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CURRENT SITUATION PLANAim: Improve percentage of triage two chest Short term: 1. Patien

pain patients seen within ten minutes to 80% 2. Call toLong term: 1. Pull fro

Current: 38% seen within 10 minutes 2. Telem3. Clinica

Discrepancy: 42%. Recurrence Preventio

Extent:Approximately 20 triage 2 chest pain patients per day.

Rationale: Currently not meeting recommended Australasian standard

PROPOSAL Why Recommended:

Increase the percentage of triage two chest pain patients seen within 10 improve the patient jou

minutes to 80% by 1st July, 2007 IMPLEMENTATION

Formed a committee o

Liaison with reception;

Introduction of tannoy Redesign waiting room

Liaison with cardiology

FOLLOW-UP

COST AND TIME ANALYSIS

FUTURE

Ensure sustainability t

Improve access to tele

Eliminate waste and b

CANTERBURY DISTRICT HEALTH BOARDTeam 1: 80% of triage two chest pain patients should be seen w

0

10

20

30

40

50

60

70

80

90

Percentage

ofPatients

Percent

% Triage 2 patients seen w

Lower Limit

Target 80%

Mean

Mean

Medical Sorting Nurse X-Ray Bed Cardiology

Records Nurse Aid Manager Registrar

ED Reg/ Orderly Cardiology

SHO Ward

Primary Pathology Transfer

Nurse Lab Nurse

Triage Reception TFA Sorting Resus X-Ray Resus/Back Cardiology

Bay Ward

No. Staff No. Staff No. Staff No. Staff No. Staff No. Staff No. Staff No. Staff No. Staff No. Staff

No. shifts No. shifts No. shifts No. shifts No. shifts No. shifts No. shifts No. shifts No. shifts No. shifts

RN TriageRegistration/

Computer entry

Initial RN

assessment -

observations

Sorting Nurse

clears Resus Bay

Primary Nurse

assessment -

monitoring,ECG

Chest X RaySorting Nurse

clears areaPut on Telemetry

Initial computer

entry

Paperwork -

labels, order

notes

Call Sorting

Nurse to arrange

transfer to Resus

Sorting Nurse

assigns Primary

Nurse

IV access,

bloods,

Dr reviews results

- decision to refer

Call Bed Manager

(alert)Transfer to Resus

Medical

AssessmentReferral

Call Sorting

Nurse to arrange

transfer to Resus

Treatment initiatedCardiology

assessment

Bed Ordered Decision made retelemetry

Writing notesBed Manager

orders bed

? 3 2 0 0 10 1 190 Lead

12 6 9 5 58 10 49 Time 355

Processing

Time 149

W WWWWW W

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Plan-Do-Check-Act Process

Title

Grasp BackgroundSituation (Existing Value, Expectations, Policy, Goal, or Plan)

Current Situation

(Analysis of Needs and Contributing Conditions)

Plan Recommendations

(Cost/Benefits)

Do Implementation

(Detail of the Plan)

Check and Act Follow Up

(Expected results - When/How They Will Be Checked)

Sourse: The Toyota Way Jeffrey Liker

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Problem Solving Process

Grasp the

Situation

Why?

Cause

Investigation

2. Clarify the Problem

3. Locate Area/

Point of Cause

Basic Cause and Effect

Investigation

4. 5 Why? Investigationof Root Cause

Why?

Direct Cause

Cause

Cause

5. Countermeasure

6. Evaluate

7. Standardise

Why?

Why?

Why?

Cause

Root Cause

Cause

1. Initial Problem Perception(Large, vague, complicated problem)

The Real Problem

POC

Source: The Toyota Way, Jeffrey Liker

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Efficient Meetings

1. Clear objectives prior to the meeting

2. The right people at the meeting

3. Prepared participants

4. Effective use of visual aids (eg the A3 format)

5. Separate information sharing form problem solving

6. The meeting starts and finishes on time

Source: The Toyota Way, Jeffrey Liker