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Am J Med Qual. 2013 Jul-Aug;28(4):301-7. doi: 10.1177/1062860612470486. Epub 2013 Jan 15.

A Lean Six Sigma quality improvement project to increase discharge paperwork completeness for admission to a comprehensive integrated inpatient rehabilitation program.

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Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Phipps 160, Baltimore, MD 21281, USA.


Lean Six Sigma (LSS) process analysis can be used to increase completeness of discharge summary reports used as a critical communication tool when a patient transitions between levels of care. The authors used the LSS methodology as an intervention to improve systems process. Over the course of the project, 8 required elements were analyzed in the discharge paperwork. The authors analyzed the discharge paperwork of patients (42 patients preintervention and 143 patients postintervention) of a comprehensive integrated inpatient rehabilitation program (CIIRP). Prior to this LSS project, 61.8% of required discharge elements were present. The intervention improved the completeness to 94.2% of the required elements. The percentage of charts that were 100% complete increased from 11.9% to 67.8%. LSS is a well-established process improvement methodology that can be used to make significant improvements in complex health care workflow issues. Specifically, the completeness of discharge documentation required for transition of care to CIIRP can be improved.


Lean Thinking; Six Sigma; discharge summary; handoff; inpatient; quality improvement; rehabilitation

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