الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 125 |  |  |
| | | from | 125 | | |
Abstract
Deep vein thrombosis (DVT), also known as venous thromboembolism (VTE), and pulmonary embolism (PE), which affects millions of people each year worldwide, are all included under the umbrella term of ”venous thromboembolism.” It’s also important to note that VTE is seen as an important health economics concern in high-, middle-, and low-income nations alike.
The Global Burden of Disease, Injuries, and Risk Factors Study (GBD Study), a comprehensive study carried out by the World Health Organization (WHO) in partnership with the World Bank, involved a systematic analysis. It involved a scientific investigation to quantify the health loss magnitude caused by the three determinants: diseases, and risk factors classified according to age, sex, and geographic region throughout the world.
The Six Sigma Define, Measure, Analyze, Improve, and Control (DMAIC) methodology was applied to improve the postsurgical VTE prophylaxis practices for surgical urology patients. The following steps were conducted in the Define Phase: Project team selection, Project charter development, performing a stakeholder analysis, performing an initial Voice of Customer (VOC) analysis and Critical to Satisfaction (CTS) identification, Project plan creation, Launching the project.
It was very important to include the extensive knowledge and buy-in of the intensivists and urologists to achieve the desired outcomes. A project charter is the statement of scope, objectives, and people who are participating in a project. Its main aim is to define the roles and responsibilities of project team participants and outlines the objectives and goals of the project. The charter also identifies the main process stakeholders and defines the critical to satisfaction issues.
The following activities have been conducted in the Measure phase: Defining the current, process, Defining the detailed Voice of the Customer (VOC), Defining the Voice of Process (VOP), and the current performance state, Validation of the measurement system. A swim lane process map is the same approach as a typical process map except that the process blocks are arranged in alignment with the lane of the department or function that performs the mentioned process step. The team had several meetings with the process stakeholders including consultants, residents, nursing staff, and admission office staff to finally settle the critical to satisfaction criteria.
A P-chart has been constructed using Minitab- 18 software to show the proportion of defective cases variability in VTE prophylaxis practices based on the abovementioned defective VTE prophylaxis addressed causes. The P-chart was drawn for the total number of 529 surgical urology patients admitted to the hospital from 1/7/2020 to 31/12/2020 (a total of 529 patients) using each point to represent the total number of weekly admitted surgical urology patients as subgroups.
The following phase was to analyze the measurements obtained from the measure phase to figure out the causes of the unaccepted out-of-control process in order to adjust and correct these causes to improve the process. The analyze phase involved the following activities: Development of a Cause-and-Effect diagram (Ishikawa diagram), and verifying the causes through hypothesis testing.
Summary, C onclusion and Recommendations
85
There was no statistically significant difference between the proportion of incomplete Caprini risk score and the proportion of incomplete Prophylaxis safety consideration checks (p-value = 0.631). So, we concluded that the majority of forms had both sections uncompleted.
After verifying the main contributing causes to poor VTE prophylaxis practices compliance in the Analyze phase, we moved on to find and implement the relevant improvement solutions in the Improve phase.
The executed activities in the Improve phase included the following: Identification of plans for improvement opportunities, Designing the future state for defined improvements, Establishment of performance improvement measurable objectives, Training of the process owners, and starting the improvements piloting. The project team had conducted several brainstorming sessions to select the best solutions to act on the resulted root causes in the analyze phase that were mainly related to VTE risk assessment practices. The generated ideas were listed and voted upon so that they have been focused on three main pillars as follows: The development of a clear VTE prophylaxis maneuvers pathway, The involvement of electronic health informatics tools to help in the process of risk assessment and prophylaxis prescription and make them as user-friendly as possible, and purchasing of the deficient logistics to implement the proper prophylaxis measures (mainly the intermittent pneumatic compression devices). The developed VTE prophylaxis pathway has been then reviewed several times before referring to as a reference to design the hospital electronic Health Information System (HIS) interfaces by the HIS developers under the supervision of the continuous quality improvement & patient safety supervisor as a mentor.
In this phase, we had to control for any unexpected errors that may affect our implemented system improvements. Making use of our team expertise-each in his/her field- we came up to conduct the following activities to achieve the desired outcomes of that phase: Measure results and manage change, report results and design the future process plan, Construct the future control plan, appreciate efforts and celebrate the success. The control phase continued for a time period of about 6 months starting from 1st July to 31st December., 2021 and included a total of 881 patients. All the VTE prophylaxis practices-related measurements were documented by the Continuous quality improvement & patient safety supervisor on a daily basis through a specially designed data collection tool then, using it for filling the designed data aggregation Excel sheet. Bi-weekly briefing meetings had been held between all project team members to highlight the process performance and overcome obstacles if any to control for any violations. At the end of the control phase, a detailed report was presented to the top management including the results of the pre-set objectives in the Improve phase.
There were no points of specific cause variation on the control chart (p-chart) for defects in the post-intervention phase. This shows us that the thorough process of VTE risk assessment and VTE prophylaxis in the post-intervention phase is maintained within the process control limitations, or that it has fully implemented statistical process control with a yield (an outcome that is free from defects) that is equivalent to 99.4%.