Business Issue

All medications are not created equally. Reopro (generic name: abciximab), Integrilin (generic name: eptifibatide) and Aggrastat (generic name: tirofiban) are all platelet-inhibiting drugs used in cardiac care. Each is priced differently. They act on patients in slightly different but clinically significant ways. The key critical to quality issue in healthcare is patient safety. Costs are a very close second.

The classic Six Sigma DMAIC (Define, Measure, Analyze, Improve, and Control) methodology is used to summarize this healthcare success story.

Define

The healthcare provider wanted to see if evidence-based medicine, using rigorous Six Sigma statistical methods, could or would promote a more standardized formulary. If so, volume purchasing of this single drug in only one hospital would yield improved patient outcomes and a $265,000 annual savings. The project champion, a doctor of pharmacy, wanted to investigate patient outcome variations in patient lengths of stay, blood utilization and complications.

• Null Hypothesis 1 (H1): There are no differences in lengths of stay related to the use of different platelet inhibiting drugs.
• Null Hypothesis 2 (H2): There are no differences in blood utilization related to the use of different platelet inhibiting drugs.
• Hypothesis 3 (H3): There are no differences in the number of complications seen with the use of different platelet inhibiting drugs.
• Hypothesis 4 (H4) There are no financial effects associated with the use of different platelet inhibiting drugs.

Measure

This project took place during a nine-month Black Belt training course. In addition, an undergraduate student was employed over the course of a two-week period of time to complete a comprehensive literature search comparing the three medications that were being scrutinized.

One-way ANOVAs (analysis of variance) were designed to compare lengths of stay, surgical complication rates, blood utilization, and cost outcomes. In addition, correlation analyses, designed experiments, Pareto charts, quality control charts, and other statistical tools were used to compare 100 percent of the physician practice patterns.

Analyze

Statistically or economically significant differences emerged immediately in all areas of study. Results observed in-house mirrored 10 years of published data in peer-reviewed journals. In the context of this medical community, a decision was reached to eliminate Reopro and Aggrastat from the formulary. Deciding factors included significantly improved patient safety, better outcomes with fewer complications and a system-wide savings of more than $1 million dollars.

Improve

The political process of presenting the data to the medical staff took months of time. The actual data collection and analysis process took only a few weeks.

Control

Standardization based on patient safety offers health maintenance organizations any number of breakthrough opportunities.

Financial Results

Conservative first-year, system-wide cost savings exceed $1 million. In addition the lower lengths of stay created new treatment capacity, which had a very favorable effect on productivity and bottom line performance results. Total time for this Master Black Belt consulting project was six months.