Facilitating Processes & Access The Shortest Distance Between Two Points is a Straight Line...
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Facilitating Processes & Access The Shortest Distance Between Two Points is a Straight Line ("Confidential- For Quality Improvement Purposes Only") Radiation Oncology QA Committee Members Teresita F. McCoo MS, John C. Roeske PhD, Angela McCrum RT(T), Michelle Reynolds RT(T), Dolores Franco, RN, Kevin Albuquerque, MD, Mohammad Siddiqui CMD, Susan Ciastko, Douglas Michels, Margaret Sowinski.
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Transcript of Facilitating Processes & Access The Shortest Distance Between Two Points is a Straight Line...
Facilitating Processes & Access
The Shortest Distance Between Two Points is a Straight Line
("Confidential- For Quality Improvement Purposes Only")
Radiation Oncology QA Committee MembersTeresita F. McCoo MS, John C. Roeske PhD, Angela McCrum RT(T), Michelle Reynolds RT(T), Dolores Franco, RN, Kevin Albuquerque, MD, Mohammad Siddiqui CMD, Susan Ciastko, Douglas Michels, Margaret Sowinski.
A New Paradigm
Description of the Project Radiation Oncology took on the challenge of
transitioning to a paperless environment to streamline its operation, maximize use of resources, make records more readily available, and to establish mechanisms to ensure that needed documentation are completed in a timely manner. The Department wanted to achieve this goal in line with the patient-centric model of service that the health system promotes.
("Confidential- For Quality Improvement Purposes Only")
Are we there yet?
Measures of Success Number of orders without a diagnosis at the time of
CT Simulation.
Target = 0 Elapse time between the CT Simulation date to the
onset of radiation treatment.
Target = 12 days Percentage of the radiation oncology treatment
chart that is converted to an electronic form.
("Confidential- For Quality Improvement Purposes Only")
Solutions Implemented
Created a task group to oversee the project. The group applied the concepts of Appreciative Inquiry in identifying what works and designed solutions that built on the department’s strengths. Principles of Lean Design were also incorporated in the process flows.
("Confidential- For Quality Improvement Purposes Only")
Solutions Implemented Created a process flow from initial consultation to
treatment
TX Order
Schedule MRI, other tests
Order transfer -IMPAC
CT SIM Images to XiO
MD- ROI
TX endsWeekly MD Check Treatment
Labs, records Adjustme
nts
TX Trial run
MD Approves plan
Plan- TX Unit
Plan
F/U Visits
Pt Education
Nursing Support
Physics Check
("Confidential- For Quality Improvement Purposes Only")
Solutions - Access through Connectivity
The Radiation Oncology Physicians are practicing and working in various sites; LOC, Hines VA, CC Breast CareClinic, CC GI Clinic, CC Head & Neck, CC Neuro Onc Center. The group addressed their lack of access to the Radiation Oncology Information System (IMPAC) from sites other that the main department, by working with the medical center IT group to make the application accessible via the Citrix server.
("Confidential- For Quality Improvement Purposes Only")
Continuing with Connectivity
EPIC does not have order entry interface with IMPAC. The department with the help of the EPIC maximization team devised a bridge process to capture the EPIC order for the CT simulation / diagnosis and “carry” that to the IMPAC system.
Established a mechanism for effective hand-off of tasks to the next step through the use of IMPAC. This maximized the use of existing resources.
("Confidential- For Quality Improvement Purposes Only")
Solutions Implemented- Application of Critical Path Methods (CPM) Developed and Implemented a process to
simultaneously broadcast the procedure order to key staff in the department so that multiple preparatory steps are done in a shorter and timely manner.
Created and published a list of available treatment planning times for physicians, to help with coordinating tasks leading to onset of treatment.
("Confidential- For Quality Improvement Purposes Only")
Solutions Implemented- Standardization of Processes
Implemented a checklist for time-outs in the electronic chart.
Standardized the naming of treatment fields. Documentation in IMPAC for administration of
Contrast media Developed a checklist for performing and
documenting the physics chart checks.
("Confidential- For Quality Improvement Purposes Only")
Results
Conversion of TX Chart to Electronic Format
Patient DemographicInformation, Diagnosis Patient Picture
Prescription, Patient Set-up ,Tretament Record SectionTreatment Planning andCalculation3-D Planning
Patient Info- Initial Consult
Weekly Management &Treatment NotesDiagnostic RadiologyStudiesSurgical Pathology andLaboratory ReportsMedical, GeneralCorrespondenceNursing Assessments
Treatment Summary/Outcomes AssessmentsFollow -up
Time-Out Documentation
Remaining Items to be Converted
("Confidential- For Quality Improvement Purposes Only")
Results Sim to TX Elapse Time: July-Dec 2007
0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
0 200 400 600 800 1000
Series1
Ave. = 7 days
Sim to TX Elapse Time: July- Dec 2008
0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
0 200 400 600 800 1000
Ave.= 5.71 days
Before
After
After
("Confidential- For Quality Improvement Purposes Only")
Results
Except for emergencies, CT Simulation Orders now come with diagnosis. The need for additional phone call was eliminated. Instead of queuing tasks, simultaneous start of prep tasks was enabled.
% of CT Sim Orders with Diagnosis
020406080
100120
Before After
Compliance before & after implementation of
process change
% C
om
pli
ance
% of CT SimOrders withDiagnosis
Analysis The combination of the processes implemented resulted in an
18.4% decrease in the average time it takes to complete the pre-treatment tasks. This is in line with our planned outcome.
Converting documents in the paper chart to electronic format needed to be done systematically and slowly to allow staff to get used to the changes. It is also imperative to have pilot periods to make sure that the computer applications behave as expected and that all the details of the documentation remain intact.
We have several computer and treatment planning systems in place: EPIC, IMPAC, CMS-XIO, Novalis, CT System, etc. Guards had to be put in place, to ensure the integrity of the data as it is passing from one system or operator to the next.
The changes made allowed the department to generate audit reports electronically. This replaced a manual process. The ease of generating reports also allowed faster intervention to reduce bottlenecks in the process.
("Confidential- For Quality Improvement Purposes Only")
What we learned: The next steps
Culture change takes time; New habits need time to grow and settle. Pilot tests are important.
Lean processes can be achieved even in complex environments
The next steps- Continue to develop, test and implement the
remaining pieces of the conversion to e-format. Audit the processes to ensure that they are working according to specifications.
("Confidential- For Quality Improvement Purposes Only")
Department of Radiation Oncology
QA Committee Members
Teresita F. McCoo MS, John C. Roeske PhD, Angela McCrum RT(T), Michelle Reynolds RT(T), Dolores Franco, RN, Kevin Albuquerque, MD, Mohammad Siddiqui CMD, Susan Ciastko, Douglas Michels, Margaret Sowinski
("Confidential- For Quality Improvement Purposes Only")
