Establishment and implementation of an improvement plan using Lean Six Sigma methodology to minimize variation in ordering laboratory tests

• Published in: Journal of the Arab Society for Medical Research 2022-07, Vol.17 (2), p.166-179
• Main Authors: Gomaa, Salwa, Abaza, Mona, Rashwan, Reham, Dowidar, Nabil, Elgaddar, Ola
• Format: Article
• Language: English
• Subjects: Analysis; laboratory request; lean six sigma; Methods; misutilization of laboratory tests; Quality control; quality improvement
• ISSN: 1687-4293; 2090-3286
• DOI: 10.4103/jasmr.jasmr_19_22

Background/aim Ordering laboratory (laboratory) tests by physicians is a part of the pre-preanalytical laboratory phase, which is a high error-prone process. Many of the laboratory tests ordered are unnecessary, where excess ordering represents as much as 25-40% of all ordered tests. The present study aimed at establishing and implementing a quality improvement project to avoid misutilization of laboratory tests using the Lean Six Sigma (LSS) methodology that could help to minimize variation in the laboratory requests ordered by clinicians. Materials and methods LSS approach methodology with its five phases, namely, define, measure, analyze, improve, and control (DMAIC), was applied to define and solve the problem of ordering of inappropriate laboratory tests. Sigma levels of the ordering process of selected laboratory tests were measured before and after implementation of the selected solutions. The stability and capability of the ordering process were retested after implementing the project. Results The sigma level of alanine aminotransferase/aspartate aminotransferase tests ordering process has been improved to 1.2 sigma, which represented 45% improvement. The sigma level of urea and creatinine ordering has been improved to 2.16 sigma, which represented 43.1% improvement, saving about 14 520 LE per year. Conclusion Successful implementation of LSS significantly improved laboratory test ordering. Simple modification in the laboratory request form could be an important source of improvement and a cost reduction tool in the pre-preanalytical laboratory phase. LSS is an evidence-based powerful tool that could improve the health care sector in general and the clinical laboratories in particular.