Decreasing Lag Time for Ward Collect Lab Draws
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1 Decreasing Lag Time for Ward Collect Lab Draws Dr. Audrey Tio Dr. Jan Patterson Audie L. Murphy VA Hospital San Antonio, TX
2 CONTACT Audrey Tio, M.D. (210)
3 TEAM PHYSICIANS Hospitalist - Audrey Tio, MD Chief / Medical Service Jan Patterson, MD Chief Resident Joanne Waltman, MD NURSING Assoc Chief of Nursing Marjory Olsen Nurse Organizer Jonell Garza, RN SUPER TECHS Julius Adams Sara Johnson Super Tech Supervisor Leonor Casto, RN MAS (Medical Admin Service) CLERKS Esther Avitia TECH/STATISTICAL SUPPORT Wayne Fischer, MS, PhD
4 LIST OF CUSTOMERS PATIENTS PROVIDERS NURSING HOSPITAL ADMINISTRATION
5 AIM STATEMENT To decrease lag time from lab order to collection for ward collect lab orders to 60 minutes and overall LOS by 0.5 days on 5A General Medicine ward over a 4 month period.
6 MEASURES Unable to get electronically generated list of ward collect labs by order time and collection time. Manual data collection completed assessing approx 100 data points within 3 time periods.
7 PRE INTERVENTION LAG TIME
8 LAG TIME BY TIME OF DAY Number of Orders Time Intervals 0-60 mins mins mins > 360 mins MN-8AM 8AM-12PM 12PM-4PM 4PM-8PM 8PM-12MN Time of Day
9 WHAT S GOING ON? Only two scheduled lab draws 5AM and 11:15AM All other labs are ward collect (collected by floor nurse or Super Tech) Process dependent on many people factors with variable availability
10 PROCESS FLOW - Pre Intervention
11 CAUSE & EFFECT DIAGRAM Ordering Ward Collect Labs
12 Along Came The Joint Commission June A few RFI s Progress on this project stalled
13 PROJECT REVIVED! Instead of requested broadcast pagers, text pagers were acquired. Protocol for reaching Super Techs were posted in all Medicine team rooms. Date of Intervention: July 3 rd
14 PROCESS FLOW - Post Intervention
15 POST INTERVENTION LAG TIME
16 RESULTS Decreased average time to lab collection (214 minutes to 78 minutes) Variability Decreased from 1150 minutes to 380 minutes. More streamlined process Less provider frustration Less duplication of work
17 RETURN ON INVESTMENT We put in We hope to achieve 5 Numeric pagers changed to text Pager cost differential $40/pager Service cost differential $3/pager/month Start-up cost = $200 Decreased average LOS of 0.5 days/patient Approx 400 medicine admissions/month Proposed decrease of 2400 hospital bed days/year $4,094,400 savings/year Yearly cost = $180
18 WHERE ARE WE GOING? Other possible interventions: Increased Phlebotomy hours Dedicated work space and dispatcher Overnight coverage for Phlebotomy or Super Techs
19 PERTINENT POINTS FROM LITERATURE Blaha, Jennifer. (2007, March 28). Lean Delivers Faster Turnaround Time in Hospital Lab. isixsigma.com. Retrieved July 22, 2008, from
20 CONCLUSIONS Baseline process was extremely complicated and involved too many people. Critical evaluation of the process enabled us to identify simple solutions that made a big difference. Seeing the variability in the SPC chart before and after intervention showed surprising but reassuring results. Knowledge of basic tools was integral to visualizing the goal and achieving the aims.
21 QUESTIONS?
22
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