Study Of Six Sigma Management Application In Standard Prevention And Control Of Deep Venous Thrombosis After Hip Replacement

Hip replacement is the clinical surgery commonly used in the treatment of diseases such as femoral neck fracture, hip osteoarthritis and femoral head necrosis. Hip replacement is included in the strict access management of diagnosis and treatment technology by the health ministry, and is also one of the key monitoring operations in the single disease quality management by the health ministry. Single disease quality management is mainly through a series of monitoring quality control index to standardize the clinical diagnosis and treatment activities, improve service process, promote the continuous improvement of clinical quality management Prevent deep vein thrombosis (DVT) is one important index of hip replacement single disease quality control. How to ensure that the prevention and control of DVT after hip replacement surgery is in accordance with the relevant diagnosis standards, so as to reduce or avoid the postoperative complications, and even avoid the occurrence of advrese medical events, and improve patient satisfaction,which becomes a seriously, urgent need to resolve problem.With China’s accession to the WTO and the deepening of the reform of medical treatment, the increasingly fierce competition in medical industry, the quality management and the safety of medical treatment is of prime importance to the survival and development of hospitals. It is necessary to implement quality as the center of development strategy in order to survivr and develop in the fierce competition in market.However, at present domestic hospital management method is still not perfect and scientific enough, urgently needing scientific management thought and analysis methods. The service object of the hospital is the patient, facing the only one life, implementation of six sigma management in hospitals can continue to improve the quality and efficiency of medical service process, improve patient satisfaction, so as to improve the competitiveness of the hospital, which reflects that the hospital constantly pursue a close to "zero defect" management goals.This study is patient-centered in order to improve the quality of medical services for the theme, taking orthopaedic hip replacement hospital admissions as the sample, DVT standard control after total hip arthroplasty as a point of penetration, the incidence of DVT after hip replacement and patient satisfaction for assessment indexes. With the project management mode, through the six sigma definition (D), measurement (M), analysis (A), improvement (I), control (C) the five stages, for ten months of continuous improvement, in the process of implementing flexible using of measurement system analysis, fishbone diagram, causal matrix analysis, failure mode and effect analysis(FMEA), statistics inspection methods and tools, we have promoted the prevention and control measures DVT after hip replacement to comply with relevant guidelines and standards, the quality of the prevention and control of the DVT after hip replacement surgery and patient satisfaction have also been improved. Through eighteen months of continuous improvement, the incidence of deep vein thrombosis after hip replacement of hospital A has been reduced significantly from12.0%to1.43%, The chi-square test (Fisher bilateral) p=0.016<0.05; Patient satisfaction has been improved greatly, overall satisfaction has increased form8.03±0.95to9.18±0.46, two independent sample Mann-Whitney U test, Z=-5.135, p=0.000<0.05; Average day in hospital of hip replacement has been reduced significantly from25.16±11.29to20.67±7.97, two independent sample Mann-Whitney U test, Z=-3.298, p=0.001<0.05; The percentage of charges for medicine in hospitalization expenses has been dropped substantially from23.58%to16.97%, two independent sample Mann-Whitney U test, Z=-7.277, p=0.000<0.05.This research shows that:(1) The quality of the prevention and control of the DVT after hip replacement and patient overall satisfaction could be improved by the application of six sigma management methods.(2)According to the six sigma management, taking the prevention and control of DVT after hip replacement as a process, using quantitative method to analyze the influence factors of care quality, and to find out the key factors and improved them, control them, so as to promote medical service process standardization, and could help standardize the medical service process, and effectively prevent the medical defects, so as to build a effective defence for perioperative complications, and ensure medical safety for patients.(3) Integrated Single diseases management and best practice of evidence-based medicine into six sigma management, taking data and facts as the basis, reasonablely using statistical methods, could avoid the "take it for granted", make the medical quality management more scientific, improve process quality of the medical service,at the same time, enhance the quality conscio usness and efficiency awareness of all the medical personnel.(4) This study is an important complement for the application of six sigma, providing a template for other researches on elective surgery perioperative care quality and the continuous improvement, and also meet the requirements of survival and development of hospital under the deepening medial reform and the medical market competition environment.