QI: “Just Do It!” Emergency Medicine Residents July 31st, 2003 Jamie Jones, QI Consultant, QIHI...
-
Upload
gervais-haynes -
Category
Documents
-
view
232 -
download
10
Transcript of QI: “Just Do It!” Emergency Medicine Residents July 31st, 2003 Jamie Jones, QI Consultant, QIHI...
-
QI: Just Do It!Emergency Medicine ResidentsJuly 31st, 2003
Jamie Jones, QI Consultant, QIHIDr. Sarah McPherson, PGY-5
-
Quality & ChangeAbout process NOT performanceNew way of practicing care NOT top down changeIts about redesigning the system we work in NOT working harder
-
My QI ExperienceIs it important to teach residents HQI?What is the best way to teach residents HQI?Does the Emergency Medicine program adequately teach HQI?If not, how could we do a better job at teaching HQI skills?
-
The Answers to My Questions1. Do Residents need to learn HQI?Absolutely YES.
Knowledge of QI principles and skills is not innate.Residents need to know how to make their workplaces and the care they provide to patients better. Residents are part of the frontline staff and are therefore uniquely able to identify potential areas for improvement in the healthcare system.
-
2. What is the best way to teach residents QI?
Many different approachesAfter reviewing the literature and discussing with other residents and medical staff, I think that..
-
Theory should be taught and then practicedEvery resident should be involved in a yearly, small scope project to utilize skills firsthandThe format should be encouraged to be group based to minimize excess workloads and to teach teamwork skillsDedicated time should be given to the teaching of QIRegular evaluation of QI education
-
3. Do the Emergency residency programs adequately teach QI? Maybe.
In the last 4 years we have had a 1 day QI workshop and 1 core rounds session (2 hrs) addressing QA/QI theoryFew QI projects have involved residents; even fewer have been initiated by residents
-
4. How could we do a better job at teaching HQI?
I propose that we should start a structured program for HQI so that all residents get to be involved.
-
What are the Goals of our Proposal?To challenge residents to regularly ask the following questions:
Why do we do what we do?How do we know that what we are currently doing works well?How do we identify specific parts of a process that require improvement?How can we change to do our work better?
-
To develop a system where residents, attending physicians, and other members of the health care team can work together on clinical and educational improvements
To continually improve care delivered by residents
To teach residents the principles and clinical skills of HQI and the improvement model (PDSA)
-
QI in ED Residency ProgramSchedule and Content:3 Scheduled QI Days each year:July 31st - Setting the context for QI in Emergency Residency programsMid-September 03 - Moving forward with measurementMid-January 04 - Successes & Holding the Gains
-
Schedule and Content:
July 31 03 Major principles of QIteam based philosophyculture of changeThe Improvement ModelBrainstorm ideas and develop resident projects
-
Schedule and content:
Mid-September 03 PDSA Cyclesmoving forward with testingmeasurement & graphing
-
Schedule and content:
Mid-January 04 Share Successes How will we hold the gains? How will we spread successes?
-
What the IOM said..Trying harder will not work anymore
Only redesign of our health care systems
Crossing the Quality Chasm, May 2001
-
What is Best Care?S - SafeT - TimelyE - EfficientE - EffectiveE - EquitableP - Patient Centered Its a STEEEP Climb to Quality!Adopted from D. Ballard, Baylor Healthcare Organization
-
To become a national leader in the delivery and measurement of quality health care.Calgary Health Region Goal:
-
Individual clinical departments/programs are ultimately responsible and accountable for quality of care.
QIHI
Does not own quality
A support service to provide consultation & information for decision-making
-
Integrative Process for QI ProjectsQuality Issues/ProblemsFront Line StaffManagementExecutivePortfolio/DepartmentalQuality Councils(Multidisciplinary)Clinical Enhancement TeamClinical Enhancement PhysicianQI ConsultantQI Data CoordinatorHealth Record AnalystData/Systems AnalystQI TeamQIHI ResourcesRegionalQuality CouncilQI TeamQI Team
-
QI MethodologyHealthcare Quality ImprovementPractical 11 step problem solving process
The Improvement Model Plan - Do - Study - Act
Methodologies require QI teams Tools & techniques
-
QI PrinciplesEmpower front line employeesFocus on processStructured problem solvingPatient focusedDecisions based on data
-
More QI PrinciplesReliance on toolsEmphasis on visual presentationPromote innovation, learning and reasonable risk takingCycle for learning and improvement
-
Trial and Learn Plan - Do - Study - Actmeasuring results and acting on themRe-evaluate and Continuous Improvementact, capture the gain and start all over
*
HealthcareQuality Improvement Model
STEP 2:
COLLECT BACKGROUND
DATA
STEP 1:
FORM TEAMS
STEP 3:
DEVELOP PROBLEM/ISSUE
STATEMENTS
STEP 4:
DIAGRAM THE PROCESS
STEP 5:
DETERMINE ROOT CAUSES OF
PROBLEMS/ISSUES
STEP 6:
VERIFY CAUSES WITH DATA
STEP 7:
CRITICAL REVIEW OF THE
LITERATURE
STEP 8:
DEVELOP AND SELECT THE
SOLUTIONS
STEP 9:
PLAN, TEST, IMPLEMENT THE
SOLUTIONS
STEP 10:
MEASURE RESULTS
STEP 11:
RE-EVALUATE AND
CONTINUOUS IMPROVEMENT
Getting Started
Getting Focused
Analysis
Decision Making
Implementation
Measurement
Continually Improve
-
A Few Required Understandings... Does baseline data support there is a problem?
What are we hereafter?Does everyone on team understand the aim?
Do we understand our process?
-
Does data support there is a problem?
-
Background DataImportant to have issue supported with data Greater confidenceUnderstand issueGreater degree of belief
-
Background DataCollect data-Many ways to gathersurveysnew performance dataexisting dataqualitative & quantitative
-
Background DataOrganize dataDisplay data
graphical display of data is key to sharing the messagea picture is worth a thousand words
e.g. histograms, run charts, Pareto charts
-
Data Drives DecisionsMeasurement is for learning NOT for judgementResearch: Just in case measurementQI: Just enough measurementMeasures tell a story; Goals give a reference point
-
DATA ContdMeasurement helps teams:manage, learn & improve work processescommunicate & understand the current process & the changes in process
But, Im not a statistician!
-
Thats ok - its easier than it looks!Random samplingPen & paper are fine - dont wait for information systemUse qualitative data, rather than waiting for quantitativeCollect useful data, not perfect dataPlot your data over time Run Charts
-
EKG Turnaround TimeWest Roxbury Center (1/22/89 - 2/3/89)32 data points 916 1 415 813 113 161417 7 220 2 2 218 317 21420 1 1 2 7 1 215 2Average = 8.3 daysDr. Peter Norton
-
Run chart of EKG Turnaround TimesDr. Peter NortonDaysEKGs
Chart1
98.34
158.34
138.34
78.34
28.34
178.34
18.34
18.34
168.34
88.34
168.34
28.34
28.34
28.34
18.34
28.34
18.34
138.34
148.34
208.34
188.34
148.34
28.34
158.34
48.34
18.34
178.34
28.34
38.34
208.34
78.34
28.34
Sheet1
98.34
158.34
138.34
78.34
28.34
178.34
18.34
18.34
168.34
88.34
168.34
28.34
28.34
28.34
18.34
28.34
18.34
138.34
148.34
208.34
188.34
148.34
28.34
158.34
48.34
18.34
178.34
28.34
38.34
208.34
78.34
28.34
Sheet1
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
Sheet2
Sheet3
-
Annotated Run ChartsRun charts:simplify the datafocus attention on trends & rangesare attention gettinghelp us evaluate the effect of change activities
-
Annotated Run ChartPlot small samples frequently over time
-
What are we hereafter?
Does everyone on the team understand the aim?
-
Issue StatementWhy is an Issue Statement important?To focus the project on the biggest issuesTo ensure all team members are on the same pageTo avoid Scope CreepTo begin thinking about measurement
-
Issue StatementThree components of an Issue StatementDirectionIncrease, improve, decrease, removeMeasure# of days, weeks, hoursCost, wait times, errors, availabilityProcessadmission processpatient teaching
-
Issue StatementReasons for MeasurementBefore/after measures are important to quantify improvementWhat gets measured tends to get results
-
Issue StatementExamplesDecrease the number of patient complaints about length of stay in ED waiting rooms.Increase, by 25%, the number of patients expressing satisfaction with care experience.Reduce lab turn around times by 50%.
-
Paramedic downtime estimated at $500,000Source: Calgary Herald 01/24/03Calgary taxpayers spent at least $500,000 paying paramedics to wait in line to drop patients off at Calgary hospitalswe are very concerned about the number of hours ambulances are tied up in emergency rooms
-
EMS Official Demands Province Provide CureCourtesy: Calgary Sun 01/04/03its just that the health region needs capacity and EMS needs fundingI think the province is dragging their feet and theres a need to address this politicallywe need to look at more efficient ways of using existing resources
-
Ambulance Delay LingersCourtesy: Calgary Sun 02/21/03Ambulances are waiting more than one-third longer at hospital emergency wardsthe concern we have is we have fewer ambulances available and spread across a larger area --- it will take us longer to reach people and we dont want it to happen
-
Frustration Shared byPatients and StaffCourtesy: Calgary Herald 02/08/03Im not sure theres always evidence the patient is compromised (by a long wait), but it certainly is extremely uncomfortable to be in pain for too long or to be worried and anxious for too long
-
Issue StatementExercise:At each table, work as a group to develop an issue statement for the following problem:EMS has long wait-times in ED hallways
-
Issue StatementGoals:Reduce turnaround time for paramedic units from arrival at ED triage to being available for next call; without negatively impacting ED waiting room patients while maintaining safe, effective & high quality patient care.
-
Understanding Work as a Process
-
HQI - Focus on ProcessConsider Juran and Demings 85/15 rule:At least 85% of problems can be dealt with by improving systems; only 15% are the direct result of people.
-
Diagram the ProcessAllows you to analyze how a process functions (or doesnt!)Most processes were never designed they just developed40 60% of everything that is done in a large complex process is non-value addingHow can you possibly improve something unless you know how it works?
-
Diagram the ProcessFlowchartstool used to diagram the processmacro or microExamples
Micro FlowchartPROF Bed Flow (ED - Unit 72 - OR)Macro FlowchartED Consultant Process
-
PATIENT TRANSFER PROCESSFMC EMERGENCY -to- PLC HOSPITALISTFind a bedArrange transferTransfer1. FMC ED doc: decision to admit2. FMC ED doc: checks PLC census3. FMC ED doc: pages PLC Hospitalist4. PLC Hospitalist: calls FMC ED doc5. PLC Hospitalist: calls PLC Admitting (bed assigned immediately1)6. PLC Hospitalist: calls FMC ED doc to accept transfer7. PLC Admitting: calls & faxes FMC ED UC to advise bed information8. FMC ED doc informs FMC ED UC1. Pt. Transport: dispatches vehicle2. Pt. Transport: arrives FMC3. Pt. Transport: collects chart/patient4. Pt. Transport: receives report5. Pt. Transport: transports patient6. Pt Transport: arrives PLC Admtg7. PLC Admitting: registers patient8. Pt. Transport: transport to unit9. Pt. Transport: check-in with UC10. Pt. Transport: report to RN11. PLC UC: pages Hospitalist1. PLC Hospitalist: calls report to inpatient unit 22. PLC Hospitalist: books Patient Transport3. FMC ED UC: puts PLC fax on pt chart4. FMC ED doc: writes order5. FMC ED RN/UC: completes transfer checklist6. ED RN: completes Admission Sheet7. ED RN: gives Admission Sheet to ED UC8. ED UC: enters into Log Book9. Admission Sheet to FMC Admitting10. FMC Admitting: calls PLC Admitting11. PLC Hospitalist: informs PLC Admitting12. PLC Admitting: assigns bed13. PLC Admitting: calls FMC Admitting14. FMC Admitting: advises ED UC15. ED UC: advises RN16. ED RN: phones report to PLC unitNotes: red indicates new steps indicates eliminated steps
-
Family Medicine - Results
Chart3
10.0743055556
20.0791666667
30.1548611111
40.0618055556
50.0784722222
60.1215277778
70.1416666667
80.1715277778
90.3652777778
100.2569444444
110.1736111111
120.0729166667
130.1319444444
140.2611111111
150.1701388889
160.1944444444
170.0833333333
180.0909722222
190.2006944444
200.0875
210.1534722222
220.0826388889
230.0645833333
240.0548611111
250.0513888889
260.0930555556
270.0819444444
280.4527777778
290.1104166667
300.0979166667
310.125
320.3131944444
330.0777777778
340.2173611111
350.1763888889
360.1284722222
370.1423611111
380.1354166667
390.1305555556
400.3111111111
410.1069444444
420.0944444444
430.4777777778
440.0923611111
450.0861111111
460.15
470.1708333333
480.1
490.1791666667
500.1395833333
510.0583333333
520.09375
530.1006944444
540.0791666667
550.2034722222
560.1270833333
570.1048611111
580.1243055556
590.0770833333
600.08125
610.0534722222
620.1805555556
630.1354166667
640.0597222222
650.1159722222
660.0673611111
670.0944444444
680.1180555556
690.1319444444
700.1715277778
710.1277777778
720.0854166667
730.0777777778
740.0430555556
750.1402777778
760.1083333333
770.0465277778
780.0972222222
790.2041666667
800.15625
810.1006944444
820.05
830.0645833333
840.0659722222
850.0611111111
860.1034722222
870.0479166667
880.0520833333
890.05625
900.0604166667
910.0798611111
920.0694444444
930.0513888889
940.1048611111
950.0555555556
960.2256944444
970.16875
980.0638888889
990.0625
1000.0506944444
1010.0611111111
1020.0673611111
1030.0256944444
1040.0958333333
1050.0506944444
Change 1
Change 2
Target
Change 3
Special cause identified; protocol not followed in these transfers.
Baseline
Patient Case
Hours
'Decision to Admit' -to- 'Transfer Complete'
All RunChart
All RunChart
10.0743055556
20.0791666667
30.1548611111
40.0618055556
50.0784722222
60.1215277778
70.1416666667
80.1715277778
90.3652777778
100.2569444444
110.1736111111
120.0729166667
130.1319444444
140.2611111111
150.1701388889
160.1944444444
170.0833333333
180.0909722222
190.2006944444
200.0875
210.1534722222
220.0826388889
230.0645833333
240.0548611111
250.0513888889
260.0930555556
270.0819444444
280.4527777778
290.1104166667
300.0979166667
310.125
320.3131944444
330.0777777778
340.2173611111
350.1763888889
360.1284722222
370.1423611111
380.1354166667
390.1305555556
400.3111111111
410.1069444444
420.0944444444
430.4777777778
440.0923611111
450.0861111111
460.15
470.1708333333
480.1
490.1791666667
500.1395833333
510.0583333333
520.09375
530.1006944444
540.0791666667
550.2034722222
560.1270833333
570.1048611111
580.1243055556
590.0770833333
600.08125
610.0534722222
620.1805555556
630.1354166667
640.0597222222
650.1159722222
660.0673611111
670.0944444444
680.1180555556
690.1319444444
700.1715277778
710.1277777778
720.0854166667
730.0777777778
740.0430555556
750.1402777778
760.1083333333
770.0465277778
780.0972222222
790.2041666667
800.15625
810.1006944444
820.05
830.0645833333
840.0659722222
850.0611111111
860.1034722222
870.0479166667
880.0520833333
890.05625
900.0604166667
910.0798611111
920.0694444444
930.0513888889
940.1048611111
950.0555555556
960.2256944444
970.16875
980.0638888889
990.0625
1000.0506944444
1010.0611111111
1020.0673611111
1030.0256944444
1040.0958333333
1050.0506944444
&C&"Arial,Bold"&18TRANSFER TIMES PROJECT: FMC EMERGENCY TO PLC HOSPITALIST2001 / 2002
&L&8&F&D&R&8Prepared by: J. Robinson210-9238
Change 1
Change 2
Target
Change 3
Special cause identified; protocol not followed in these transfers.
Baseline
Patient Case
Hours
'Decision to Admit' -to- 'Transfer Complete'
All RunChart Data
0.1510706019
0.1125816993
0.09634661840.072037037
0.0794117647
&C&"Arial,Bold"&18TRANSFER TIMES PROJECT: FMC EMERGENCY TO PLC HOSPITALIST2001 / 2002
&L&8&F&D&R&8Prepared by: J. Robinson210-9238
Change 2:n=15,8 'special cause cases' removed from mean
Change 2: n=23 (all cases)
Baseline -Apr/May/Jun 2001
FMC Admittingremoved
Hospitalists doingmany steps
Removeduplicate steps
Mean - All Cases Included
Mean - CC2 'Long Cases' Removed
Mean Transfer Times by Change Cycle
For tbpi manual
0.0743055556
0.0791666667
0.1548611111
0.0618055556
0.0784722222
0.1215277778
0.1416666667
0.1715277778
0.3652777778
0.2569444444
0.1736111111
0.0729166667
0.1319444444
0.2611111111
0.1701388889
0.1944444444
0.0833333333
0.0909722222
0.2006944444
0.0875
0.1534722222
0.0826388889
0.0645833333
0.0548611111
0.0513888889
0.0930555556
0.0819444444
0.4527777778
0.1104166667
0.0979166667
0.125
0.3131944444
0.0777777778
0.2173611111
0.1763888889
0.1284722222
0.1423611111
0.1354166667
0.1305555556
0.3111111111
0.1069444444
0.0944444444
0.4777777778
0.0923611111
0.0861111111
0.15
0.1708333333
0.1
0.1791666667
0.1395833333
0.0583333333
0.09375
0.1006944444
0.0791666667
0.2034722222
0.1270833333
0.1048611111
0.1243055556
0.0770833333
0.08125
0.0534722222
0.1805555556
0.1354166667
0.0597222222
0.1159722222
0.0673611111
0.0944444444
0.0777777778
0.0430555556
0.1083333333
0.0465277778
0.0972222222
0.1006944444
0.05
0.0645833333
0.0659722222
0.0611111111
0.1034722222
0.0479166667
0.0520833333
0.05625
0.0604166667
0.0798611111
0.0694444444
0.0513888889
0.1048611111
0.0555555556
0.16875
0.0638888889
0.0625
0.0506944444
0.0611111111
0.0673611111
0.0256944444
0.0958333333
0.0506944444
&C&"Arial,Bold"&14TRANSFER TIMES PROJECT 2001: FMC EMERGENCY TO PLC HOSPITALIST
&L&8&F&D&R&8Prepared by: J. Robinson210-9238
Target
Baseline
Change 1
Between
Change 2
Patient Case
Hours
TRANSFER TIMES: 'Decision to Admit -to- 'Transfer Complete'
day,eve,nt
CC Patient NumberOverall Patient Number'Dec to Admit' -to- 'Complete'With Change 2 'Problem Cases' Removed
Baseline111:471:47
221:541:54
333:433:43
441:291:29
551:531:53
662:552:55
773:243:24
884:074:07
998:468:46
10106:106:10
11114:104:10
12121:451:45
13133:103:10
14146:166:16
15154:054:05
16164:404:40
17172:002:00
18182:112:11
19194:494:49
20202:062:06
21213:413:41
22221:591:59
23231:331:33
24241:191:19
25251:141:14
26262:142:14
27271:581:58
282810:5210:52
29292:392:39
30302:212:21
31313:003:00
32327:317:31
33331:521:52
34345:135:13
35354:144:14
36363:053:05
37373:253:25
38383:153:15
39393:083:08
40407:287:28
41412:342:34
42422:162:16
434311:2811:28
44442:132:13
45452:042:04
46463:363:36
47474:064:06
48482:242:24
Change 11494:184:18
2503:213:21
3511:241:24
4522:152:15
5532:252:25
6541:541:54
7554:534:53
8563:033:03
Between1572:312:31
2582:592:59
3591:511:51
4601:571:57
5611:171:17
6624:204:20
7633:153:15
8641:261:26
9652:472:47
Change 21661:371:37
2672:162:16
3682:50
4693:10
5704:07
6713:04
7722:03
8731:521:52
9741:021:02
10753:22
11762:362:36
12771:071:07
13782:202:20
14794:54
15803:45
16812:252:25
17821:121:12
18831:331:33
19841:351:35
20851:281:28
21862:292:29
22871:091:09
23881:151:15
Change 31891:211:21
2901:271:27
3911:551:55
4921:401:40
5931:141:14
6942:312:31
7951:201:20
8965:25
9974:034:03
10981:321:32
11991:301:30
121001:131:13
131011:281:28
141021:371:37
151030:370:37
161042:182:18
171051:131:13
"Revisited"11061:47
21072:44
31082:53
41091:06
51101:41
61111:44
71123:18
81132:15
91141:46
101151:43
111163:51
121171:20
131181:44
141193:49
151201:08
161211:20
171222:23
181232:20
191241:29
201252:13
211262:35
221271:14
231281:34
241291:18
"Special Cases Removed"
AverageAverage
Baseline3:37Baseline
Change 12:42Change 1
Change 22:1836%Change 21:4352%
Change 31:5447%Change 31:4153%
Review 12:0343%
B-3 difference1:4347%
transfers/wk8
13:45patients time saved per week
per year715hrs Emerg saved per year
pt days30days Emerg saved per year
red line & boxes displaced to compensate when copying to powerpoint
&C&"Arial,Bold"&12PATIENT TRANSFERS: FMC EMERG TO PLC HOSPITALISTS - 2001/02
&L&8&F,&A&R&8J.Robinson, 210-9238
Special cause identified;protocol not followed in these transfers.
Baseline
Change 1
Change 2
Change 3
Review 1
Patient Case
Hours
'Decision to Admit' -to- 'Transfer Complete'
0.0743055556
0.0791666667
0.1548611111
0.0618055556
0.0784722222
0.1215277778
0.1416666667
0.1715277778
0.3652777778
0.2569444444
0.1736111111
0.0729166667
0.1319444444
0.2611111111
0.1701388889
0.1944444444
0.0833333333
0.0909722222
0.2006944444
0.0875
0.1534722222
0.0826388889
0.0645833333
0.0548611111
0.0513888889
0.0930555556
0.0819444444
0.4527777778
0.1104166667
0.0979166667
0.125
0.3131944444
0.0777777778
0.2173611111
0.1763888889
0.1284722222
0.1423611111
0.1354166667
0.1305555556
0.3111111111
0.1069444444
0.0944444444
0.4777777778
0.0923611111
0.0861111111
0.15
0.1708333333
0.1
0.1791666667
0.1395833333
0.0583333333
0.09375
0.1006944444
0.0791666667
0.2034722222
0.1270833333
0.1048611111
0.1243055556
0.0770833333
0.08125
0.0534722222
0.1805555556
0.1354166667
0.0597222222
0.1159722222
0.0673611111
0.0944444444
0.1180555556
0.1319444444
0.1715277778
0.1277777778
0.0854166667
0.0777777778
0.0430555556
0.1402777778
0.1083333333
0.0465277778
0.0972222222
0.2041666667
0.15625
0.1006944444
0.05
0.0645833333
0.0659722222
0.0611111111
0.1034722222
0.0479166667
0.0520833333
0.05625
0.0604166667
0.0798611111
0.0694444444
0.0513888889
0.1048611111
0.0555555556
0.2256944444
0.16875
0.0638888889
0.0625
0.0506944444
0.0611111111
0.0673611111
0.0256944444
0.0958333333
0.0506944444
0.0743055556
0.1138888889
0.1201388889
0.0458333333
0.0701388889
0.0722222222
0.1375
0.09375
0.0736111111
0.0715277778
0.1604166667
0.0555555556
0.0722222222
0.1590277778
0.0472222222
0.0555555556
0.0993055556
0.0972222222
0.0618055556
0.0923611111
0.1076388889
0.0513888889
0.0652777778
0.0541666667
&C&"Arial,Bold"&12PATIENT TRANSFERS: FMC EMERG -to- PLC HOSPITALISTS, 2001/02
&L&8&F,&A&R&8J.Robinson, 210-9238
Change 2:n=15,8 'special cause cases' removed from mean
Change 2: n=23 (all cases)
Baseline -Apr/May/Jun 2001
Remove FMC Admitting
Hospitalists domany steps
Removeduplicate steps
ReviewJan '02
Hours
All Cases
No 'Spec Cause'
Mean Transfer Times by Change Cycle
Baseline
Baseline
Change 1
Change 1
Change 2
Change 2
Change 3
Change 3
Review 1
Review 1
0.1510706019
0.1125816993
0.0963466184
0.072037037
0.0794117647
0.0855034722
PtTrans Response
PtTrans Response
490.1791666667
500.1395833333
510.0583333333
520.09375
530.1006944444
540.0791666667
550.2034722222
560.1270833333
570.1048611111
580.1243055556
590.0770833333
600.08125
610.0534722222
620.1805555556
630.1354166667
640.0597222222
650.1159722222
Change 1
Change 2
Target
Patient Case
Hours
'Decision to Admit' -to- 'Transfer Complete'
Change 3 Data
BaselineChange 1Change 2Change 3Review 1
Day11%30%6%25%
Evening33%17%47%33%
Night56%52%47%42%
Change 3 Data
000
000
000
000
000
&L&8&F,&A&R&8J. Robinson, 210-9238
Day
Evening
Night
Percent
PATIENT TRANSFERS: FMC EMERG -to- PLC HOSPITALISTSProportion by Shift
CC 2 Data Analysis
PATIENT TRANSPORT RESPONSE TIMES
Datemins
3-Jan-0220
4-Jan36
4-Jan44
5-Jan15
5-Jan14
7-Jan40
7-Jan34
7-Jan45
7-Jan24
8-Jan36
8-Jan35
8-Jan31
9-Jan95
9-Jan40
9-Jan47
9-Jan26
9-Jan27
10-Jan8
10-Jan33
10-Jan62
10-Jan16
10-Jan28
12-Jan16
12-Jan19
12-Jan20
13-Jan51
13-Jan18
13-Jan23
13-Jan19
13-Jan15
13-Jan63
13-Jan12
15-Jan26
15-Jan43
15-Jan58
17-Jan45
17-Jan33
18-Jan47
19-Jan27
19-Jan39
21-Jan37
21-Jan7
21-Jan46
21-Jan14
22-Jan14
23-Jan29
23-Jan35
24-Jan15
24-Jan20
26-Jan21
26-Jan7
27-Jan43
27-Jan70
28-Jan10
28-Jan8
29-Jan32
29-Jan40
30-Jan24
30-Jan27
31-Jan16
31-Jan15
31-Jan15
31-Jan14
31-Jan11
1-Feb21
2-Feb46
2-Feb27
3-Feb30
3-Feb33
3-Feb23
3-Feb32
4-Feb51
4-Feb5
6-Feb6
6-Feb5
7-Feb19
8-Feb8
9-Feb73
9-Feb31
9-Feb31
10-Feb36
10-Feb19
11-Feb20
11-Feb22
12-Feb20
12-Feb20
13-Feb16
13-Feb9
13-Feb1
15-Feb13
15-Feb16
16-Feb40
18-Feb57
18-Feb20
19-Feb19
20-Feb23
22-Feb18
22-Feb21
22-Feb30
24-Feb27
25-Feb26
26-Feb45
27-Feb43
27-Feb6
28-Feb35
28-Feb44
average28
max95
min1
median26
there are more transfers here than in the project data; all fmc to plc transfers are represented here whereas our project data only represents PLC Hospitalists patients
Change 2 Data
CHANGE CYCLE 3: December 8'01 - January 8'02
#Hospita-listDateData from FMC EDData from HospData from PLC AdLast NamePHNAdmit FMC EDDec to AdmitDec to Admit ShiftED doc calls Hospi-talistAdmis-sion Sheet to ED UCHospitalist requests bedPLC faxes ED w/ bedED RN phones reportHospitalist Books Pt Transport"Dec to Admit" -to- "Pt Transport booked"Vehicle dispatchedActual Pick UpCom-pletion"Dec to Admit" -to- "Com-pletion"Hospitalist Notified by Unit"Dec to Admit" -to- "Hospitalist Notified"Booked to Completion
1Dec-10xJurcevic59423120021:36e21:3621:5122:120:3622:1022:1722:571:2123:502:140:45
2TrainorDec-10xxBischoff35846051122:28e22:2822:4922:5522:490:2122:4623:2123:551:270:121:4424:00:001:06
3Dec-11xLai64879772015:37e15:3715:4115:440:0716:2116:4817:321:5517:452:081:48
4Dec-11xBearshirt4456768006:38n6:386:466:400:027:107:258:181:408:201:421:38
5KassamDec-13xxKluczeweski23:00n23:0023:0823:4723:000:0023:0223:370:141:14"no medical beds"1:14
6BryantDec-16xBeregszaszi23013221019:41e19:4119:4620:390:5820:4221:3222:122:3122:302:49"first call to PLC Admtg - no staff; patient mrsa positive"1:33
7Dec-17xBarclay34529480016:04e16:0416:1016:090:0516:0516:3617:241:2018:102:061:15
8ConradieDec-18xLeys1:30n1:301:551:590:295:366:106:555:25"FMC ED reports PLC accepted care 0130, but hospitalist delayed until 0600 to sleep"; Hospitalist provided no id to PtTransport4:56
9Dec-19xFrancis71411160014:00d14:0015:2515:491:4916:3017:0918:034:03unexplained delay between "Dec to Admit" and "Pt Transport Booked" = 01:492:14
10Dec-20xLinddlad42151900021:50e21:5022:0322:030:1322:0822:3623:221:3223:451:55"Admitting would not confirm bed until unit here was called to confirm availability"1:19
11Dec-20xWindrem94494061122:00e22:0022:0522:050:0522:0722:5423:301:3023:501:501:25
12KassamDec-20xxMurphy26135181023:20n23:2023:4023:4323:290:0923:320:110:531:131:24
13KassamDec-20xxDerhakhsham23:30n23:3023:4023:4323:300:0023:360:180:581:281:28
14KassamDec-21xxClaggette9203729112:00n2:001:102:122:150:152:262:493:371:373:451:451:22
15KassamDec-21xLarsen6439637003:00n3:003:092:123:030:033:073:023:370:373:450:450:34
16KassamDec-21xxSchwaier2186519004:15n4:154:204:124:220:075:235:416:332:186:402:252:11
17Jan-03xOgle10773301022:42e22:4222:5022:440:0222:5423:1423:551:130:301:4824:00:001:11
day1count1717count12
evening8average0:181:54average1:551:36
night8max1:495:25max2:49
min0:000:37min0:45
Incomplete Data
1NixonDec-12xDuncanno datan23:4023:4723:510:0023:560:140:570:000:00
2StassenDec-16xxGrantno datan0:300:450:490:000:501:081:440:000:00
3CullyDec-18xDowningno datan23:402:0023:440:0023:460:201:030:000:00
4CullyDec-19xHerdmanno datan2:402:532:360:004:325:025:450:000:00"Hospitalist provided no id data to PtTransport"; hi volume transfers delayed transport
5CullyDec-19xMumcuogluno datan4:314:251:280:006:036:307:130:000:00"Hospitalist provided no id data to PtTransport"; hi volume transfers delayed transport
6CullyDec-19Iversonno datan6:086:105:580:006:026:307:170:000:00"Hospitalist provided no id data to PtTransport"; hi volume transfers delayed transport
7KassamDec-21xHuttonno datan1:102:120:00not transported by PT0:000:00PT arrived at FMC to find patient no longer there - unknown how pt was transported
Transfers not Reported by Hospitalist, FMC ED, PLC Admitting (I.e. extracted from Pt. Transport dbase only)
823-DecMyers
926-DecDebniak
1026-DecGalloway
1127-DecWiegle
1228-DecGuo
1328-DecHufnagel
1430-DecHarcus
1531-DecReviczkw
161-JanNelson
173-JanMurray
184-JanStimson
194-JanSingh
205-JanPachal
215-JanBonderoff
227-JanDunsmoor
237-JanScheunert
247-JanMcRae
258-JanLalande
268-JanLo
278-JanAlexander
288-JanGacek
Between cc1-cc2
CHANGE 2 DATA November 7 - December 7, 2001
#Hospita-listDateFMC EDHospPLC AdLast NamePHNAdmit FMC EDDec to AdmitDec to Admit ShiftED doc calls Hospi-talistAdmis-sion Sheet to ED UCED UC requests bedPLC faxes ED w/ bedED RN phones reportHospitalist Books Pt Transport"Dec to Admit" -to- "Pt Transport booked"Vehicle dispatchedActual Pick UpCom-pletion"Dec to Admit" -to- "Com-pletion"Hospitalist Notified by Unit"Dec to Admit" -to- "Hospitalist Notified"
1Gatzke10-NovxxxManyshots0:2014:19day14:1914:5615:0514:320:1314:3415:1415:561:3716:161:57
2Gatzke10-NovxxxDionne94866398:3514:45day14:51015:210:3615:2416:1317:012:1617:583:13
813-NovxxPopham58127021:01evening21:2321:4121:4721:230:2221:2522:1022:531:520
913-NovxxSamson944337322:00evening22:0222:1522:030:0322:0622:2123:021:0223:441:44
11Hakes14-NovxxxMunro948667011/14/01 3:153:00night3:003:154:123:080:084:204:575:362:366:053:05
12Bryant14-NovxxxNicholson66056160011/14/01 23:2011/14/01 23:10night23:0523:1823:3011/14/01 23:140:0423:2323:3811/15/01 0:171:0711/15/01 0:201:10
1314-NovxWilkinson35302512111/13/01 21:302:00night2:052:203:061:063:263:394:202:20
16Conradie24-NovxxxCuthbert921804023:1011/24/01 22:30evening22:5323:2011/24/01 22:550:2523:520:0911/25/01 0:552:2511/25/01 1:303:00
17Conradie24-NovxxIwazyk007339317:3822:00day22:0822:130:1322:2722:3123:121:1211/25/01 0:182:18
1826-NovxxHewitt5:4511:05day11:1511:150:1011:3011:5112:381:3314:153:10
1926-NovxBrown64226xx8:2013:15day13:3513:3813:210:0613:5114:0414:501:35
2027-NovxxJohn63325188019:551:10night1:111:291:150:051:422:002:381:282:391:29
2127-NovxxSharpe3549291119:3519:40evening19:1719:5019:5120:170:3721:0221:2922:092:2922:372:57
22Cran5-DecxxXie, Guang34616153023:2912/5/01 23:17night23:1823:3023:3512/5/01 23:200:0323:2423:4612/6/01 0:261:09
23Cran6-DecxxGullacher8343392005:10night5:105:115:225:210:115:275:426:251:15
count15
average0:17average1:43
max1:06max2:36
min0:03min1:02
3Cran12-NovxxMeads948695311/12/01 18:302:30night2:352:550.11805555563:260:563:504:315:202:50patient transport not booked by Hospitalist
4Cran12-NovxxBaylis948696111/12/01 19:432:10night2:152:550.12152777783:281:183:504:315:203:10patient transport not booked by Hospitalist
5Kassam13-NovxxGuyong925646211/12/01 22:550:20night0:200:471:511:313:203:444:274:07patient transport not booked by Hospitalist
6Kassam13-NovxxKing936171511/13/01 16:560:09night0:090:470.03472222221:541:451:572:383:133:04patient transport not booked by Hospitalist
713-NovxxWiggins100457211/13/01 10:1514:45day14:4515:2015:501:0515:5215:5816:482:0317:090.1patient transport not booked by Hospitalist
10Kassam13-NovxxHudson948525211/12/01 20:142:30night0:203:400.15833333333:421:124:395:105:523:22patient transport not booked by Hospitalist
1414-NovxRothwell95681022011/13/01 17:422:00night2:054:042:045:576:076:544:54no comments received, assume as others
15Cully19-NovxxHarrendance34773608012/31/99 11:2517:05day17:10unaware0.802083333319:492:4419:5120:0620:503:45patient transport not booked by Hospitalist
count15
Incomplete Data
Samis7-NovxDobruk92392970:460:491:101:51
Cully28-NovxChebrehiwet23:2023:162:112:293:08
Cully28-NovxxOrr911261321:4123:2023:152:533:043:4423:16
28-NovxOstafichuk932227821:0521:3123:1223:3511/29/01 0:170.0270833333
28-NovxKok949339821:4121:5521:510:260:4911/29/01 1:310.1236111111
Cully29-NovxSitu94911363:503:433:464:154:52
Jeanine Boyarchuk:orange denotes transfers where Hospitalist did not contact Patient Transport
Change 1 Data
CHANGE 2 DATA November 7 - December 7, 2001
#Hospita-listDateFMC EDHospPLC AdLast NamePHNAdmit FMC EDDec to AdmitDec to Admit ShiftED doc calls Hospi-talistAdmis-sion Sheet to ED UCED UC requests bedPLC faxes ED w/ bedED RN phones reportHospitalist Books Pt Transport"Dec to Admit" -to- "Pt Transport booked"Vehicle dispatchedActual Pick UpCom-pletion"Dec to Admit" -to- "Com-pletion"Hospitalist Notified by Unit"Dec to Admit" -to- "Hospitalist Notified"Booked to Completion
1Gatzke10-NovxxxManyshots0:2014:19day14:1914:5615:0514:320:1314:3415:1415:561:3716:161:571:24
2Gatzke10-NovxxxDionne94866398:3514:45day14:51015:210:3615:2416:1317:012:1617:583:131:40
3Cran12-NovxxMeads948695311/12/01 18:302:30night2:352:552:503:260:563:504:315:202:50patient transport not booked by Hospitalist1:54
4Cran12-NovxxBaylis948696111/12/01 19:432:10night2:152:552:553:281:183:504:315:203:10patient transport not booked by Hospitalist1:52
5Kassam13-NovxxGuyong925646211/12/01 22:550:20night0:200:471:511:313:203:444:274:07patient transport not booked by Hospitalist2:36
6Kassam13-NovxxKing936171511/13/01 16:560:09night0:090:470:501:541:451:572:383:133:04patient transport not booked by Hospitalist1:19
713-NovxxWiggins100457211/13/01 10:1514:45day14:4515:2015:501:0515:5215:5816:482:0317:090.1patient transport not booked by Hospitalist0:58
813-NovxxPopham58127021:01evening21:2321:4121:4721:230:2221:2522:1022:531:5201:30
913-NovxxSamson944337322:00evening22:0222:1522:030:0322:0622:2123:021:0223:441:440:59
10Kassam13-NovxxHudson948525211/12/01 20:142:30night0:203:403:483:421:124:395:105:523:22patient transport not booked by Hospitalist2:10
11Hakes14-NovxxxMunro948667011/14/01 3:153:00night3:003:154:123:080:084:204:575:362:366:053:052:28
12Bryant14-NovxxxNicholson66056160011/14/01 23:2011/14/01 23:10night23:0523:1823:3011/14/01 23:140:0423:2323:3811/15/01 0:171:0711/15/01 0:201:101:03
1314-NovxWilkinson35302512111/13/01 21:302:00night2:052:203:061:063:263:394:202:201:14
1414-NovxRothwell95681022011/13/01 17:422:00night2:054:042:045:576:076:544:542:50
15Cully19-NovxxHarrendance34773608012/31/99 11:2517:05day17:10unaware19:1519:492:4419:5120:0620:503:45patient transport not booked by Hospitalist1:01
16Conradie24-NovxxxCuthbert921804023:1011/24/01 22:30evening22:5323:2011/24/01 22:550:2523:520:0911/25/01 0:552:2511/25/01 1:303:002:00
17Conradie24-NovxxIwazyk007339317:3822:00day22:0822:130:1322:2722:3123:121:1211/25/01 0:182:180:59
1826-NovxxHewitt5:4511:05day11:1511:150:1011:3011:5112:381:3314:153:101:23
1926-NovxxBrown64226xx8:2013:15day13:2013:3513:3813:210:0613:5114:0414:501:351:29
2027-NovxxJohn63325188019:551:10night1:111:291:150:051:422:002:381:282:391:291:23
2127-NovxxSharpe3549291119:3519:40evening19:1719:5019:5120:170:3721:0221:2922:092:2922:372:571:52
22Cran5-DecxxXie, Guang34616153023:2912/5/01 23:17night23:1823:3023:3512/5/01 23:200:0323:2423:4612/6/01 0:261:091:06
23Cran6-DecxxGullacher8343392005:10night5:105:115:225:210:115:275:426:251:151:04
count23
day730%average0:44average2:181:34
evening417%max2:44max4:54
231214night1252%min0:03min1:02
Incomplete Data
Samis7-NovxDobruk92392970:460:491:101:51
Cully28-NovxChebrehiwet23:2023:162:112:293:08
Cully28-NovxxOrr911261321:4123:2023:152:533:043:4423:16
28-NovxOstafichuk932227821:0521:3123:1223:3511/29/01 0:170.0270833333
28-NovxKok949339821:4121:5521:510:260:4911/29/01 1:310.1236111111
Cully29-NovxSitu94911363:503:433:464:154:52
Jeanine Boyarchuk:orange denotes transfers where FMC UC indicated that Hospitalist did not contact Patient Transport; Transfer #14 appears to also fit this category
Baseline
BETWEEN CC1 and CC2 (non-test patients) October 17th - November 6th, 2001
DateLast NamePPR or PLC #Admit FMC EDDec to AdmitDec to Admit ShiftED doc calls HospitalistAdmis-sion Sheet to ED UCED UC requests bed from PLCPLC assigns bedED RN phones reportED UC books Pt Transport"Dec to Admit" -to- "Pt Transport booked"Vehicle dispatchedActual Pick UpCompletion"Dec to Admit" -to- "Com-pletion"Hospitalist Notified by Unit"Dec to Admit" -to- "Hospitalist Notified"Booked to Completion
117-OctCorasinitiTeresa101070110/17/01 2:10night10/17/01 3:50
218-OctCherniwchanMary Anne360645610/18/01 3:35night10/18/01 3:3510/18/01 3:5010/18/01 3:540:1910/18/01 4:1010/18/01 5:1810/18/01 6:062:312:12
322-OctCannellCarlos910340610/22/01 20:45evening10/22/01 20:4510/22/01 22:201:3510/22/01 22:3810/22/01 23:0610/22/01 23:442:591:24
422-OctZeebRose134704610/22/01 23:30night10/22/01 23:4810/23/01 0:060:3610/23/01 0:2010/23/01 0:4410/23/01 1:211:511:15
523-OctTitmarshRamon340276510/23/01 23:15night10/23/01 23:1510/24/01 0:050:5010/24/01 0:1110/24/01 0:3710/24/01 1:121:571:07
624-OctFjeldstromSonya230373310/24/01 2:35night10/24/01 2:440:0910/24/01 2:4810/24/01 3:0410/24/01 3:521:171:08
725-OctJuhnMartina Sara427628310/25/01 0:10night10/25/01 1:0710/25/01 0:1010/25/01 1:541:4410/25/01 3:1310/25/01 3:4710/25/01 4:304:202:36
825-OctUrbainMargaret734447210/25/01 0:15night10/25/01 0:1510/25/01 1:4510/25/01 1:411:2610/25/01 2:3610/25/01 2:5610/25/01 3:303:151:49
92-NovBannanMargaret767824611/2/01 22:45evening11/2/01 23:130:2811/2/01 23:1811/2/01 23:3511/3/01 0:111:260:58
104-NovMacKinnonTheresa929334511/3/01 23:50night11/4/01 12:1511/4/01 1:0511/4/01 1:051:1511/4/01 2:0311/4/01 2:0111/4/01 2:372:471:32
average2:291:33
Incomplete Data
18-OctEaglesonJames541381010/18/01 3:1510/18/01 3:3710/18/01 3:3910/18/01 4:0810/18/01 4:43
22-OctOrbanLaszlo947897710/22/01 0:4010/22/01 1:4510/22/01 1:4810/22/01 2:0910/22/01 2:46
26-OctGeruygPieter913177010/26/01 1:2310/26/01 1:3210/26/01 2:3610/26/01 2:5610/26/01 3:30
26-OctBlaischuckShannon896832310/26/01 0:3710/26/01 1:0410/26/01 1:3610/26/01 1:5310/26/01 2:27
3-NovYeeTeddy948423511/4/01 9:0511/4/01 21:3411/4/01 21:3811/4/01 21:5411/4/01 22:34
3-NovLalondePhyllis248046511/3/01 9:0511/3/01 21:3311/3/01 21:3711/3/01 22:0311/3/01 22:46
jmr:report tried 0320 (no one available), 0330 (no answer), and again at 0350
jmr:not prospectively collected so unavailable from charts unless noted
jmr:chart not pulled
jmr:chart not pulled
jmr:chart not pulled
jmr:chart not pulled
jmr:chart not pulled
Pivot Baseline
DateLast NamePHNAdmit FMC EDDec to AdmitDec to Admit ShiftED doc calls Hospi-talistAdmis-sion Sheet to ED UCED UC requests bedPLC assigns bedED RN phones reportED UC books Pt Transport"Dec to Admit" -to- "Pt Transport booked"Vehicle dispatchedActual Pick UpCom-pletion"Dec to Admit" -to- "Com-pletion"Hospitalist Notified by Unit"Dec to Admit" -to- "Hospitalist Notified"Booked to Completion
9-OctCates8:3015:40evening10:4915:4015:4015:4216:1716:200:40No Record-EMS?
9-OctDick12:4019:05evening19:2319:4019:4220:2020:3721:001:5522:2622:4223:234:1823:454:402:23
10-OctMacIntyre20:470:04night23:450:040:300:391:202:362:322:333:033:253:214:003:560:49
11-OctThomson12:4521:15evening21:0021:1521:1521:2021:2521:300:1521:2621:5522:391:2421:251:09
11-OctTernes93746020013:132:29night2:292:452:452:55unavail3:090:403:414:014:442:151:35
14-OctKinakin19:2510:00day10:0010:0510:0510:2010:5911:051:0511:0011:4012:252:2514:454:451:20
14-OctParnell53995931012:4523:30night23:4523:590:020:16unavail0:220:520:230:511:261:541:401:541:04
15-OctDuFour9961589202:454:55night4:555:275:316:526:587:192:248:268:389:484:532:29
17-OctCora23:451:51night1:512:122:152:162:253:552:044:134:154:543:030:59
day11%average1:23average2:563:481:28
evening33%median1:05median2:444:181:14
night56%
missing data
9-OctHoare61028091019:2821:55unavail21:5521:5622:15unavailprivate veh.No Record-private veh.
time elapsed from step to step
9-OctCates7:100:000:000:020:350:03
9-OctDick6:250:180:170:020:380:170:231:260:160:41
9-OctHoare2:270:010:19
10-OctMacIntyre3:170:260:090:411:160:300:22
11-OctThomson8:300:150:000:050:050:050:290:44
11-OctTernes13:160:000:160:000:100:320:200:43
14-OctKinakin14:350:000:050:000:150:390:060:400:45
14-OctParnell10:450:150:140:140:010:280:35
15-OctDuFour2:100:000:320:041:210:060:211:070:121:10
17-OctCora2:060:000:210:030:010:091:300:180:020:39
average7:040:050:150:040:190:210:321:320:400:220:423:17
median6:470:000:150:010:120:170:210:320:240:42
avg step percent of time (to Booked)16%4%21%24%35%100%
avg step percent of time (to Completion)8%2%11%12%18%23%13%24%112%
7.6923076923
35%24%21%16%4%
0
0
0.0504050926
0.0498263889
13
&C&"Arial,Bold"&12FAMILY MEDICINE COLLABORATIVETRANSFER TIMES - FMC ED to PLC HOSPITALISTS
CHANGE CYCLE 1
&L&8JRobinson&F&D&10
jmr:appears to be inaccurate
jmr:calculation is -3 minutes - - impossible
jmr:calculation is -4 minutes - impossible
jmr:calculation is - 5 minutes - impossible
jmr:for this case, use Dec to Admit time versus ED doc calls hospitalist
jmr:only two cases, eliminate from calculations
jmr:"PLC unable to take patient until after 0700h"
jmr:"bed will not be ready until 12:00" - note in chart dated 1100h
Bar Proportion Delay
FMC Chart #FMC Admit DtFMC Disch DtDecision Admit ED to IPTime Dec to Admit to DischCalc ED Phys Assess TimePLC Chart #Admit to PLCDischargeHoursBookedAppointmentPickup"Dec to Admit" - to - "Pt Transport Booked"DispatchActual PickupTime Dec to Adm to Actual Pick-Up (P-D)CompletionTransport TimeDec to Adm to PLC Admit TimeTime Dec to Adm to CompletionTime Dispatch to Pick-Up (O-N)Booked to Completion
040811202-Apr-2001 11:5902-Apr-2001 21:3002-Apr-2001 20:48420202591402-Apr-2001 22:3503-Apr-20011.0802-Apr-2001 21:2902-Apr-2001 23:0002-Apr-2001 22:150:4102-Apr-2001 21:3202-Apr-2001 21:460:5802-Apr-2001 22:350:491:471:470:141:06
086732602-Apr-2001 18:5203-Apr-2001 00:5903-Apr-2001 00:50108402871803-Apr-2001 02:4303-Apr-20011.7303-Apr-2001 01:1803-Apr-2001 03:1503-Apr-2001 02:300:2803-Apr-2001 01:2103-Apr-2001 02:041:1403-Apr-2001 02:440:401:531:540:431:26
096203702-Apr-2001 19:4703-Apr-2001 09:3003-Apr-2001 07:151350749343003-Apr-2001 11:1216-Apr-20011.703-Apr-2001 09:2803-Apr-2001 11:0003-Apr-2001 10:152:1303-Apr-2001 09:5203-Apr-2001 10:163:0103-Apr-2001 10:580:423:573:430:241:30
066921004-Apr-2001 10:0804-Apr-2001 18:3004-Apr-2001 11:104400601856804-Apr-2001 12:4207-Apr-2001-5.804-Apr-2001 11:3704-Apr-2001 13:1504-Apr-2001 12:300:2704-Apr-2001 11:5304-Apr-2001 11:550:4504-Apr-2001 12:390:441:321:290:021:02
041141804-Apr-2001 22:5605-Apr-2001 02:2005-Apr-2001 01:10704592074905-Apr-2001 02:4808-Apr-20010.4705-Apr-2001 01:2005-Apr-2001 03:0005-Apr-2001 02:150:1005-Apr-2001 01:2205-Apr-2001 02:151:0505-Apr-2001 03:030:481:381:530:531:43
939744504-Apr-2001 19:0405-Apr-2001 06:3005-Apr-2001 04:151350939744505-Apr-2001 07:1013-Apr-20010.6705-Apr-2001 04:4605-Apr-2001 06:4505-Apr-2001 06:000:3105-Apr-2001 05:5005-Apr-2001 06:262:1105-Apr-2001 07:100:442:552:550:362:24
100578909-Apr-2001 14:1310-Apr-2001 02:3309-Apr-2001 23:301830833911110-Apr-2001 02:5509-May-20010.3710-Apr-2001 01:3210-Apr-2001 03:1510-Apr-2001 02:302:0210-Apr-2001 01:5810-Apr-2001 02:152:4510-Apr-2001 02:540:393:253:240:171:22
033831509-Apr-2001 22:1210-Apr-2001 02:4010-Apr-2001 01:30700889678910-Apr-2001 02:5712-Apr-20010.281:270:00
061844211-Apr-2001 13:0211-Apr-2001 19:5911-Apr-2001 16:1023018930709211-Apr-2001 20:1625-Apr-20010.2811-Apr-2001 18:3811-Apr-2001 20:1511-Apr-2001 19:302:2811-Apr-2001 19:1311-Apr-2001 19:363:2611-Apr-2001 20:170:414:064:070:231:39
938453510-Apr-2001 22:3311-Apr-2001 20:1411-Apr-2001 12:004940938453511-Apr-2001 20:5116-Apr-20010.6211-Apr-2001 19:1011-Apr-2001 20:4511-Apr-2001 20:007:1011-Apr-2001 19:3111-Apr-2001 20:038:0311-Apr-2001 20:460:438:518:460:321:36
082131911-Apr-2001 12:5911-Apr-2001 22:1511-Apr-2001 16:4133422625030211-Apr-2001 22:5201-May-20010.6211-Apr-2001 20:0311-Apr-2001 21:0011-Apr-2001 20:153:2211-Apr-2001 21:4811-Apr-2001 22:125:3111-Apr-2001 22:510:396:116:100:242:48
114347614-Apr-2001 22:4515-Apr-2001 03:4515-Apr-2001 00:1021525632832215-Apr-2001 01:3021-Apr-2001-2.2515-Apr-2001 03:1215-Apr-2001 04:4515-Apr-2001 04:003:0215-Apr-2001 03:4215-Apr-2001 03:323:2215-Apr-2001 04:200:481:204:108:001:08
037057716-Apr-2001 04:0417-Apr-2001 00:5016-Apr-2001 22:5511528004981717-Apr-2001 00:4813-May-2001-0.0316-Apr-2001 23:4517-Apr-2001 01:3017-Apr-2001 00:450:5017-Apr-2001 23:5617-Apr-2001 00:061:1117-Apr-2001 00:400:341:531:458:000:55
003627617-Apr-2001 18:3818-Apr-2001 01:1517-Apr-2001 22:0818767569561418-Apr-2001 01:3116-May-20010.2717-Apr-2001 00:4018-Apr-2001 02:1518-Apr-2001 01:302:3218-Apr-2001 00:5018-Apr-2001 00:432:3518-Apr-2001 01:180:353:233:108:000:38
114329617-Apr-2001 21:5718-Apr-2001 16:1018-Apr-2001 10:45325228238241418-Apr-2001 17:0125-Apr-20010.8518-Apr-2001 15:1518-Apr-2001 16:4518-Apr-2001 16:004:3018-Apr-2001 15:4618-Apr-2001 16:125:2718-Apr-2001 17:010:496:166:160:261:46
921200619-Apr-2001 22:1420-Apr-2001 02:5920-Apr-2001 01:259532897242420-Apr-2001 03:2620-Apr-20010.452:010:00
000432520-Apr-2001 01:5920-Apr-2001 09:1320-Apr-2001 05:402130940554820-Apr-2001 10:0111-May-20010.820-Apr-2001 08:2320-Apr-2001 10:0020-Apr-2001 09:152:4320-Apr-2001 08:3320-Apr-2001 09:043:2420-Apr-2001 09:450:414:214:050:311:22
939762920-Apr-2001 19:5121-Apr-2001 14:5921-Apr-2001 12:001800939762921-Apr-2001 16:4026-Apr-20011.6821-Apr-2001 14:5221-Apr-2001 16:3021-Apr-2001 15:452:5221-Apr-2001 15:2721-Apr-2001 15:583:5821-Apr-2001 16:400:424:404:400:311:48
940656723-Apr-2001 08:4323-Apr-2001 13:3023-Apr-2001 12:50400940656723-Apr-2001 14:5002-May-20011.3323-Apr-2001 13:1923-Apr-2001 15:0023-Apr-2001 14:150:2923-Apr-2001 13:2323-Apr-2001 14:031:1323-Apr-2001 14:500:472:002:000:401:31
940696923-Apr-2001 22:4024-Apr-2001 04:3024-Apr-2001 03:0090190940696924-Apr-2001 05:1025-Apr-20010.6724-Apr-2001 04:0324-Apr-2001 05:4524-Apr-2001 05:001:0324-Apr-2001 04:0824-Apr-2001 04:291:2924-Apr-2001 05:110:422:102:110:211:08
036878124-Apr-2001 14:2425-Apr-2001 01:091356940734425-Apr-2001 01:3528-Apr-20010.4325-Apr-2001 00:2625-Apr-2001 02:0025-Apr-2001 01:1525-Apr-2001 00:2825-Apr-2001 00:5425-Apr-2001 01:360:420:261:10
929468227-Apr-2001 11:5028-Apr-2001 00:4527-Apr-2001 19:403050844846627-Apr-2001 23:5302-May-2001-0.8727-Apr-2001 23:2528-Apr-2001 01:0028-Apr-2001 00:153:4528-Apr-2001 23:2727-Apr-2001 23:504:1028-Apr-2001 00:290:394:134:498:001:04
007312027-Apr-2001 22:2628-Apr-2001 03:5928-Apr-2001 02:31891940899328-Apr-2001 04:4329-Apr-20010.7328-Apr-2001 03:2528-Apr-2001 04:1528-Apr-2001 03:300:5428-Apr-2001 03:2728-Apr-2001 04:011:3028-Apr-2001 04:370:362:122:060:341:12
062663429-Apr-2001 01:1029-Apr-2001 10:1529-Apr-2001 06:302250499465329-Apr-2001 10:1202-May-2001-0.0529-Apr-2001 07:3529-Apr-2001 10:1529-Apr-2001 09:301:0529-Apr-2001 09:0429-Apr-2001 09:333:0329-Apr-2001 10:110:383:423:410:292:36
085160130-Apr-2001 12:0530-Apr-2001 19:5930-Apr-2001 18:35850929594330-Apr-2001 20:3802-May-20010.6530-Apr-2001 19:1630-Apr-2001 21:0030-Apr-2001 20:150:4130-Apr-2001 19:1830-Apr-2001 19:501:1530-Apr-2001 20:340:442:031:590:321:18
940992830-Apr-2001 15:1001-May-2001 01:2311113424601-May-2001 00:1309-May-2001-1.1701-May-2001 00:5301-May-2001 02:3001-May-2001 01:4501-May-2001 00:5601-May-2001 01:1201-May-2001 01:500:380:160:57
072021501-May-2001 20:3502-May-2001 01:3002-May-2001 00:20700271112502-May-2001 01:1308-May-2001-0.2802-May-2001 00:5702-May-2001 02:3002-May-2001 01:450:3702-May-2001 00:5902-May-2001 01:140:5402-May-2001 01:530:390:531:330:150:56
041519202-May-2001 18:1002-May-2001 23:4502-May-2001 23:3015305869429103-May-2001 00:4808-May-20011.0502-May-2001 23:5303-May-2001 01:3003-May-2001 00:450:2303-May-2001 23:5503-May-2001 00:080:3803-May-2001 00:490:411:181:198:000:56
082733104-May-2001 16:3504-May-2001 22:5904-May-2001 22:006040192474504-May-2001 23:0917-May-20010.1704-May-2001 21:5604-May-2001 23:3004-May-2001 22:4504-May-2001 21:5804-May-2001 22:260:2604-May-2001 23:140:481:091:140:281:18
939256404-May-2001 18:1405-May-2001 01:3704-May-2001 23:51106106939256405-May-2001 02:0825-May-20010.5205-May-2001 01:0805-May-2001 02:3005-May-2001 01:451:1705-May-2001 01:1005-May-2001 01:291:3805-May-2001 02:050:362:172:140:190:57
114520504-May-2001 17:1805-May-2001 03:3005-May-2001 01:53970756915505-May-2001 03:0108-May-2001-0.4805-May-2001 03:0005-May-2001 04:3005-May-2001 03:451:0705-May-2001 03:0105-May-2001 03:151:2205-May-2001 03:510:361:081:580:140:51
941233105-May-2001 21:5506-May-2001 02:591155941233106-May-2001 07:2712-May-20014.4706-May-2001 06:1206-May-2001 07:4506-May-2001 07:0006-May-2001 06:1306-May-2001 06:3506-May-2001 07:110:360:220:59
900173809-May-2001 09:5510-May-2001 00:4809-May-2001 14:2062845900173810-May-2001 01:1822-May-20010.510-May-2001 23:2010-May-2001 01:0010-May-2001 00:159:0010-May-2001 23:4010-May-2001 00:3010:1010-May-2001 01:120:4210:5810:528:008:00
107597812-May-2001 14:3012-May-2001 21:40180921332212-May-2001 22:1324-Jul-20010.5512-May-2001 21:0612-May-2001 22:4512-May-2001 22:0012-May-2001 21:0912-May-2001 21:3012-May-2001 22:130:430:211:07
941233612-May-2001 16:1813-May-2001 03:4013-May-2001 01:251350941233613-May-2001 02:1615-May-2001-1.413-May-2001 02:2213-May-2001 04:0013-May-2001 03:150:5713-May-2001 03:4013-May-2001 03:502:2513-May-2001 04:040:140:512:390:101:42
026157113-May-2001 14:3014-May-2001 02:2714-May-2001 00:301170511968014-May-2001 01:0617-May-2001-1.3514-May-2001 01:3814-May-2001 03:1514-May-2001 02:301:0814-May-2001 02:0314-May-2001 02:181:4814-May-2001 02:510:330:362:210:151:13
075720014-May-2001 00:2214-May-2001 06:5014-May-2001 04:1815230587247814-May-2001 05:0216-May-2001-1.814-May-2001 05:4914-May-2001 07:3014-May-2001 06:451:3114-May-2001 06:0114-May-2001 06:332:1514-May-2001 07:180:450:443:000:321:29
941731317-May-2001 06:2217-May-2001 19:5917-May-2001 13:3538557826818717-May-2001 21:0624-May-20011.1217-May-2001 19:3517-May-2001 21:1517-May-2001 20:306:0017-May-2001 19:3917-May-2001 20:156:4017-May-2001 21:060:517:317:310:361:31
937503817-May-2001 17:3018-May-2001 00:4017-May-2001 23:307075865685218-May-2001 01:2112-Jun-20010.6817-May-2001 23:5518-May-2001 01:3018-May-2001 00:450:2518-May-2001 23:5918-May-2001 00:361:0618-May-2001 01:220:461:511:528:001:27
110951418-May-2001 17:5019-May-2001 15:5019-May-2001 11:002900402493119-May-2001 16:2114-Jun-20010.5219-May-2001 14:3619-May-2001 16:1519-May-2001 15:303:3619-May-2001 14:3919-May-2001 15:254:2519-May-2001 16:130:485:215:130:461:37
079288120-May-2001 20:0921-May-2001 09:3021-May-2001 05:502200778842521-May-2001 10:0526-May-20010.5821-May-2001 07:3621-May-2001 09:1521-May-2001 08:301:4621-May-2001 09:0021-May-2001 09:223:3221-May-2001 10:040:424:154:140:222:28
074898122-May-2001 12:3522-May-2001 20:3522-May-2001 18:001550923664322-May-2001 21:0622-Jun-20010.5222-May-2001 19:2922-May-2001 21:0022-May-2001 20:151:2922-May-2001 19:4522-May-2001 20:232:2322-May-2001 21:050:423:063:050:381:36
085220222-May-2001 08:5922-May-2001 20:501487136667322-May-2001 20:5826-May-20010.1322-May-2001 19:3922-May-2001 21:1522-May-2001 20:3022-May-2001 19:4622-May-2001 20:1622-May-2001 20:570:410:301:18
027970722-May-2001 10:5022-May-2001 22:1522-May-2001 19:22173260764382822-May-2001 22:5130-May-20010.622-May-2001 19:5422-May-2001 21:3022-May-2001 20:450:3222-May-2001 21:1322-May-2001 22:082:4622-May-2001 22:470:393:293:250:552:53
941916222-May-2001 10:2822-May-2001 23:4522-May-2001 21:50115448941916223-May-2001 01:2224-May-20011.6222-May-2001 22:4322-May-2001 00:1522-May-2001 23:300:5322-May-2001 23:5423-May-2001 01:053:1523-May-2001 01:050:003:323:151:112:22
046136423-May-2001 03:5023-May-2001 18:5923-May-2001 13:31329265281500923-May-2001 16:4126-May-2001-2.323-May-2001 14:4923-May-2001 17:0023-May-2001 16:151:1823-May-2001 15:5523-May-2001 15:512:2023-May-2001 16:390:483:103:088:001:50
021920624-May-2001 13:3624-May-2001 23:2024-May-2001 17:05375154712159325-May-2001 00:4407-Jun-20011.424-May-2001 22:0524-May-2001 23:4524-May-2001 23:005:0024-May-2001 23:0924-May-2001 23:466:4125-May-2001 00:330:477:397:280:372:28
063517925-May-2001 22:4026-May-2001 07:3026-May-2001 03:402300219708526-May-2001 06:1203-Jun-2001-1.32:320:00
058464528-May-2001 14:1428-May-2001 23:3828-May-2001 21:25133106918356528-May-2001 23:5808-Jun-20010.3328-May-2001 22:1228-May-2001 00:1528-May-2001 23:300:4728-May-2001 23:1128-May-2001 23:231:5828-May-2001 23:590:362:332:340:121:47
941942028-May-2001 18:5929-May-2001 01:3028-May-2001 23:391110046814029-May-2001 02:0205-Jun-20010.5329-May-2001 00:2029-May-2001 02:0029-May-2001 01:150:4129-May-2001 00:5129-May-2001 01:171:3829-May-2001 01:550:382:232:160:261:35
103973430-May-2001 01:2530-May-2001 16:4530-May-2001 05:566490362705630-May-2001 17:2401-Jun-20010.6530-May-2001 16:0230-May-2001 17:3030-May-2001 16:4510:0630-May-2001 16:0730-May-2001 16:3110:3530-May-2001 17:240:5311:2811:280:241:22
942501304-Jun-2001 18:0505-Jun-2001 00:5504-Jun-2001 22:0017535942501305-Jun-2001 01:1615-Jun-20010.3504-Jun-2001 23:2304-Jun-2001 01:0004-Jun-2001 00:151:2304-Jun-2001 00:0105-Jun-2001 00:132:1305-Jun-2001 00:133:162:130:120:50
024699811-Jun-2001 09:5211-Jun-2001 16:0511-Jun-2001 14:5075118438359211-Jun-2001 18:3612-Jun-20012.523:460:00
020603516-Jun-2001 11:3016-Jun-2001 21:5016-Jun-2001 21:1931560468414816-Jun-2001 23:2318-Jun-20011.5516-Jun-2001 22:1316-Jun-2001 23:4516-Jun-2001 23:000:5416-Jun-2001 22:3516-Jun-2001 22:421:2316-Jun-2001 23:230:412:042:040:071:10
098565926-Jun-2001 01:5226-Jun-2001 06:4526-Jun-2001 04:001653588931626-Jun-2001 07:3701-Jul-20010.8726-Jun-2001 04:5726-Jun-2001 07:1526-Jun-2001 06:300:5726-Jun-2001 06:0526-Jun-2001 06:472:4726-Jun-2001 07:360:493:373:360:422:39
004157326-Jun-2001 20:3026-Jun-2001 23:4526-Jun-2001 22:159055230493927-Jun-2001 02:1927-Jun-20012.5726-Jun-2001 23:3627-Jun-2001 02:1527-Jun-2001 01:301:2127-Jun-2001 01:2627-Jun-2001 01:413:2627-Jun-2001 02:210:404:044:060:152:45
044151829-Jun-2001 22:4530-Jun-2001 15:1530-Jun-2001 13:2511065943579630-Jun-2001 15:4906-Jul-20010.5730-Jun-2001 14:2730-Jun-2001 16:0030-Jun-2001 15:151:0230-Jun-2001 14:3030-Jun-2001 15:041:3930-Jun-2001 15:490:452:242:240:341:22
average2:352:57average0:403:371:32
median1:082:21median0:423:021:26
April-May count51
57count47count4853
> 3:0010
-
Order of diagnostics waiting diagnostic results RN busy (cant get tests done) UC busy/UC forgets to page Waits to page consultant (nights) MD delay in re-assessing patient after diagnostic results are backTriage DelaysMacro Flowchart ED Consult Process More diagnostics ordered level of experience of responding consultant Is it appropriate service? ordering of further tests prior to admit so dont have to wait for tests on ward transfers care to another service many ED patients to assess returns to OR/Clinic/Unit to d/c patientsConsult Delays
-
Diagram the ProcessReasons to flowchartDevelop common understanding of processGet a complete pictureEasily identify issues in the processduplication of effortsources of delaysnon value adding activitiesRedesign the processCommunicate changes to the process
-
Diagram the ProcessAnalysis of Flowchart / Process RedesignCan it be standardized?Does every step or activity add value?Is there duplication of work?Is it possible to simplify?
-
Exercise - Diagram the ProcessIn your group, create a flowchart of: EMS arriving at triage through to treatment space & transfer of care to RNSuggestions:use a post-it note for each stepfind a large space on which to work
-
The Improvement ModelPDSA
-
Trial and Learn Plan - Do - Study - Actmeasuring results and acting on themRe-evaluate and Continuous Improvementact, capture the gain and start all over
*
HealthcareQuality Improvement Model
STEP 2:
COLLECT BACKGROUND
DATA
STEP 1:
FORM TEAMS
STEP 3:
DEVELOP PROBLEM/ISSUE
STATEMENTS
STEP 4:
DIAGRAM THE PROCESS
STEP 5:
DETERMINE ROOT CAUSES OF
PROBLEMS/ISSUES
STEP 6:
VERIFY CAUSES WITH DATA
STEP 7:
CRITICAL REVIEW OF THE
LITERATURE
STEP 8:
DEVELOP AND SELECT THE
SOLUTIONS
STEP 9:
PLAN, TEST, IMPLEMENT THE
SOLUTIONS
STEP 10:
MEASURE RESULTS
STEP 11:
RE-EVALUATE AND
CONTINUOUS IMPROVEMENT
Getting Started
Getting Focused
Analysis
Decision Making
Implementation
Measurement
Continually Improve
-
Framework for Trial & LearningImprovement Model PDSA
-
The model consists of two parts: 3 questions & a cycle for learning and improvement What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in I improvement?
-
Improvement CyclePDSA
-
Facilitates the use of teams to make improvementsProvides a framework for the use of effective measurement and use of improvement toolsEncourages planning to be based on evidence-based theoryEmphasizes and encourages learning (trial and learn)Empowers people to take actionCreates the will for improvement
Improvement Model PDSA
-
BreakthroughResultsTheories, hunches,& best practicesLearning and improvementPDASPDASPDASPDASTheories, hunches,& best practicesLearning and improvementPDASPDASPDASPDASRapid and repeated use of the cycle helps teams build knowledge sequentially
-
Use the PDSA Cycle forTesting or adapting a change ideaImplementing a changeSpreading the changes to the rest of your system
-
Hip Fracture Project Orthopedics and EDPurpose of Project: Reduce (ALOS) in ED for all hip fracture patients by 50%Fracture hip patients receive surgery within 24 - 48 hoursScope & Boundaries: All hip fracture patients at FMC site.Improvement Objectives: Optimize time to surgery to ensure patients receive high quality care with positive outcomesAddress co-morbidity factors prior to discharge.
-
PDSA Cycle 1Act:: Implement checklist to ensure streamline care of hip # pts.Study: Chart review of all # hip patients in ED. Does checklist decrease LOS in ED? Plan: Test feasibility of utilizing guidelines in ED Do: - Use Guidelines to develop a checklist for hip # pts in ED
-
Hip fracture checklist streamlines care = LOS in ED.
Improved communication between ED and Orthopedics
awareness of flow (ED to OR) PDSA 1 Learning's:
-
PDSA Cycle 2Act: Continue with PROF (Pre-Operative Fracture) bed until November 30, 2002Study: Findings - ALOS in ED & time to OR Plan: Test feasibility of having a designated PROF bed. Can anesthesiology assist with surgical clearance in timely manner? Do: - Create a designated bed for hip fractures on unit 72 - Work with anesthesiology to assist with surgical clearance
-
A designated bed (PROF) for hip #s enhances flow of patients from ED to OR
Right staff is caring for the right patient in the right bed
Pre-op delays are reduced PDSA 2 Learnings:
-
PDSA Cycle 3Plan: Work on effectiveness & efficiency of flow for hip # across continuum of careDo: Follow all hip fracture patients admitted to the FMCStudy: Chart & bed utilization review (ALOS in ED; Time to O.R.; ALOS as inpatient; patient outcomes)Act: Refine the flowchart = communication amongst care providers
-
Progress to date: ALOS in ED: ALOS in ED: 13 hours < 5 hours Time from admit to O.R: 5-7 days 17 - 24 hours Inpatient ALOS: 21 days 12 days Direct admits bypassing EDHip Fracture Project Orthopedics and ED
-
Run Chart: Hip # Patients (FMC)
BASELINE
Target in ED
Target to O.R
PDSA 1
PDSA 2
PDSA 1: ED Checklist EstablishedPDSA 2: PROF Bed OpenedPDSA 3: communication/awareness
Pt. To ICU d/t co-morbidity
PDSA 3
Chart2
26.536
896
932
1313
1316
824
817
1675
147
818
1056
1331
926
12.512
1736
12.535
1132
1050
9.568
3617
15.313
1212
584
512
924
731
414
715
215
511
514
428
210
415
615
510
442
227
715
48
47
319
526
618
28
319
310
521
221
1031
724
35
326
Hours in ED
Hours to OR
Patient Case Number
Hours
ALOS in ED; Time to O.R.
Sheet1
Case #Hours in EDHours to OR
1.026.536.0N/A
2.08.096.0N/A
3.09.032.0N/A
4.013.013.0N/A
5.013.016.0N/A
6.08.024.0N/A
7.08.017.0N/A
8.016.075.0N/A
9.014.07.0N/A
10.08.018.0N/A
11.010.056.0N/A
12.013.031.0N/A
13.09.026.0N/A
14.012.512.0
15.017.036.0
16.012.535.0
17.011.032.0
18.010.050.0
19.09.568.0
20.036.017.0
21.015.313.0
22.012.012.0
23.05.084.0
24.05.012.0
25.09.024.0
26.07.031.0
27.04.014.0
28.07.015.0
29.02.015.0
30.05.011.0
31.05.014.0
32.04.028.0
33.02.010.0
34.04.015.0
35.06.015.0
36510
37442
38227
39715
4048
4147
42319
43526
44618
4528
46319
47310
48521
49221
501031
51724
5235
53326
Sheet1
26.536
896
932
1313
1316
824
817
1675
147
818
1056
1331
926
12.512
1736
12.535
1132
1050
9.568
3617
15.313
1212
584
512
924
731
414
715
215
511
514
428
210
415
615
Hours in ED
Hours to OR
Patient Case Number
Hours
Run Chart: Hip # Patients
Sheet2
Sheet3
Mention that we didnt have time to OR in baseline data on individual cases; however we did have the mean time to OR as within 5-7 days prior to initiation of test cycles.
-
Emergency Triage ProjectChallenge: at-risk patient population in triage line-ups and waiting rooms triage practices targeted for QI11 step HQI methodology PDSATrial and Learn for change ideas: sequential building of knowledge breakthrough results
-
REDIS Snapshot Over Capacity
-
Site Core Teams(FMC, RGH, PLC)Ideas to Test: Rapid assessment of line-up by RN Promote information/security in waiting room Consistent communication Re-allocate resources D.I. patients at triage desk ED patients presenting x 2 at triage
-
Criteria for a Good Action PlanSMART Planspecificmeasurableaction orientedresponsibilities definedtime lined
-
Rapid Triage AssessmentTest cycles:nurse educator to assist assessing line-uppost-it notes > 5 patients in line-up or PRNone day/one nurse spread dedicated chair for sicker patientsre-allocate staff
-
Rapit Triage - Graph
317
319
216
418
323
216
629
421
526
419
Rapid Triage
Normal Triage
Minutes
Mean Time to Primary Assessment at RGH Triage
Sheet1
Rapid TriageNormal Triage
2001Oct. 5317
Oct. 15319
Nov. 7216
Nov. 10418
Nov. 13323
Nov. 18216
Dec. 10629
Dec. 14421
2002Jan. 9526
Jan. 12419
Sheet2
Sheet3
-
Re-evaluate and Continuous ImprovementPDSAPlanDoStudyActact, capture the gain and start all over
-
Exercise : Create a Plan for a PDSA CycleWhat is the objective of this cycle?What change are you testing?What is your prediction?Details of the planWho ?What ?Where ?When?How?
-
Anyone who has never made a mistake has never tried anything newAlbert Einstein
-
Create a PDSA Cycle for EMS Delays
-
Go forth and work.
-
Questions?
Simplify the data - runcharts are easy to understand
Attention getting - easy for people to see the impact of change!3Simple method to improve performance
3 fundamental questions that provide a framework for trial & learning approach
Focus on the questions, thus emphasis on framework for learning, the use of data and design of small trialsDevelop Plan - 5 Ws - who, what , when, where, why & howDo: trial on small scalecollect dataStudy:Compare the results of the test with the predictions madeDATA - different methods of capturing;- ease of collecting data- plotting data- special causeAct: Turn the learning's into action
Next PDSA Creates an environment of reasonable risk taking
BEFORE going to next slide:
TALK ABOUT CHANGE - CREATIVITY
Think outside of the boxChallenge your boundariesi.e. direct admits were being admitted through ED.
Increased waiting timesIncreased number of critical incidentsIncrease number of patient complaintsstaff anxiety and concern
Recommendations - communication Re-assessments Initiating labs at triage
Challenge the boundaries:triage window was boundary - move beyond it
Communication - P.A. system (comfort level for some initially - spread to others)
Involve pertinent team members - one at a timeRe-evaluated purpose of resuscitation room -
They are patient care areas that can be utilized for sicker patients until another bed is available
Use of huddles to communicate test cycles & learning
Plotting data over to time to communicate success