Joseph Slaughterbeck III Program Analyst, CPHT, VA-CASE, VERC

Patient Transport Study

AIMs & Objectives:– Shadowing– Voice of the Customer– Simulation

Analysis: – Root Cause, observation, Voice of the customer

Key Findings:– Observation, Implication & potential opportunity

– Short term to Future term

Shadowing

Objective 1:– Observe real interactions

between patients and escorts.

– See the first hand challenges patient escorts face throughout the day.

– Analyze how patient escorts interact with their environment and tools.

Voice of the Customer

Objective 2:– Gain a better understanding of current patient

transporting system.– Understand challenges hospital staff currently

face.– Discover possible opportunities for improvement.

Simulations

Objective 3:Gain an understanding of the process through the patient’s eyes.

Case 1: Isolation room to exam room Case 2: Multiple transferCase 3: ER to observation room (transfer from cart to bed) Case 4: Change of plans (exam cancelled by doctor)Case 5: Bariatric wheelchair with equipment (IV, Oxygen tank) attachedCase 6: Crowded hallway with a bedridden patient (slide-transfer from bed to cart) Case 7: Discharge

Analysis

•Root Cause Analysis,•Prioritization Matrices,•VOC, Observation

Key Quotes & Observations:

Key Findings & Implications

Key Perspectives:– Patient Perspective– System Perspective– Equipment

Perspective

Short Term

Long Term

Patient Perspective

Observation: Patients are left outside of testing rooms alone while waiting for the nurse to greet them, putting them in an awkward situation.

Implication:•Patient feels awkward waiting in non designated areas. •Patient’s experience is fragmented

Create more wheelchair and cart compatible waiting stations outside of testing rooms.

Short Term

Long Term

Patient Perspective

Observation: Patients have a lot of questions and concerns while on their journey with Patient Escorts.

Implication:•The amount of information Patient Escorts can give is limited.•Experience can be confusing and frightening

Short Term

Long Term

Prepare a pamphlet or tablet with information on procedure and the providers the patient will meet.

Equipment PerspectiveObservation:•Equipment is utilized on a by-need basis.  •Personal preference for particular equipment•There is no way to update the location or condition of the equipment.

Sign in/ out sheets around the equipment.

Tracking system for the different pieces of equipment.

Short Term

Long Term

Implication:•Transactions take longer as the escort must find and assemble equipment.•Equipment is utilized even when unnecessary•Little Feedback about the use of particular equipment; therefore harder to account for wear and tear.

Implication:•Excessive wasted motion and additional wear incurred upon equipment. returning to dispatch.•Missed opportunity to complete a series of jobs located in proximity.

Equipment Perspective

Observation:•Escorts are frequently returning equipment to an arbitrary location regardless of where the next job is located.

Short Term

Long Term

Move the dispatcher to the same location as the escort waiting room.

1. Shift to a call-in based queue system.

2. Use smart phones to locate jobs in proximity. “Google maps layer”

Adopt an “air traffic control” system to plot out optimal job sequencing and pathways.

Implication: •Lack of communication between department compromise the efficiency of patient escort.

System PerspectiveObservation: •The communication of transport request between issuer and dispatcher lacks clarity at times.•Transactions are not synced between the clinical departments and patient transport team during shift changes

Short Term

Long Term

Establish unified format and time schedule for information update.

One system is used throughout the whole hospital with different levels dedicated to each department.

Include a transporter in a huddle, to brief them on patient situation.

Implication: Continuous information about current workload and upcoming jobs will enable escorts to be more adaptive to balance between efficiency and courteous service.

System Perspective Observation:Escorts must either call in or physically report to dispatch; No automatic status update regarding the current workload.

Short Term

Long Term

Utilize the functions (e.g. text message) of a cellphone to update workload status between escorts and dispatcher.

Develop stand-alone electronic application for tracking and updating escorts.

Implications: The system is not encouraging the patient escort to improve interpersonal relationship with patient.

System Perspective ObservationPerformance evaluation of a transporter is more quantitatively focused.

Short Term

Long Term

Incentivize escorts to more fully engage the patient during transportation through reward system.

Proactively gather patient’s vote to evaluate quality of transportation through digital application.

Summary/ Discussion

Goals & Objectives:– Shadowing– Voice of the Customer– Simulation

Analysis: – Root Cause

Key Findings:– Observation and

Implication

Discussion

Acknowledgements

•Institute for Creative Integration (iCi)

•Aurora Health Care

•Clinical Partnerships in Healthcare Transformation, VA- Center for Applied Systems Engineering, U.S. Veterans Health Administration