Assessing Nursing Time Spent Tracking Equipment University of Michigan Health System (UMHS)

Program and Operations Analysis

Final Report

Submitted to:

Hank Davis Patient Equipment Manager, Material Service

Frank Krupanksy

Director, Materiel Services

Jackie Lapinski Project Manager, Children’s and Women’s Project

Submitted by:

Team Number 9, IOE 481:

Kevin Brown Norman Chao

Benjamin Killmer Limor Yoeli

Date Submitted: December 1, 2008

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Table of Contents

Executive Summary .......................................................................................................... 4

Introduction ....................................................................................................................... 6 Goals and Objectives .............................................................................................................. 6 Background ............................................................................................................................. 6 Project Scope .......................................................................................................................... 7

Overview of Project .......................................................................................................... 7 Support Required from Operating Entities ............................................................................. 7 Expected Impact ..................................................................................................................... 8 Approach................................................................................................................................. 8

Findings .............................................................................................................................. 9 Nursing Time Spent Tracking Equipment ............................................................................ 10 Nursing Observations ........................................................................................................... 11 Frequency of Equipment Requests ....................................................................................... 11 Tracking Times by Equipment Type .................................................................................... 12

Conclusions ...................................................................................................................... 13

Recommendations ........................................................................................................... 14 Investigate Materiel Services ................................................................................................ 14 Investigate Redistribution of Unit-Owned Equipment Allocation ....................................... 14 Investigate Patient Mobility .................................................................................................. 14

Appendix A: Data Entry Form ...................................................................................... 15

Appendix B: Patient-Owned Equipment ...................................................................... 16

Appendix C: Unit-Owned Equipment .......................................................................... 17

Appendix D: Nursing Personnel Equipment Tracking Flowchart............................. 18

Appendix E: Interview Questions for Nursing Personnel ........................................... 19

Appendix F: Count of Observed Equipment Requiring Active Tracking Time ....... 20

Appendix G: Count of Observed Equipment Requiring Waiting Time .................... 21

Appendix H: Bibliography of Investigated Works from Literature Search ............. 22

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List of Tables and Figures Table 1: Observation Times by Nursing Type ............................................................... 9 Table 2: Observation Times by Location........................................................................ 9 Table 3: Summary of Nursing Tracking Times per 8 Hour Shift (Hour:Min:Sec) .. 10 Table 4: Summary of Active Nursing Tracking Time (Hour:Min:Sec)..................... 12 Table 5: Summary of Nursing Waiting Time (Hour:Min:Sec) .................................. 13

Figure 1: Tracking Time Breakdown ........................................................................... 10 Figure 2: Equipment Requests by Nursing Unit .......................................................... 11 Figure 3: Equipment Requests by Equipment Type ................................................... 12

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Executive Summary In preparation for the new C.S. Mott Children’s Hospital and Women’s Hospital (C&W), the University of Michigan Hospital System (UMHS) requested that a team of engineers investigate the time nursing personnel spend tracking equipment. This report is a detailed account of our analysis of the current equipment tracking procedure across five nursing units (PCTU, NICU, 5 East, 5 West and Birthing Center), our evaluation of the procedure and recommendations for future investigation. Hank Davis, Patient Equipment Manager of Materiel Services; Frank Krupanksy, Director of Materiel Services and Jackie Lapinski, Project Manager for Children’s and Women’s Project, asked the team to quantify the time nursing personnel spend tracking equipment and gain staff level insight about the pros and cons of the current tracking system. To develop an initial project approach, a literature search was conducted. The search focused on the data collection techniques such as Westinghouse Multifactor Pace Rating System and its rating factors – skill, effort, conditions, and consistency. The literature search also included research on how nurses spend time working in hospitals and how to conduct effective time studies. During the next phase of the project, 12 employees were interviewed for 20 minutes each to gain staff level insight about the current tracking system. The nursing personnel unanimously felt that the implementation of the Periodic Automatic Replenishment (PAR) was a pro because the system greatly reduced the time spent tracking equipment. The staff felt that a long delivery time was the main con for the current system. Specifically, 50% of the interviewed nursing personnel perceived a significant amount of wait time associated with patient mobility and pumps ordered from the Patient Equipment Department. A lack of unit-owned equipment was expressed by nursing personnel as well as observed in PCTU. In contrast, NICU never experienced a shortage of unit-owned equipment and appears to have an excess inventory of unit-owned equipment. This equipment disparity was confirmed by PCTU staff who also stated that sometimes they find it necessary to borrow equipment from NICU or hoard certain types of equipment to have an extra readily available (specifically pacemakers). After conducting staff interviews, the current equipment tracking process was defined by observing the nursing personnel at the hospital. Depending on the nursing unit, 1 to 3 staff members were shadowed and any equipment that the staff member tracked was recorded. A total of 40 visits to Mott hospital, lasting 2 to 4 hours each, were made to document the current tracking processes and volume of equipment being tracked. Data samples were collected across six different shifts – morning, evening, and nighttime, for both the week and weekend. The team visited all five available nursing units. In total, 73 individual pieces of equipment were observed. Nursing personnel aggregated across the five units spend approximately 29 minutes per shift actively tracking equipment. Total equipment tracking time including wait time ranged from 18 minutes in the NICU to 1.5 hours per shift in the PCTU and Birthing Center. Of the pieces of equipment that required waiting time, 79% were pumps and

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patient mobility. Typically, patient mobility equipment required the most waiting time. After examining the current situation and other references, the team developed several statistics to illustrate and quantify the differences in equipment tracking across nursing units and indentified several avenues for further investigation. Based on the project findings, Materiel Services should investigate the possibility of expanding the PARs to include other types of equipment. As patient mobility equipment is typically large, it would be impossible to implement a PAR system due to a lack of storage space. Also, the demand does not appear large enough to warrant a PAR system for patient mobility equipment. Instead, UMHS should investigate the routing and order response process for patient mobility equipment to reduce the delivery lag time. Also, UMHS should work to develop a method to express the urgency of an equipment request. Based on observations, Materiel Services should also explore the re-distribution of unit-owned equipment across PCTU and NICU.

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Introduction UMHS is building the new C&W hospital and is searching for ways to improve current nursing tasks such as equipment tracking. The Materiel Services department of the UMHS requested that a team of engineers study the time nursing personnel spend tracking equipment in C.S. Mott Children’s and Women’s Hospital (Mott). The purpose of the project is to identify any problematic areas in the equipment tracking process. This information will be used to influence the design and organization of equipment in the new C&W hospital. The manager of Patient Equipment is primarily concerned with the ordering, managing, cleaning, transporting and inventorying of equipment. The results of the project quantify how much time nursing personnel spend tracking equipment. This report presents an overview of the project, the findings, the conclusions and the recommendations.

Goals and Objectives The goals of the project were to:

• Determine how much time nursing personnel spent tracking equipment • Understand which types of equipment were the most problematic to track • Identify which nursing units were having the most difficulty tracking equipment

UMHS will use the project’s findings and recommendations while designing the material services department at the new C&W hospital to increase the efficiency of the system.

Background UMHS is building a new C&W hospital and would like to study the current hospital to identify areas of potential improvement for the new hospital. Previously, UMHS was interested in the implications of implementing an automated radio-frequency identification (RFID) tracking system for patient equipment in the new C&W hospital. In 2007, a team of Mechanical and Biomedical Engineers completed a partnership project in which they analyzed the potential for an RFID system. UMHS did not implement the RFID tracking system, but requested another study to quantify the amount of time nursing personnel spend tracking equipment to see if a new system should be implemented Prior to this project, a PAR system was implemented to relieve equipment needs in Mott hospital. The PAR system involves periodic replenishment of frequently used pieces of equipment by Materiel Services personnel. Each nursing unit typically has a storage space where frequently used pieces of equipment are stored. Stock levels are checked and replenished accordingly several times a day by Materiel Services staff. Although no historical data were collected before the PAR system, UMHS is interested in staff opinions on the effectiveness of the PAR system.

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UMHS will use the project’s quantitative data to distinguish problematic areas in the equipment tracking process. Specifically, UMHS would like a breakdown of the time spent tracking the following groups of equipment: Beds, Cribs, or Isolettes; Pumps; Patient Mobility; Unit-Owned Equipment; Accessories and Other. In order isolate and understand the effectiveness of the PAR system, any equipment that was tracked using the PAR system was included in the unit-owned equipment category. The tracking process included ordering, managing, cleaning, transporting and inventorying equipment. The following nursing units were observed in Mott hospital: 5 East, 5 West, Birthing Center, Newborn Intensive Care Unit (NICU) and Pediatric Cardio-Thoracic Unit (PCTU). Although the project evaluated processes in Mott hospital, the study will be used to determine if a different tracking system should be implemented in the new C&W hospital. As proposed, the following key issues are driving the need for the project:

• There is a nursing shortage in Mott and in hospitals across the country • There is a lack of equipment storage space in Mott • The new C&W hospital is considering alternate equipment tracking methods • No historical data were collected before the PAR system, but UMHS would like

qualitative data on the effectiveness of the PAR system

Project Scope This project only focused on the equipment tracking process. Any task not directly related to the tracking process was not included in the scope of this project. Specifically, tasks or activities associated with other hospitals or with using the medical equipment were not studied. As defined in the project, the equipment tracking process began when a nurse requested equipment and ended when the nurse received the equipment and completed any additional cleaning or equipment management needed prior to patient use. The project included observations concerning which groups of equipment require extra time or resources and identified any specific problems with particular pieces of equipment. Plans for the new C&W hospital were not evaluated. The project did not include a return on investment analysis, although the project findings may be used for such an analysis.

Overview of Project The project progressed according to the original schedule and proposal definition. The project tasks were completed on schedule and no significant problems or setbacks occurred.

Support Required from Operating Entities The primary parties involved in this project are the Patient Equipment Manager, the Director of Materiel Services, the Associate Hospital Director, charge nurses, registered

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nurses, nursing assistant personnel and the Project Manager of the Children’s and Women’s Project. Hank Davis, Patient Equipment Manager, provided details of the problem at hand, requirements, expectations and contact information. He provided background information on patient equipment including itemized lists and descriptions. He also acted as a liaison between the team and Materiel Services to ensure full cooperation. Finally, Hank Davis provided the team with a report that described the number of orders that the Patient Equipment Department received over a specific week according to shift. Jackie Lapinski, the Project Coordinator, mentored and guided the team. She helped maintain analytical quality and a positive client relationship. The project coordinator provided the team with data collection tools such as stopwatches and clipboards. In addition, she walked the team through a tour of Mott hospital system and additional relevant areas. Finally, the project coordinator provided feedback regarding project progress and assisted the team’s professional development.

Expected Impact Conclusions derived from the project assessed the current tracking system and included staff-level insight into the benefits and shortcomings of the current system. This knowledge will be used to aid the design of the tracking system for the new C&W hospital. Also, the conclusions from this project will be used to evaluate the impact of Materiel Services taking over the delivery of patient mobility equipment on tracking times within the new C&W hospital.

Approach To determine how much time nursing personnel spend tracking equipment in Mott hospital, several steps were taken. The team conducted a literature search, interviewed nursing personnel, observed the nursing units, conducted time studies and analyzed the collected data. Literature Search The team conducted a literature search to understand different time study techniques and hospital equipment tracking methods. The bulk of the research was on the Westinghouse Multifactor Pace Rating System and its rating factors – skill, effort, conditions, and consistency. The team also reviewed research papers outlining how nurses spend time working in hospitals and how to conduct effective time studies. The knowledge gained from the literature search aided in the design of our data collection methods and gave the team a general understanding of the nursing profession. A bibliography of investigated works can be found in Appendix H. Personnel Interviews The project team gathered feedback directly from 12 employees as they tracked equipment. These employees included nine nurses, two clerks, and one tech. The nursing interviews lasted approximately 20 minutes each. Working directly with the nursing personnel ensured that the gathered data is relevant to the tracking process. The

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questions that the team asked the nursing staff can be found in Appendix F. The preliminary interviews helped the team gain a basic understanding of the problem areas in the equipment tracking process. Workplace Observations and Time Studies The current equipment tracking process was defined by observing the nursing personnel work at the hospital. Team members followed 1 to 3 nursing personnel each and recorded any equipment that the nursing personnel tracked. A total of 40 visits to Mott hospital, lasting 2 to 4 hours each, were made to document the current tracking processes and volume of equipment being tracked. The on-site observations were scheduled and confirmed at least a week in advance to ensure nursing personnel availability. The team conducted a preliminary time study to define and categorize relevant nursing tasks. Additionally, the team used a formal time study to quantify the amount of time nursing personnel spend tracking equipment. Stopwatches were used to measure time required to track equipment. Data samples were collected across six different shifts – morning, evening, and nighttime, for both the week and weekend. The team visited all five available nursing units. In total, 73 individual pieces of equipment were observed. The team dedicated 118.25 man-hours to observing the equipment tracking process across the five available units. See Tables 1 and 2 for a breakdown of observation times by nursing type and location.

Table 1: Observation Times by Nursing Type

Nurses Clerks Techs 98.5 hours 16.75 hours 3 hours

Table 2: Observation Times by Location

5 East 5 West Birthing Center NICU PCTU 24.25 hours 16.5 hours 22 hours 18 hours 25 hours Analysis The data gathered through observations, interviews, time studies and physical measurements was combined using Microsoft Excel. The data were organized by type of equipment, key tasks, shift time, and location using pivot tables. Analysis was conducted using Microsoft Excel and MiniTab statistical software.

Findings After the data were analyzed using Microsoft Excel and MiniTab software, several key findings were made clear. These findings represent sample sizes of only three or more pieces of equipment to ensure significance. Also, no beds, cribs or isolettes were observed during any of the data collection sessions.

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Nursing Time Spent Tracking Equipment Total tracking time was divided into two categories – active tracking time and waiting time (see Figure 1).

Figure 1: Tracking Time Breakdown

Table 3 below summarizes nursing tracking times per shift. In terms of total tracking time, nursing personnel spend 1.25 hours per shift actively tracking and waiting for equipment. However, there is a wide range of total tracking times among units. PCTU and Birthing Center nursing personnel spend the most amount of time with an average of 1.5 hours per shift spent actively tracking and waiting for equipment. The average time per shift that nursing spends only actively tracking equipment is 29 minutes. PCTU and Birthing Center spend the most amount of time actively tracking equipment with nearly 34 minutes and 33 minutes, respectively, per shift. NICU spends the least amount of time with 18 minutes per shift.

Table 3: Summary of Nursing Tracking Times per 8 Hour Shift (Hour:Min:Sec)

Only Active and Active Waiting Only Waiting Total Overall per Shift 0:29:16 0:45:35 1:14:51 5 East 0:23:16 0:17:03 0:40:19 5 West 0:28:32 0:35:36 1:04:07 Birthing Center 0:33:09 0:51:55 1:25:04 NICU 0:18:26 -- 0:18:26 PCTU 0:33:37 0:53:33 1:27:11

The amount of time that nurses spend only waiting for equipment to arrive was also investigated. The team observed 14 pieces of equipment that required nursing to wait for arrival. Four of the 14 observed pieces never arrived during the team’s data collection session. For the pieces of equipment that did not arrive, the team recorded how long the pieces were being waited for before the team left. 50% of the observed equipment pieces that required waiting were observed in the PCTU. PCTU and Birthing Center both require an average of around 1.5 hours per shift for pieces that required waiting. NICU did not have any observed pieces of equipment that required waiting times.

Total Tracking Time

Active Tracking Time

Waiting Time

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Nursing Observations Direct feedback was gathered from 12 employees through interviews. The interview questions can be found in Appendix F. All 12 employees mentioned the positive effect that the PAR system had on decreasing tracking times. Since the PAR system includes the unit-owned equipment, the most frequently ordered equipment type, it significantly reduces the number of orders and corresponding wait time. Patient Equipment Department can now respond more rapidly to the remaining orders, reducing overall wait time. However, 50% of the interviewed nursing personnel perceived a significant amount of wait time associated with patient mobility and pumps ordered from the Patient Equipment Department.

Frequency of Equipment Requests Equipment was steadily observed over each of the units, signifying that equipment is requested at a consistent rate across units (see Figure 2).

Count 18 18 14 12 11Percent 24.7 24.7 19.2 16.4 15.1Cum % 24.7 49.3 68.5 84.9 100.0

Location 5 EastNICU5 WestPCTUBirthing Center

80

70

60

50

40

30

20

10

0

100

80

60

40

20

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Coun

t

Perc

ent

Pareto Chart of Equipment Requests by Location

Figure 2: Equipment Requests by Nursing Unit The most frequently observed equipment type was the unit-owned equipment, which accounted for 42% of the observed equipment (see Figure 3).

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Count 31 13 12 9 8Percent 42.5 17.8 16.4 12.3 11.0Cum % 42.5 60.3 76.7 89.0 100.0

Equipment TypeOt

her

Pumps

Patie

nt Mob

ility

Acce

ssorie

s

Unit-Owne

d

80

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Pareto Chart of Overall Equipment Requests

Figure 3: Equipment Requests by Equipment Type

Although nursing units were observed over all times of day, 74% of the observed equipment occurred between 10 a.m. and 10 p.m.

Tracking Times by Equipment Type Of the 73 observed pieces of equipment, 81% did not require any waiting. The average active tracking time associated with equipment that does not require waiting is 3.3 minutes, with a standard deviation of 2.6 minutes (see Table 4).

Table 4: Summary of Average Active Nursing Tracking Time (Hour:Min:Sec)

Around one of every five pieces, or 19%, of equipment required both waiting and active tracking. The two most common pieces of equipment that required waiting were pumps and patient mobility, which combined accounted for 11 of the 14 pieces of equipment. Pumps require an average tracking time of 42 minutes and patient mobility requires 1.25 hours (see Table 5).

Accessories Other Patient Mobility Pumps Unit-Owned Unit Average 5 East 0:03:48 0:02:33 0:02:40 0:10:55 0:02:55 0:03:44 5 West 0:01:46 0:02:38 0:03:53 -- 0:01:27 0:02:16 Birthing Center 0:02:13 -- 0:02:15 0:01:20 0:03:33 0:02:40 NICU -- -- -- -- 0:04:10 0:04:10 PCTU 0:02:15 0:03:15 0:01:30 -- 0:04:28 0:03:53 Equipment Ave. 0:02:22 0:02:42 0:02:40 0:06:07 0:03:47 0:03:19

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Table 5: Summary of Average Nursing Waiting Time (Hour:Min:Sec)

Accessories Other Patient Mobility Pumps Unit-Owned Unit Average 5 East -- -- -- 0:23:00 -- 0:23:00 5 West -- 0:02:00 3:00:00 0:08:00 -- 0:48:00 Birthing Center 2:00:00 -- -- 0:20:00 -- 1:10:00 NICU -- -- -- -- -- -- PCTU -- -- 1:26:50 1:01:15 -- 1:12:13 Equipment Ave. 2:00:00 0:02:00 1:50:07 0:42:17 -- 1:01:28

The average combined waiting and active tracking time associated with the pieces of equipment that required waiting is a little longer than 1 hour. The average pure waiting time for these pieces of equipment is 54 minutes. However, the standard deviation for pure waiting time is 52 minutes.

Conclusions Pure waiting time is a significant contributor to total tracking time for each nursing unit, except NICU. Waiting times also vary greatly within the units, suggesting that it is difficult for nursing to predict when ordered equipment will arrive. Unit-owned equipment is the most frequently tracked type of equipment and is also rarely ordered since it is replenished through the PAR system. In interviews, nursing often expressed dissatisfaction about the waiting time to receive patient mobility equipment and beds. Although beds were never observed, patient mobility was one of the slowest types of equipment to be tracked. Items such as wheelchairs often had to be ordered during busy periods and the waiting process frequently required several hours. Based on the qualitative findings, the PAR system reduces the time necessary to retrieve frequently needed equipment. One of the shortcomings of the current hospital has been a lack of standardization in nursing tasks, as well as facility layouts. Equipment storage systems were not consistent throughout different units, which increased the time nursing personnel spend tracking equipment. In most units, unused equipment was placed in the hallways or other empty spaces because there is a lack of storage space. Several of the designated storage rooms appeared over-packed and unorganized. The lack of storage space also increased equipment tracking times. Management perceptions of the material service delivery times are different from nursing perspectives. For example, management expected PARs to be checked and replenished once per hour for each unit. Through interviews, nursing personnel expressed suspicions that the PARs were being checked less frequently than once per hour. Management also believed that 90% of all equipment requests were filled within one hour of ordering. However, nursing personnel felt that requests require more time and this sentiment has

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been supported by the project’s findings. Delivery times also vary significantly across nursing units.

Recommendations Based on the quantitative and qualitative findings of this project and the analysis that was conducted, the project resulted in several key recommendations. These recommendations include the investigation of current systems and processes including PAR system, equipment allocation, and delivery routes.

Investigate Materiel Services During staff interviews, the success of the PAR system was expressed across the units. Nursing personnel felt that not having to order equipment for each new patient saved a large amount of time. Nursing personnel also confirmed that the PAR re-stocking rate is appropriate for the needs of the units. From the project’s study, PAR-tracked equipment required an average tracking time, including waiting, of less than 4 minutes per piece of equipment, compared with an average of more than 1 hour for other types of equipment. Therefore, the team recommends that Materiel Services investigate the possibility of expanding the PARs to include other types of equipment. The team also recommends investigating how to express the urgency of an equipment request so the system is properly used by nursing personnel.

Investigate Redistribution of Unit-Owned Equipment Allocation Unit-owned equipment comprised over 70% of tracked equipment for NICU and PTCU. This high percentage of equipment verifies that unit-owned equipment is critical to both NICU and PTCU. A lack of unit-owned equipment was expressed by nursing personnel as well as observed in PCTU. In contrast, NICU never experienced a shortage of unit-owned equipment and appears to have an excess inventory of unit-owned equipment. This equipment disparity was confirmed by PCTU staff who also stated that sometimes they find it necessary to borrow equipment from NICU or hoard certain types of equipment to have an extra readily available, specifically pacemakers. The team recommends that Materiel Services investigate the re-distribution of unit-owned equipment across PCTU and NICU.

Investigate Patient Mobility Patient mobility and pumps were the only categories that had a significant number of equipment pieces require waiting. Patient mobility required an average of 1 hour and 50 minutes of wait time, compared with 40 minutes for pumps. The long wait times associated with patient mobility were confirmed during staff interviews. As patient mobility equipment is typically large, it would be impossible to implement a PAR system due to a lack of storage space. Also, the demand does not appear large enough to warrant a PAR system for patient mobility equipment. Instead, the team recommends investigating the routing and order response process for patient mobility equipment as a means of reducing the lag time associated with delivery.

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Appendix A: Data Entry Form

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Appendix B: Patient-Owned Equipment

Patient-Owned Equipment List Name Category Wall Suction* Accessory Iv Poles DME Wheelchairs Mobility Stretchers Mobility Alaris Single Pump DME Medfusion Syringe Pump* DME Flowtron Compression Device DME Syringe Pump (Baxter) DME Alaris Pump DME Kangaroo Feeding Pump DME PCA Pump DME Warmflo Blood/Solution Warmer DME Pacemaker DME Omni Flow DME Gaymar T-Pad DME Bair Hugger DME Epidural Pump DME Portable Suction DME General Care Beds Mobility Birthing Beds Mobility Cribs Mobility Isolettes Mobility Marquette Monitor DME Blanketroll II Other Wound Vac (Rental) ² DME HEPA Filter ² Other ICP Monitor DME Crash Carts Mobility Peritoneal Dialysis Cycler DME Moblvac DME Triology Pump DME Wedge Frame Other Foot Compression DME Flolan Pump DME

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Appendix C: Unit-Owned Equipment

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Appendix D: Nursing Personnel Equipment Tracking Flowchart

Identify equipment needed

Is equipment unit owned?Walk to Clerk Search for

equipment YesNo

Request Order

Wait

Walk to Clean Room

Walk to Storage Room

Walk to Soiled Room

Equipment Found?

No

Yes

Equipment Clean?

No

Clean Equipment

Equipment Arrive?

Yes

Take Equipment to Room

Yes

No

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Appendix E: Interview Questions for Nursing Personnel

• Currently, what is the procedure you follow for tracking equipment? • Which equipments do you use most often?

o Can you estimate roughly how many times per day? • Which equipments do you use least often?

o Can you estimate roughly how many times per day? • What is your procedure if tracking a piece of equipment requires two nursing

personnel? • Which equipments do you spend the most of your time tracking? • Which equipments do you spend the least of your time tracking? • Do nursing assistive personnel track equipment?

o How does their level of participation / procedure differ from yours? • Do you have any suggestions for improvements that will decrease the time you

spend tracking patient equipment? • Has equipment tracking has changed for you since the PAR system was added?

o Better or worse? o What was it like prior to the PAR system? o How big was the impact of introducing the PAR system? o Do all nursing personnel use the PAR system?

• How do you know where the specific equipment that you are located for is located?

o Are you ever unable to find the equipment? o If so, who do you contact?

• How would you categorize the equipments that you track daily? • Have you developed any helpful improvisations to locate equipment more easily

(such as post-it notes or handwritten lists)? • Which shifts do you work the most? • What other shifts do you take? • What are the differences that you notice in the time it takes you to track

equipment across the different shifts? o Across weekend/ week day o Across different time within one shift

• Does the time you spend tracking equipment ever interfere with a task that needs immediate attention?

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Appendix F: Count of Observed Equipment Requiring Active Tracking Time

Count of Observed Pieces of Equipment Only Requiring Active Tracking Accessories Other Patient Mobility Pumps Unit-Owned Grand Total 5 East 2 3 2 1 2 10 5 West 3 2 2 -- 3 10 Birthing Center 6 -- 3 1 6 16 NICU -- -- -- -- 12 12 PCTU 1 1 1 -- 8 11 Grand Total 12 6 8 2 31 59

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Appendix G: Count of Observed Equipment Requiring Waiting Time

Count of Observed Pieces of Equipment Requiring Waiting Time

Accessories Other Patient

Mobility Pumps Unit-Owned Grand Total 5 East -- -- -- 1 -- 1 5 West -- 2 1 1 -- 4 Birthing Center 1 -- -- 1 -- 2 NICU -- -- -- -- -- -- PCTU -- -- 3 4 -- 7 Grand Total 1 2 4 7 -- 14

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Appendix H: Bibliography of Investigated Works from Literature Search Buck, James R., and Mark R. Lehto. Introduction to Human Factors and Ergonomics for

Engineers. Danbury: Lawrence Erlbaum Associates, Incorporated, 2007. Fry, Emory A., and Leslie A. Lenert. "MASCAL: RFID Tracking of Patients, Staff and

Equipment to Enhance Hospital Response to Mass Casualty Events." University of California San Diego School of Medecine and the San Diego Veterans Affairs Healthcare System, AMIA 2005 Symposium Proceedings, 2005, San Diego, CA. PubMed Central. National Institute of Health. <http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1560691>.

Hendrich, Ann, Marilyn Chow, Boguslaw A. Skierczynski, and Zhenqiang Lu. "A 36-

Hospital Time and Motion Study: How Do Medical-Surgical Nurses Spend Their Time?" The Permanente Journal 12 (2008): 25-34.

Lee, Ting-Ting, Mary E. Mills, and Ming-Huei Lu. "Impact of a Nursing Information

System on Practice Patterns in Taiwan." CIN: Computers, Informatics, Nursing 26 (2008): 207-14.

Mayer, Raymond R. Production and Operations Management. Madison, WI: McGraw-

Hill, 1975. Sangwan, Raghvinder S., Robin G. Qui, and Daniel Jessen. "Using RFID tags for

tracking patients, charts and medical equipment within an integrated health delivery network." Networking, Sensing and Control, 2005. Proceedings. 2005 IEEE. (2005): 1070-074.