Graduation Semester and Year
Spring 2026
Language
English
Document Type
DNP Project
Degree Name
Doctor of Nursing Practice
Department
Nursing
First Advisor
Kimberly Siniscalchi
Abstract
Prolonged in-room wait time in an outpatient orthopedic oncology clinic was identified as an important driver of dissatisfaction and operational inefficiency. Baseline in-room times in this setting were reported as M=96.2 minutes for patients receiving injections and M=92.9 minutes for those not receiving injections. This quality improvement project used Lean Six Sigma (LSS) DMAIC (Define, Measure, Analyze, Improve, Control) framework to streamline clinic workflow for the joint injection process. Over an eight-week period, four key interventions were introduced: a standardized order set for medications, pre-bundled supplies and portable supply toolbox, telephone pre-consenting of patients, and optimized scheduling of patients. A total of N=449 visits were analyzed (n=219 pre-intervention; n=230 post-intervention). For patients receiving injections, mean in-room time increased by 3.9 minutes, from M=96.2 to M=100.1, p=.592. For patients not receiving injections, the mean in-room time decreased by 4.6 minutes, from M=92.9 to M=88.3, p=.246). Although these time differences were not statistically significant, descriptive staff survey responses suggested improved workflow. Most notably, the proportion of staff who reported leaving the room for missing supplies decreased from 57% to 0%. While the project did not meet its primary goal of reducing injection-related room time by 30 minutes, possibly due to significant staffing turnover and the complexity of the oncology population, it did successfully improve staff workflow and supply chain efficiency. These findings suggest that LSS principles can enhance the clinical workflow, even when external variables impact quantitative time metrics.
Keywords
Lean Six Sigma, DMAIC, Orthopedic oncology, Joint injections, Workflow optimization, Quality improvement
Disciplines
Nursing | Other Nursing
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Recommended Citation
Byrd, William Alexander, "Optimizing Efficiency in Joint Injections in an Outpatient Orthopedic Oncology Clinic Using Lean Six Sigma" (2026). Doctor of Nursing Practice (DNP) Scholarly Projects. 116.
https://mavmatrix.uta.edu/nursing_dnpprojects/116