optimizing patient throughput baylor university medical center katy moffett carolyn trimble jessica...
TRANSCRIPT
Optimizing Patient Throughput
Baylor University Medical Center
Katy MoffettCarolyn TrimbleJessica Trimmer
Ashley VanMeter
Background of Problem
• Baylor Task Force
• Connie Bowling, Baylor Engineering Management
• John Dixon, head of Nursing Management and Nursing Research
• Jamey Koontz, Baylor Engineering Management
Problem
• Emergency Department’s admissions process was in need of a more streamlined flow and the elimination of bottlenecks
• Average wait time in Emergency Department is 6 hours
Description of Problem
Description of Problem
Baylor’s Overall Goal
• Reduce Emergency Department wait time by 20%
• This would be an average wait time of 4 and ¾ hours instead of 6 hours
• Initial Investigation• Due to the Emergency Department’s very complicated
process, the realm of our project needed to be
narrowed to the bed placement
• Further Investigation• We discovered the underlying problem for bed
placement was the patient discharge process
• Final Decision• We decided that the discharge process was a feasible
and rewarding project.
• Focus turned to 2 Johnson and 2 Intensive Care Unit
Background/Description of Problem
• Main Baylor Correspondents
• Marcella Owens, 2 Jonsson Clinical Manager
• Charlotte Farris, 2 Intensive Care Unit Clinical
Manager
• Nathan Thompson, Manager of Environmental
Services
Description of Problem
Our Team Goal
• Map out flow analysis of every possible situation encountered • Collect relevant corresponding data
• Observe the process and make alterations
• Analyze the data and make subsequent suggestions
Description of Problem
Description of Problem
Questions Addressed
• What are the bottlenecks for the discharge process?
• What are the roles of each person involved?
• How long does each action take?
• What are the prerequisites for each step?
• What is the order of hierarchy among Baylor employees?
Decisions Made
• What exact data needs to be collected?
• Who are the relevant people to contact about the processes?
Description of Problem
Analysis of the Situation
• Observed detailed discharge and transfer process for all types
of patients
• Ordered the specific steps into separate flow charts
• Included completion times for steps when available
• Examined flow chart and average procedure times to find bottlenecks
General Approach to the Problem
Types of Patients
• Discharged to Home (2 ICU)
• Transferring Cardiac Patient (2 ICU)
• Transferring Medicine Patient (2 ICU)
• Expired Patients (2 ICU)
• Against Medical Advice (2 ICU)
• Discharged to Home (2 Jonsson)
• Against Medical Advice (2 Jonsson)
Analysis of the Situation
Model Assumptions
• Discharge procedures are accurate
• Task times recorded are accurate
• All patient types are covered within the given discharge processes
• All nurses follow a similar procedure
Analysis of the Situation
Technical Description of Model
Process is very patient-specific
• After Medical Doctor writes order or transfer, there are
many different scenarios
• We created flow charts for each type of patient
• No patient is ever the same
Technical Description of Model
Variables & Constraints
• Linear Variables of Patient Flow•Each required step of the patient flow process•Illustrated in flow chart
• Integer Variables in Patient Flow•Time of the completion of each step
• Constraints• The steps in process that have to be completed in order to continue
Transferring Cardiac Surgery Patient - 2ICU
NurseICU Charge
NurseDestination Floor
Charge NurseEnvironmental
ServicesMiscellaneous
Actors
MD writes orderfor transfer
Informed by MDthat patient is
ready fortransfer
Obtainspreprinted
cardiac surgerypatient transfer
document
5 minutes
Informs chargenurse of transferand bed request
Calls 13R torequest bedavailability
unavailable available
Calls 10Rfor bed
availability
Assigns newnurse to patient
from transferfloor
Writesnew roomon ADT
Log
Patientstays inICU until
bed found
Calls 2ICUcharge nursewhen bed is
ready
Informs nurseabout progressin finding a bed
Readiespatient fortransfer
20 minutes
unavailableavailable
Readiesarterial line
5 minutes
5 minutes
85 minutes
These times were found from observing two patients andaveraging the amount of time it took to complete each step Transferring Cardiac Surgery Patient - 2ICU
NurseICU Charge
NurseDestination Floor
Charge NurseEnvironmental
ServicesMiscellaneous
Actors
Picks uptelemetry boxand attaches
box
Removechest tubes if
present
Disconnectslines
Call Unit Techfor help with
transportation
Removes/leaves in
neckline perMD’s request
Readiespulmonarycathetor
5 minutes
5 minutes
Transferpatient tonew room
Gives detailedreport to
receiving nurse
CallsEnvironmental
Services aspatient leaves
floor
5 minutes
5 minutes
5 minutes
2 minutes
Physicallytransfer patient
to new bed
Cleans room aspatient is
transferred
Alerts systemthat room is
clean
Returns toICU room
Preparesfor new
ICU patient
10 minutes
12 minutes
Unit Techassists in
transportingpatient to new
floor
Unit Tech &Receiving Nurse
assist intransferring
patient to new bed
Notified ofempty room
15 minutes
New patientis admitted
20 minutes
These times were found from observing two patients andaveraging the amount of time it took to complete each step
Patient Discharged to Home - 2ICU
NurseMiscellaneous
ActorsEnvironmental
ServicesMedical Doctor
Writes order fordischarge on
dischargeinstruction sheet
Informed by MDthat patient is
ready fordischarge
ObtainsMicrodexprintout
Teaches patientabout medical
home care
Writesprescriptions on
dischargeinstruction sheet
Determinespatient’s level ofcomprehension
Wait forfamily/
caregiverand explain
to them
Doesn't understand
Fills ininformation on
dischargeinstruction sheet
Gives patientfree
immunizations ifneeded
Gives patientpamphlets about
their condition
Has patient signthe discharge
instruction sheet
Patient/Patient’sfamily signsdischarge
instruction sheet
Signsdischargeinstruction
sheet
understand
Attempts tostabilize blood
pressure
Patient Discharged to Home - 2Jonsson
NurseMiscellaneous
ActorsEnvironmental
ServicesMedical Doctor
Informs UnitSecretary thatpatient is ready
to leave
30 minutes
Unit Secretarycalls for
transportation
Notified ofempty room
Cleans room
Alert systemthat room is
clean
33 minutes
30 minutes
Transportationarrives
Patient leaves
Unit Secretarycalls
EnvironmentalServices to clean
room
Prepares fornew patient
New patient isadmitted
These times were found from observingtwo patients and averaging the amount of
time it took to complete each step
34 minutes
Analysis of Data
2 ICU Discharge Process Average Times (50 Patients)
Order Written - Patient ready for discharge
Patient ready - Patient leaves
EVS notif ied - EVS dispatched
EVS Dispatched - EVS arrives
EVS arrives - Room ready for patient
Analysis of Data
2 Jonsson Discharge Process Average Times (25 patients)
Order written - Patient ready for discharge
Patient ready - Transportation called
Transportation called - Patient leaves
EVS notified - EVS dispatched
EVS dispatched - EVS arrives
EVS arrives - Room ready for new patient
Conclusions
General Solutions
• Type instructions to cut down on time spent interpreting
handwriting
Admissions Solutions• Implement a real-time bed display system
Solutions for 2 ICU
• Combine steps during periods of down time
Conclusions
Solutions for 2 Jonsson
• Doctors should keep nurses updated through
instructions in patient charts
• Implement a discharged patient waiting room
• Offer alternate transportation
• Mandatory discharge check-out time