OR Process Improvement Candice K. Bergsneider, MT Deborah - - PowerPoint PPT Presentation

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OR Process Improvement Candice K. Bergsneider, MT Deborah - - PowerPoint PPT Presentation

Aug 29, 2022 334 likes •713 views

T HE CLEVELAND C LINIC F OUNDATION OR Process Improvement HIMSS 2000 April 12, 2000 OR Process Improvement Candice K. Bergsneider, MT Deborah Atsberger, RN MSN Jaye A. Wolfe Agenda Introduction Background Pre-plan

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SLIDE 1

THE CLEVELAND CLINIC FOUNDATION

OR Process Improvement HIMSS 2000 April 12, 2000

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SLIDE 2

OR Process Improvement

Candice K. Bergsneider, MT Deborah Atsberger, RN MSN Jaye A. Wolfe

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SLIDE 3

Agenda

  • Introduction
  • Background
  • Pre-plan Assessment
  • Project Design and Implementation
  • Evaluation
  • Conclusions
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SLIDE 4

Learning Objectives

  • Plan for a successful project by carefully defining the

scope

  • Describe the composition of a multi-disciplinary team,

its roles and responsibilities

  • Define a workflow that provides the map for re-

engineering patient tracking

  • Design measurement strategies that monitor initial

implementation and monitors ongoing compliance for continual process improvement

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SLIDE 5

BACKGROUND

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SLIDE 6

History

  • In past, many patients were

hospitalized before surgery

  • Now, many patients arrive the day
  • f surgery
  • Increase in overall number of

surgical patients

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SLIDE 7

Average Number of Cases Per Day Per Year

50 100 150 200 92 93 94 95 96 97 98 99

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SLIDE 8

Complexity of Environment

  • Three admitting sites
  • Three pre-operative nursing units
  • Sixty operating rooms in four

buildings

  • Three post anesthesia care units
  • Five intensive care units
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SLIDE 9

Patient Information

  • Multiple phone calls to locate

patients

  • Communication of status of

patient’s readiness for surgery

  • Patient status information for family

members

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SLIDE 10

Key Criteria

  • Maintaining high OR utilization
  • Patient and family satisfaction
  • Efficient utilization of personnel

time

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SLIDE 11

PRE-PLAN ASSESSMENT

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SLIDE 12

Operating Room Management Group (ORMG)

  • Chairman of Surgery
  • Chairman of Anesthesiology
  • Chief Information Officer
  • Director of OR Nursing
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SLIDE 13

ORMG Key Issues

  • Delays in OR start time
  • Inefficient use of nursing personnel

to locate patients

  • Inefficient use of receptionists’ time

in locating patients

  • Family members unsure if surgery

has started

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SLIDE 14

Development of Multi-Disciplinary Team

■ OR nursing specialist ■ OR clinical analyst ■ Anesthesiology system manager ■ IT project manager ■ IT systems analyst ■ Admission/Discharge/Transfer/Registration

(ADT/R) system manager

■ Surgical waiting area administrator ■ Pre-operative supervisor

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SLIDE 15

Flow Considerations

  • Types of surgical admissions

■Already in-house (Inpatient) ■Admitted on same day as surgery

(TCI)

■Admitted and discharged on the

same day (Outpatient)

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SLIDE 16
  • Special Populations

■ Pediatrics ■ Psychiatrics ■ Gastrointestinal

Exceptions to Process

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SLIDE 17
  • Special preparatory procedures

■ Laboratory tests ■ Radiology exams ■ Radiological Procedure ■ Special anesthesiology

procedures

■ Physician Consult

Exceptions to Process

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SLIDE 18

PROJECT DESIGN AND IMPLEMENTATION

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SLIDE 19

Process Design

In/Out Surgical and Same Day Admission Patients

Same Day Admit

Location changed by

Admitting Personnel Out Patient Admi t

Location changed by

Admitting Personnel SDS Waiting Room

Location changed by

SDS Receptionist SDS Pre-surgical Unit

Location changed by

SDS Unit Secretary Induction/Operating Room

Location changed by

Patient Transporter Out Patients H

  • me

Location changed by

PACU Secretary SDA to Hospital

Location changed by

PACU Secretary PACU

Location changed by

PACU Secretary

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SLIDE 20

Pre-Determined Outcome Evaluation Measures

  • SDS Call Study
  • Usage Statistics
  • System Credibility Study
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SLIDE 21

DESIGN IMPLEMENTATION

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SLIDE 22

FADAI471 CLEVELAND CLINIC FOUNDATION 12/13/99 10:43 INQSTL SURGERY TRACKING LOG A489918 STEP

  • S. OPLOC. TIME PATIENT NAME CLINIC NBR SUBTYPE PHYSICIAN

1 M020-01 10:20 PAVLOV,DOUG,MR 2-225-807-2 IO R. DANE READY 2 M020-02 10:26 CARPENTER,RICHARD,K,MR 2-059-750-5 IO J. COOK ARRIVAL 3 M020-04 9:48 RAND,JOSHUA,MR 2-181-960-0 IO A. GUTHRIE ARRIVAL 4 M020-05 10:41 TRAVENTONO,FRANK,A,MR 3-954-037-3 IO A. GUTHRIE ARRIVAL 5 M020-07 9:27 KLEIN,DARREL,MR 2-215-768-4 IO R. DANE ARRIVAL HOLD 6 M020-08 9:30 KINSKI,MARRY,M,MISS 1-805-592-0 IO A. WILSON ARRIVAL 7 M020-09 10:15 KONIK,CATHY,E,MISS 2-125-810-2 IO R. DANE ARRIVAL SELECTION NUMBER: STATUS: TEXT: CLINIC NUMBER: (ENTER SELECTION # FOR AVAILABLE BED AND CL#) PF4 HOLD PF5 FAMILY LOUNGE PF7 BKWD PF8 FRWD PF10 REFRESH NEXT RESPONSE: MENU NEXT KEY: DC905012 BOTTOM OF LOG *

Surgery Tracking Log

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SLIDE 23

Training

  • Training based on PC expertise

■Nurses, secretaries and receptionists

had exposure in current job

■Transporters were given basic PC skill

training first

  • All had to sign competency form
  • Training manual
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SLIDE 24

Budget

  • Contract Programmer
  • Equipment
  • Training materials
  • Personnel Cost for Training Time
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SLIDE 25

Project Time Line

ID Task Name 1 Hire Consultant(s) 2 Complete Design and Spec 3 Investigate Bar Code 4 ORMG Presentation 5 ADT Tracking Changes 6 Test Prototype 7 Review Flow with Prototype 8 Communicate Changes 05/25 06/15 07/06 07/27 08/17 09/07 June July August September

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SLIDE 26

EVALUATION

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SLIDE 27

1 2 3 4 5

09/30/97

Outgoing Incoming

Pre-Implementation SDS Call Study Average Calls Per Case

Before Go-Live

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SLIDE 28

50 100 150 200 250 300

10/22/97 12/09/97 01/27/98 10/20/98 04/20/99 07/22/99 08/10/99

Total Calls from 6AM to Noon

Incoming Outgoing Cases

SDS Post-Implementation Call Studies

Compliance Check Compliance Check Compliance Check Compliance Check After One Year System Familiarity After Go-Live

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SLIDE 29

Patient Look-up March & April 1998

200 400 600 800 1000 1200 1400 1600 3 / 2 / 1 9 9 8 3 / 4 / 1 9 9 8 3 / 6 / 1 9 9 8 3 / 8 / 1 9 9 8 3 / 1 / 1 9 9 8 3 / 1 2 / 1 9 9 8 3 / 1 4 / 1 9 9 8 3 / 1 6 / 1 9 9 8 3 / 1 8 / 1 9 9 8 3 / 2 / 1 9 9 8 3 / 2 2 / 1 9 9 8 3 / 2 4 / 1 9 9 8 3 / 2 6 / 1 9 9 8 3 / 2 8 / 1 9 9 8 3 / 3 / 1 9 9 8 4 / 1 / 1 9 9 8 4 / 3 / 1 9 9 8 4 / 5 / 1 9 9 8 4 / 7 / 1 9 9 8 4 / 9 / 1 9 9 8 4 / 1 1 / 1 9 9 8 4 / 1 3 / 1 9 9 8 4 / 1 5 / 1 9 9 8 4 / 1 7 / 1 9 9 8 4 / 1 9 / 1 9 9 8 4 / 2 1 / 1 9 9 8 4 / 2 3 / 1 9 9 8 4 / 2 5 / 1 9 9 8 4 / 2 7 / 1 9 9 8 4 / 2 9 / 1 9 9 8

April 6 - 1483 Patient Look-ups

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SLIDE 30

August 1999

68.18% 12.22% 19.60%

0% 1 0% 20% 30% 40% 50% 60% 70% 80%

Correct Rms Out side OR Incorrect Rms

System Credibility Check

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SLIDE 31

Key Obstacles

  • Delays between patient’s OR

departure and the new location update

  • Delays between patient’s move into

the OR from an induction room

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SLIDE 32

RESULTS

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SLIDE 33

Lessons Learned

  • Design -> Budget
  • Presentations to users and

management

  • Limited time and budget
  • Physician representation
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SLIDE 34

Lessons Learned

  • Define expectations
  • Careful analysis
  • On-going compliance checking
  • Non-computer user training
  • Replacement system justification
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SLIDE 35

Tangible Benefits

  • “Where is my patient now?”
  • 66% decrease in total number of

calls per case

  • 50% decrease in number of
  • utgoing calls per case
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SLIDE 36

Intangible Benefits

  • JCAHO Compliance
  • Staff Satisfaction
  • Patient Satisfaction