System Improvement to Increase Last Case Efficiency and Decrease Overtime

Bineyam Gebrewold1 Corina Voicu2, Esther Mena2, Natarsha Fields2

May 27, 2015

Nuclear Medicine/PET Center

Team members

Bineyam Gebrewold: Project leader (Technologist)

Corina Voicu : member (Supervisor)

Esther Mena : member (Physician)

Natarsha Fields : member (PSC)

Objectives

• Describe our efforts to improve last case efficiency by applying the Lean sigma system improvement concept.

• To demonstrate the impact of innovative utilization of existing resources in workflow improvement.

QI Project “Elevator Speech”

• In PET-CT department Residents and Technologists were required to stay for unplanned overtime due to poor last case efficiency.

• This project improved the last case efficiency by applying the lean sigma system improvement concepts.

JHH Strategic Priorities

• Integrity: Innovative model of care delivery …. Enhance quality and reducing cost.

• Our Department’s mission is to improve the public health and well being by ……., supplying an outstanding education for our residents, fellows

Six Sigma DMAIC QI Stages

Define

Measure

Analyze

Control

Improve

Lean Sigma, Prescription for Healthcare. Armstrong Institute for Patient Safety

and quality. Johns Hopkins Medicine. Rev Sep-2014. 6

Problem Statement

Work flow efficiency in PET-CT is particularly challenging because of combination of out patient and inpatient being scheduled through out the day.

Inefficiency results in delays and ultimately, the necessity for technologists and residents to stay over time.

The Residents overtime violates the residency duty hours standard set by Accreditation Council for Graduate Medical Education (ACGME).

The Technologists overtime may lower staff satisfaction and incurs additional avoidable expense to the department.

Project Goal and Scope

To improve last

case efficiency in PET-CT

department from base line of

47 %

in September 2014 to

90 %

in February 2015.

Project Benefits

– Hard Benefits

• Compliance with residency duty hours set by ACGME.

• Minimize unplanned over time.

– Soft Benefits

• Increase staff satisfaction.

• Increase patient satisfaction.

Project Name: System Improvement to Increase

Last-Case Efficiency and Decrease

Overtime in PET-CT

Champion:

Rathan Subramaniam M.D., Ph.D

Quality Advisor: Jeff Leal

Problem Statement:

Work flow efficiency is highly impacted by the timeliness of the first-case of the day in a department like PET-CT that require longer physiological preparation before a scan can be done. Patient scheduling in PET-CT is carefully designed to avoid camera down time, as soon as a patient scan is completed the next one will follow with in a minute. Any delay in a patient scan will have a cascade effect on the subsequent scans leading to poor last case completion rate and unplanned overtime.

Project Goal:

To improve last-case efficiency in PET-CT department from base line of 47 % in September 2014 to 90 % in February 2015.

Project Y / Path-Y:

Percentage of last cases completed before 5:00 pm.

Scope:

First and last case of the day in PET-CT division from September 2014 to April 2015.

Team Members:

Bineyam Gebrewold: Project leaderCorina Voicu : member (Technologist)Esther Mena : member (Physician)Natarsha Fields : member (PSC)

Benefits:

Minimize unplanned over time.Compliance with residency duty hours set by ACGME.Increase staff satisfaction.Increase patient satisfaction.

Project Charter

8/4/2016 11

Identification of Process Waste

Waiting

Over Production

Six Sigma DMAIC QI Stages

Define

Measure

Analyze

Control

Improve

Lean Sigma, Prescription for Healthcare. Armstrong Institute fro Patient Safety

and quality. Johns Hopkins Medicine. Rev Sep-2014. 13

Baseline Data (September, 2014)

• Data was collected everyday using a spread sheet form.

• Data accuracy was verified by comparing with time stamp information in the PACS system. 0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Before5:00

5:00-5:30 5:31-6:00 After 6:00

47%

33%

13%

7%

JHU PET/CT Percentage distribution of Last Patient Of the Day for September, 2014

Interventions

• Start the first case 30 minutes earlier (6:30 am)

• Change in patient scheduling.– No in-patients in late afternoon

– Reduce successive inpatients

– No cardiac viability after 12:00 pm.

• Change in residents work distribution.

• Change in Staff schedule. (Add early techs)

• Eliminated unnecessary delayed scans.

• Staff education and empowerment.

Six Sigma DMAIC QI Stages

Define

Measure

Analyze

Control

Improve

Lean Sigma, Prescription for Healthcare. Armstrong Institute fro Patient Safety

and quality. Johns Hopkins Medicine. Rev Sep-2014. 16

Results and Outcomes

91% of last cases completed before 5:00 pm by April, 2015.

Patient volume increased by

from September, 2014.

No Staff overtime reported for the last three months.

44 %

I

n

c

r

e

a

s

e

I

n

c

r

e

a

s

e

20%

Projected in February- Achieved in April

8/4/2016 Bineyam Gebrewold Rad QI 2015 18

0%

10%

20%

30%

40%

50%

60%

70%

80%

Before 5:00 5:00-5:30 5:31-6:00 After 6:00

47%

33%

13%

7%

80%

10% 10%

0%0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Before 5:00 5:00-5:30 5:31-6:00 After 6:00

47%

33%

13%

7%

91%

9%

Sep vs. Feb Sep vs. April

JHU PET-CT Percentage distribution of Last Patient from Sep, 2014 - April, 2015

8/4/2016 Bineyam Gebrewold Rad QI 2015 19

0%

20%

40%

60%

80%

100%

47%

60%

76%65%

85%80%

73%

91%

Before 5:00 5:00-5:30 5:31-6:00 After 6:00

Lessons Learned

Lean sigma concepts are instrumental to improve efficiency in imaging departments.

Data collection is often challenging and needs patience.

Testing accuracy of data should be done at the early stage of the project.

Seeking continuous feedback and advise from champions and colleagues is a key for project success.

Six Sigma DMAIC QI Stages

Define

Measure

Analyze

Control

Improve

Lean Sigma, Prescription for Healthcare. Armstrong Institute fro Patient Safety

and quality. Johns Hopkins Medicine. Rev Sep-2014. 21

What’s the Next Step

• Second phase: (Refine Operation)

– distribution of the work through the day.

– achieve 45% of completion 12 noon.

What’s the Next Step

Control

• Maintain and improvise patient scheduling template.

• Maintain staff scheduling.

• Monitor the trend periodically.

The Result of Efficiency

August 4, 2016 Gebrewold 24

Thank You