P-206: Decreasing length of stay in diabetes clinic in a tertiary teaching hospital
E Klamet, S Carzoo, B Edwards, H Stinson, K M C Hong, J Indyk, D Buckingham, M KambojAbstract
Introduction
Pediatric Type 1 Diabetes (T1D) clinic visits are lengthy, based on need to see the provider and regular visits with nutrition, education, and social work. T1D clinic visits often exceeded length of stay (LOS) >120 minutes. Patient/family surveys confirmed dissatisfaction. We aimed to optimize clinic workflows to focus on non-value process waste to reduce visit LOS <120 minutes.
Objectives
Increase visits with average LOS <120 minutes from baseline 58% in 2024 to 72% by 12/31/2025.
Methods
A multidisciplinary QI team was formed. The five-phase “DMAIC Six Sigma” methodology to optimize T1D clinic healthcare delivery was utilized as noted:Define - Gathered “voice of the patient” expectations for clinic visits inclusive of meeting with each team member.Measure - Drew process maps to visualize visit flow and identify inefficient handoffs, delays, gaps, and redundancy. Sample time studies collected data for various care segments to evaluate the impact of non-value-added process steps.Analysis – Performed root-cause analysis of delays to determine key drivers, suggesting potential solutions to improve efficiency. Targeted interventions were chosen to test the impact on LOS duration.Improve - Prioritized interventions were aligned using a key driver diagram. Implementation followed the Plan, Do, Study, Adjust scientific test of change method. Control -Sustained new workflows and interventions implemented at both system and staff levels.
Results
From baseline average 58%, care delivery quickly accelerated service to 68%, ultimately sustaining at average 71% patient visits <120 minutes. Project impact achieved an effective 22% improvement. (FIG)
Conclusions
Reducing clinic LOS was successful. The DMAIC Six Sigma framework was inclusive of feedback from the patients, families, clinical and non-clinical staff. This initiative is now a standard of care in our clinic.