aim of improving efficiency of care and reducing the LOS.

Results: The project identified several variables influencing LOS, and interventions were designed to improve the process of care. Significant results were achieved by reducing both the average LOS by 4.2 days (-31%) and the average duration of surgery by 57 minutes (-36%). The average LOS of patients discharged to a nursing home reduced by 4.4 days.

Conclusion: The findings of this study show a successful application of LSS methodology within the development of a clinical pathway. Further research is needed to explore the effect of the use of LSS methodology at clinical outcome and quality of life.

Keywords: efficiency of care; process improvement; reducing length of stay.

Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Critical Pathways / standards*
  • Efficiency, Organizational
  • Female
  • Hip Fractures* / diagnosis
  • Hip Fractures* / therapy
  • Humans
  • Length of Stay / statistics & numerical data*
  • Male
  • Netherlands
  • Operative Time
  • Outcome and Process Assessment, Health Care / methods
  • Patient Admission / standards
  • Patient Care Team / organization & administration*
  • Patient Discharge / standards
  • Prospective Studies
  • Retrospective Studies
  • Total Quality Management / organization & administration
  • Trauma Centers / standards*