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Memorial Health System: 30% Reduction in Wait Times Using DMAIC Todd S. Roberts, MBA, CLSSMBB Administrator, Quality and Safety Memorial Health System
| Date post: | 15-Jul-2015 |
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Memorial Health System:
30% Reduction in Wait Times
Using DMAIC
Todd S. Roberts, MBA, CLSSMBB
Administrator, Quality and Safety
Memorial Health System
SIMUL8 Corporation | SIMUL8.com | [email protected]
1 800 547 6024 | +44 141 552 6888
Presenters
Todd S. Roberts
Administrator, Quality and Safety
Memorial Health System
Brittany Hagedorn
SIMUL8 Healthcare Lead, North America
LEED AP
SIMUL8 Corporation
Systems thinking is the ability to see things as a whole (or holistically), including the many different types of relationships between the diverse elements of a complex system
Necessary component of “learning organizations”
Takes cause-and-effect thinking to a higher level and encourages the user to see not just the linear causal connections but also the web of causal interconnections that come into play in real systems
“The Fifth Discipline”
“Adjusting the system or process
inputs to produce the best possible
average response with minimum
variability”
System Optimization
The sensitive
dependence on initial
conditions, where a
small change at one
place can result in
large differences to a
later state.
Butterfly Effect
Three types of failures in complex systems:
– Procedural• Failure to adhere to/execute a defined process
• Single, obvious mistakes
• Special-cause variation
• Plan, Do, Check, Act or corrective action
– Engineered• People, process, materials
• Common-cause variation
• Defined processes
• Lean Six Sigma projects
– System• Complex interactions between processes and risk factors
• Difficult to understand and pinpoint cause and effect relationships
• Discrete event simulation
Failure in Complex Systems
The Emergency Department CT machine experiences high volumes with at times high amounts of back up causing delays in patient care. In the past the ED CT department has used several experimental initiatives such as: additional tech assistants and doing patient work-ups ahead of time. The department was no longer able to work up patients ahead of time, as the needed staff were no longer available. Prior process work was done, showing the benefit of having an extra FTE, however request were unsuccessful.
The ED CT Department has been frontloaded with moving towards more CT exams without oral contrast.
There is additional project work showing more lab test for fewer CT tests, in order to rule out DVT
Stroke and Trauma services compete for CT services
When the ED CT scanner is backed up, the patient flow process moves patients up to the Medical Imaging first floor CT machine.
Emergency Department Case Study
Background
DEFINE MEASURE ANALYZE IMPROVE CONTROL
Wait times for patients causes delays in patient care. This causes an increase in anxiety for the patient, a delay in receiving a definitive diagnosis, as well as a delay in the treatment plan.
Press Ganey 30th Percentile for ED Radiology Wait Times
ED CT machine is the most used in the system
Lost Revenue
Business Case
• ED CT Department
• TAT CT Exam ordered vs.
Started
OUT OF SCOPE• MMC 1st floor CT
• Baylis CT
• Dictation process
• TAT Results Received vs.
Discharge Time
Project Scope
IN SCOPE
Insert your process map here
Project CharterProblem Statement: The Emergency Department CT machine is the busiest in the health
system, however the delays in ED CT Throughput of patients creates cost on the
organization, decreases staff satisfaction, creates quality concerns, and decreases patient
satisfaction with increased patient wait times averaging an hour from ordered to started.
Who is/are the customer(s): Patients, Ordering Clinician, Medical Imaging, Families, MHS,
Radiologists, Nurses, Emergency Department
What is the Cost of Poor Quality (COPQ): Harm and pain to patients, delay in treatments plans
for patients, waste of machine/room usage, nursing time with patients
What is Critical to Customer Satisfaction (CTS) or Critical to Quality (CTQ): Timely Efficient
Patient Centered
Current Project Y: CT completed in Emergency Department in a timely manner
Project Y Specification: Start CT Exam in ED within 45 minutes of being ordered
Project Y Metric: TAT CT Started vs. CT Ordered
Defect Definition: CT Exam starting > 45 minutes from being ordered
Project Objective: Reduce TAT from CT Exam ordered versus CT Exam Started
Unit Definition: CT Exam in ED
Baseline Zst: 2.0 Baseline DPMO: 539,125
DEFINE MEASURE ANALYZE IMPROVE CONTROLMEASURE
Focus
CT Paged to TA Sent- 40:31 minutes
TA Sent to Patient Arrival- 5:05 minutes
Patient Arrival to Landmarked- 3:57 minutes
Total Average time from Paged to Scan Occurring- 49:33 Minutes
15 of the 38 cases observed, patient was not ready
Is the Patient Ready for CT Exam?
DEFINE MEASURE ANALYZE IMPROVE CONTROLANALYZE
Why are ED Staff paging that a Patient is ready?
• ED Staff assume patient is prepped accordingly and labs are complete and that the patient is ready for CT.
What do they believe this? • The pre-labs are ordered and staff believe they are
complete.
Why do they believe they are complete?• Because no one in the ED is validating that the labs are
or are not complete before the CT Exam.
Why is no one validating that the labs are not complete?
• The resources needed to do so, are not present or available in the department.
5 Whys Analysis
Patients are not ready for their CT in the ED upon page because the needed resources are not available to validate that the patient is ready.
Point of Care testing, this includes both creatinine and pregnancy testing, is not taken advantage of on the patients that require pre-CT Lab testing (CT with Contrast).
Critical Inputs
Micro problem Statement
CT Exams performed in the ED require a patient to be properly prepped and ready for their exam. Patient needs to have the proper IV in place, dressed appropriately, restroom used, jewelry off, consents complete, and the required pre-CT labs complete. When this is not complete it causes a delay in patient care with increased patient wait time, averaging an hour from ordered to start. These delays can be attributed to lack of resources in order to validate the patient is ready for the exam and Point of Care testing not being taken advantage of in the ED.
Determine whether the implementation of
an additional technician assistant will
improve CT turnaround time
ED Simulation Goals
Compared both a day and a week elapse
Based on ED CT Data for May, June, and July
Compares Current State with 1 CT Tech Assistant vs. 2 CT Tech Assistants
Based on time CT is ordered vs. CT started
Simulation Model
Queuing Model Results
Current State
1 Day Elapse
Queuing Model Results
Extra Tech Assistant
73% have CT within 30 minutes of order
27% reduction in longest time a
patient waits
1 Days Elapse
Queuing Model Results
Current State
1 week elapse
Queuing Model Results
Extra Tech Assistant
33% reduction in longest time a patient waits
82% Patients are having CTs within 36 minutes of order
1 Week Elapse
DEFINE MEASURE ANALYZE IMPROVE CONTROLIMPROVE
New CT Tech Asst Process
CT Tech Assistant• 7 days a week, 11:00-7:30• 1.5 FTEs • Patient Prep
• Jewelry• Clothing
• Communication of Delays • Consent forms• Screening forms• Confirmation of labs• Transports Pt to ED Scanner• Transports Pt to main MI if
needed • Communicates with ED Staff
CT TA Intervention Results
UCL 3:40:393:20:11
CL 1:36:491:10:36
0:00:00
1:12:00
2:24:00
3:36:00
4:48:00
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tart
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Patient Enounter
ED CT Tech Asst. ResultsComparison Hours 11:00-19:30
27% Reduction in
Wait Time
Baseline Z Score= 2.0 Pilot Z Score 3.49
Requires deep process understanding (avoid tampering)
Creates a shared visual understanding of the process for all parties
Allows for observational analysis and modification without physical intervention in a complex environment (offline trial and error)
Supports improved decision-making through management by fact
Discrete Event Simulation Benefits
House-wide patient placement (PACU, ED,
direct admits, etc.)
Pharmacy IV compounding production
ED intake process (critical access hospital)
System (hospital) CT utilization optimization
Emergency department “pod” structure
ED admission handoff process
Current Projects
SIMUL8 Corporation | SIMUL8.com | [email protected]
1 800 547 6024 | +44 141 552 6888
QUESTIONS
• Please forward any topics you would like
to see covered to [email protected]
• Continue the discussion on SIMUL8 in
Health – LinkedIn Group
