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Utilizing a business model (The 4 Disciplines of Execution) to improve consistency and efficiency in microvascular autologous breast reconstruction
Easton, Joseph
Lax, Elizabeth
Dale, Elizabeth
University of Cincinnati Medical Center
2020-01-31
Presenter: Easton, Joseph
Affidavit:
This data and abstract has not been presented at any other meetings or conferences
Director Name: Ann Schwentker
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
BACKGROUND
Microvascular free flap procedures require significant resources and coordination of many clinical teams. The "Four Disciplines of Execution" (4DX) is a method for quality improvement that has been previously implemented in business sectors, and could improve consistency and efficiency of the microvascular free flap process.
METHODS
Data from December 2015 to January 2020 was compiled including patients' in-facility time, patients' in-OR time, procedure start time, and procedure end time. 4DX methods were implemented in April 2019 including 1) defining a "wildly important goal (WIG)", 2) identifying lead measures to achieve the goal, 3) displaying data with a real-time "scoreboard" of the measures and 4) utilizing a "cadence of accountability" meeting to develop and commit to improvement. Primary outcome was total case duration time, and secondary outcomes included in-facility to in-OR time and in-OR to procedure start time between the time frames of December 2015 to March 2019, and April 2019 to January 2020. These time frames were compared using student t-tests.
RESULTS
Average case duration time from the first to second time frame decreased from 757 minutes to 623 minutes, lower by 134 minutes (p = 0.0058). Average in-facility to in OR-time decreased from 120 to 117 minutes (p = 0.61). Average in-OR to procedure start time decreased from 64 to 54 minutes (p = 0.00031).
CONCLUSION
Implementing the 4DX methods created more efficient pre-operative workflow and decreased the total operative time of microvascular free flap procedures at our institution by over 2 hours.
