Lean Six Sigma Prevents 96 Acute Kidney Injuries and Saves $675,000 Annually in High-Volume Cardiac Catheterization Lab Program

The goal of this project was to reduce the incidence of contrast-induced neuropathy (CIN) as a result of percutaneous coronary intervention (PCI). From January to May 2014, the cardiac catheterization lab completed 735 diagnostic-only procedures and 487 diagnostic and intervention procedures. The contrast volume (CV) mean was 124 mL, and there were 148 cases with CV dose greater than their glomerular filtration rate (GFR x 3.7). Key improvements included the implementation of procedural Time-out process, starting in May 2014, which included declaration of pre-procedural GFR and a recommended upper CV limit defined by evidence-based literature predictive of CIN (GFR x 3.7).

From May to October 2014, the cardiac catheterization lab completed 978 diagnostic-only procedures and 217 diagnostic and intervention procedures. The contrast volume mean was 98 mL, a 21 percent reduction, and there were 65 cases with CV greater than their GFR x 3.7. Incidence of CIN following PCI decreased from 12 percent to 8 percent or 96 cases annually. Annualized cost savings for contrast utilization, length of stay and prevented cost of care were $675,000.

This case study is part of the Illinois Health and Hospital Association's annual Quality Excellence Achievement Awards. Each year, IHA recognizes and celebrates the achievements of Illinois hospitals and health systems in continually improving and transforming health care in the state. These organizations are improving health by striving to achieve the Triple Aim—improving the patient experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita cost of health care—and the Institute of Medicine's six aims for improvement—safe, effective, patient centered, timely, efficient, and equitable. To learn more, visit https://www.ihaqualityawards.org/javascript-ui/IHAQualityAward/