Authors (including presenting author) :
Lam WK(1), Lee YH(2), Li CH(2), Yip SF(1)
Affiliation :
(1)Department of Clinical Pathology, Tuen Mun Hospital, (2)Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital
Introduction :
Iron deficiency in children has significant implications for their growth and development in addition to iron deficiency anaemia. While readily treatable, under-diagnosis and under-treatment of this condition pose a significant challenge in clinical practice. This study employed Lean Six Sigma, a process improvement methodology commonly used in industry, to analyse the diagnostic process for paediatric iron deficiency, identify root causes of under-diagnosis and under-treatment, and implement data-driven solutions within our hospital setting.
Objectives :
To evaluate the impact of a Lean Six Sigma intervention on paediatric iron deficiency management within the New Territories West Cluster (NTWC).
Methodology :
A five-phase Lean Six Sigma (Define, Measure, Analyse, Improve, Control) approach was used. Pre-intervention (July-December 2022) and post-intervention (November 2023-April 2024) assessments evaluated diagnostic and treatment practices for paediatric iron deficiency in NTWC. Patients with known iron deficiency, current iron replacement, or transfusions within one year were excluded. Data included ferritin levels, iron profiles, clinician identification of iron deficiency, iron replacement prescriptions, and red cell parameters. Anaemia was defined per World Health Organization (WHO) criteria. Failure Mode and Effect Analysis and fishbone diagrams were used to identify root causes. Statistical significance was set at p≤0.05.
Result & Outcome :
Results: Pre-intervention, the diagnosis rate was 54.7% (1.6σ) and the iron replacement prescription rate was 50% (1.5σ). WHO-defined anaemia prevalence was 71.9%. Patients receiving iron replacement showed significantly greater haemoglobin improvement than those without (median 2.3 g/dL vs. 0.1 g/dL, p< 0.001). Two key problems were identified: 1) ferritin reports lacked the paediatric diagnostic cut-off (< 45 pmol/L); 2) lack of clear guidance for iron deficiency management. Two interventions were implemented: 1) adding the diagnostic cut-off to ferritin reports; 2) paediatrician education on iron deficiency. Post-intervention, the diagnosis rate increased significantly to 86.9% (2.6σ) (p< 0.001), and the iron replacement prescription rate rose to 75.4% (2.2σ) (p=0.002). A reference guide and annual training for diagnosing and managing paediatric iron deficiency were implemented for sustained improvement.
Conclusion: This Lean Six Sigma intervention significantly improved paediatric iron deficiency diagnosis and treatment. This demonstrates Lean Six Sigma’s potential to enhance not only workflows but also diagnostic accuracy and treatment, ultimately improving patient care.
