Part 4. Change Concepts for Improving Adult Cardiac Surgery. In this section, you will learn a group. of change concepts that can be applied in
|
|
- Roderick Todd
- 5 years ago
- Views:
Transcription
1 Change Concepts for Improving Adult Cardiac Surgery Part 4 In this section, you will learn a group of change concepts that can be applied in different ways throughout the system of adult cardiac surgery.
2 102 Breakthrough Series Guide: Improving Outcomes and Reducing Costs in Adult Cardiac Surgery Change Concepts for Improving Adult The following are general change concepts that organizations can use to improve outcomes and reduce costs in adult cardiac surgery. These concepts and examples represent the strategies that have proven most effective. Organizations can use the following list of change concepts to develop good ideas for process changes that will lead to rapid, significant improvements. Each change concept is followed by examples of specific process changes based on the concept.
3 Part 4 Change Concepts for Improving Adult Cardiac Surgery 103 Cardiac Surgery 1 Do Tasks in Parallel 2 Use Multiple Processes 3 Use Pull Systems 4 Standardize 5 Minimize Handoffs 6 Synchronize 7 Consider People to Be in the Same System 8 Smooth the Work Flow For a comprehensive explanation of the use of change concepts in accelerating improvement in a variety of business contexts, see Langley GJ, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. San Francisco, CA: Jossey-Bass Publishers; Improve Predictions 10 Identify and Manage the Constraint 11 Convert Internal Steps to External 12 Eliminate Things That Are Not Used 13 Reduce or Eliminate Overuse
4 104 Breakthrough Series Guide: Improving Outcomes and Reducing Costs in Adult Cardiac Surgery 1 Do Tasks in Parallel Instead of doing tasks sequentially, redesign the process to do some or all tasks in parallel. In many processes, tasks are done in sequence: the second task is not begun until the first task is completed. This is especially true when different groups within the organization are involved in the different steps of a process. Redesigning the process so that some or all tasks are done in parallel can often save time and reduce costs. When tasks are done in parallel, the work in step 5, for example, can begin as soon as step 1 is complete, rather than waiting until steps 2, 3, and 4 are done. Inform all key staff concurrently of cardiac catheterization results. To expedite moving patients from catheterization to cardiac surgery, the cath lab cardiologist should inform all key staff including the attending physician, the cardiac surgeon, the cardiothoracic surgery office, and the referring cardiologist of the catheterization results. Instead of having each individual call the next in sequence the cath lab cardiologist calls the referring physician, who calls the surgeon, who calls the cardiothoracic surgery office for scheduling, and so on all key staff are notified directly by the cath lab. In this way, organizations can save days of waiting from catheterization to cardiac surgery. To reduce operating room turnover time, develop a list of tasks that must be performed prior to incision and do them in parallel. At one organization, tasks in the turnover process were performed in sequence: no steps could proceed until the scrub nurse finished setting up the instrument table, at which time the patient was brought in and prepared while the scrub nurse stood idle. The team redesigned the process to do tasks in parallel: now staff bring the patient into the room while the scrub nurse sets up. By the time the scrub nurse has completed the setup, the patient is fully prepared for surgery and the operation can begin.
5 Part 4 Change Concepts for Improving Adult Cardiac Surgery Use Multiple Processes Rather than use a single one-size-fits-all process, use multiple versions of the process, each customized to meet the different needs of patients or providers. Example Use multiple, customized processes to prepare patients for elective CABG. Instead of using one standard process for preparing the patient and family for cardiac surgery, an organization offers three options: home health providers will visit the home prior to surgery, see patients when they come in for their preoperative visit, or prepare them by phone. Patients can choose whichever process suits them best. 3 Use Pull Systems When work is being transferred through a process, instead of pushing it from one step to the next, have the later step pull it from the previous step. The timely transition of work from one step in the process to another is the primary responsibility of the downstream, or subsequent, process for example, the ICU orchestrating the transfer of patients from the operating room or the post-anesthesia care unit (PACU). This is in contrast to most traditional push systems, in which the transition of work is the responsibility of the upstream, or prior process for example, the operating room or the PACU pushing patients into the ICU. Example Use a pull system to move patients expeditiously from the cath lab to the operating room. Once the cath lab cardiologist has decided that a patient is a surgical candidate, the lab notifies the cardiac surgical office, which immediately notifies the on-call surgeon. The surgeon or a partner sees the patient as soon as possible, often within minutes of the request for consultation, while the patient is still in the cath lab. If the surgeon decides to proceed with surgery, he or she schedules the patient in the next available operating room slot preferably, on the same day the catheterization is performed. In such a process, cath-to-cabg time is a matter of hours instead of days.
6 106 Breakthrough Series Guide: Improving Outcomes and Reducing Costs in Adult Cardiac Surgery 4 Standardize Perform the same task in the same way. Performing the same task in a variety of ways results in broad variation in practice, a reduced ability to monitor outcomes, and wasted time, effort, and money. Understanding and designing standard approaches to repetitively performed tasks yields great efficiencies. In addition, it is easier to make changes to standardized tasks and to determine if those changes are leading to improvement. To reduce extubation time, standardize anesthetic management, pain control, and weaning methods. To reduce surgical mortality, standardize the approach to dealing with high-risk patients. To reduce turnover time and shorten CABG time, standardize operating room turnover and operative procedures. To reduce the rate of atrial fibrillation, standardize prophylaxis and treatment. Treatment of atrial fibrillation typically varies widely within an organization, often increasing lengths of stay by two days or more for patients who develop atrial fibrillation. Organizations that standardize their treatment of atrial fibrillation report limiting increases in length of stay to less than half a day. Standardize case carts. Instead of providing each surgeon with a unique set of instruments a practice associated with very high inventory costs have all surgeons use essentially the same instruments. Standardize heart valves and other instruments. To achieve such standardization, surgeons must agree to forgo some personal preferences. Often, these preferences reflect the nuances of surgeons individual training but without evidence of improved outcomes.
7 Part 4 Change Concepts for Improving Adult Cardiac Surgery Minimize Handoffs Redesign the work flow to minimize unnecessary handoffs in the process. Many systems require that elements for example, a customer, a form, or a product be transferred to multiple people, offices, or workstations to complete the processing or service. The handoff from one stage to the next can incur increased time and costs and cause problems in the quality of care. Staff may lose or improperly transmit information. Handoffs can also be dangerous. Patients in transition, for example, could be harmed if something is forgotten or lines are detached. It is often preferable to redesign these processes so that fewer workers are involved. For example, reduce layers of management that require multiple reviewers, meetings, and approvals. Expand clerical jobs to include scheduling, staffing, planning, and analysis. Cross train workers to handle many functions rather than one specific function. Reduce handoffs in surgery. Staff often hand off patients multiple times between providers or between floors moving from the floor to the preoperative area, preoperative area to the operating room, operating room to the post-anesthesia care unit, PACU to the ICU, and ICU to the floor. Information, too, may be handed off for example, a patient's history or a staff member's knowledge of what happened during surgery. Reduce handoffs between providers by creating a single cardiac surgery unit that functions as both a critical care area and a general post-cardiac surgery ward. Patients move from the operating room to the cardiac surgery unit and remain there for the rest of their stay. Because patients do not need to be moved from floor to floor, nurses remain familiar with them during their complete postoperative stay, thus minimizing the risks and costs of transferring them between units.
8 108 Breakthrough Series Guide: Improving Outcomes and Reducing Costs in Adult Cardiac Surgery 6 Synchronize Synchronize all of the steps in a process to a clearly defined, agreed-upon reference point. Complex systems such as surgery usually require coordinating multiple processes that function at different times and at different speeds. Staff often spend considerable amounts of time waiting for one step in the process to be completed before moving on to the next step. Using a precisely defined, generally agreed-upon synchronization point allows everyone to know when they must begin their tasks in order to have them completed on time. Individuals can work together to determine which tasks to perform in parallel in order to be ready by the synchronization point. Synchronize steps in the surgery process to the time of incision. Surgery requires much coordination prior to beginning: scrub and circulating nurses must prepare the operating room, hospital transport must deliver the patient on time, anesthesia must prepare the patient after arrival, and the surgeon must be present, scrubbed, and prepared to begin. Incision time is the logical synchronization point for surgery because it is the one common point at which all tasks must converge. Everyone nursing, anesthesia, housekeeping, and surgery must complete their tasks before the incision can be made. Define start time precisely. Despite the fact that several processes must occur prior to incision, operating room staff often disagree about the definition of start time of a case. For example, does 8:00 AM surgery mean that the patient arrives at registration at 8:00 AM, the patient is brought into the operating room at 8:00 AM, induction occurs at 8:00 AM, or cut time is 8:00 AM? Confusion concerning the definition of start time often leads to unnecessary delays and inefficient use of staff time.
9 Part 4 Change Concepts for Improving Adult Cardiac Surgery Consider People to Be in the Same System Help people see themselves as part of the same system, and make the patient the center of that system. Individuals who share a common purpose will work to optimize the large system instead of trying to optimize their own part of the system. Consider the cath lab, the cardiologist, the surgeons, and operating room scheduling as parts of the same system. Often, staff see these areas as separate domains rather than parts of a system that shares the common goal of optimizing care for patients. Barriers that prevent smooth communication and coordination among these areas result in prolonged, unnecessary waiting in the hospital between cardiac catheterization and surgery. Each part of the system each department and each individual must understand the common purpose and their role within the system. Reduce cath-to-cabg time by having people see themselves as part of the same system. Instead of waiting for multiple information handoffs between providers, the cardiac cath lab makes the preliminary decision to proceed with surgery and calls the operating room directly to schedule the case as soon as possible. After scheduling the case, the cath lab notifies the attending physician and the cardiac surgeon. If necessary, the surgeon can always cancel the case. However, because the providers have a common understanding about the criteria for proceeding with surgery, surgeons rarely reverse the cath lab s decision. Consequently, the time patients must wait in the hospital between catheterization and CABG is significantly reduced.
10 110 Breakthrough Series Guide: Improving Outcomes and Reducing Costs in Adult Cardiac Surgery 8 Smooth the Work Flow Take steps to reduce fluctuations in demand. Changes in demand often cause the work flow to fluctuate widely at different times of the year, month, week, or day. Rather than trying to increase staff to handle the times of peak demand, managers can often take steps to even out the demand. This results in a smooth work flow rather than continual peaks and valleys. Example Schedule elective cardiac surgery patients at times of lower demand. The demand for cardiac surgery varies. Instead of creating a system that smoothes the work flow, many organizations staff for maximum capacity even though they rarely require it. The high cost of this practice could easily be reduced if staff scheduled elective patients at times of lower demand. The key is to determine average demand, staff for the average, and work to distribute this demand evenly. 9 Improve Predictions Predict demand based on past experience and plan capacity to meet these predictions. Plans, resources, and staffing are based on predictions. Use simple historical data displayed in control charts to study variation and construct accurate predictions. Use historically based prediction of a surgeon s length of case to improve operating room scheduling. Use a historically based prediction of the number of emergency cases to improve staffing. Use a historically based prediction of mortality risk to improve patients' ability to make an informed decision about surgery. Organizations that incorporate prediction of surgical mortality into their preoperative assessment of all cardiac surgery patients are able to identify high-risk patients, develop special mechanisms for managing these patients, and reduce overall cardiac surgery mortality.
11 Part 4 Change Concepts for Improving Adult Cardiac Surgery Identify and Manage the Constraint Find and remove the bottlenecks in the system. A constraint or bottleneck is any point in a system that prohibits the smooth flow of patients or information to the next point in the system that is, any point that restricts the throughput of the system. A constraint within an organization is any resource for which the demand is greater than its available capacity. For example, operating room availability may be a constraint to moving more patients into surgery; limited ICU beds may be a constraint to increasing operating room throughput; and slow staff response to managing postoperative atrial fibrillation may be a constraint to timely management and discharge. Constraints or bottlenecks should be identified and reduced or eliminated to improve the performance of the system. They can usually be identified by looking for points where people are waiting (for example, waiting for surgery) or where work is piling up. Example Remove constraints to transferring patients out of the ICU. The constraint to moving patients out of the ICU within 12 hours of surgery or early the next day is often prolonged extubation, or the lack of beds, telemetry, or nursing personnel. When such constraints delay transfer from the ICU, they, in turn, become constraints to increasing operating room throughput and cause additional backups further upstream. In some cases for example, early extubation managing a constraint can also reduce direct costs. In other instances for example, adding telemetry beds reducing the constraint may increase cost. However, this cost must be weighed against the costs of not relieving the constraint: the additional resources consumed upstream versus the limitations on total system throughput.
12 112 Breakthrough Series Guide: Improving Outcomes and Reducing Costs in Adult Cardiac Surgery 11 Convert Internal Steps to External Perform tasks that are typically done as part of the process either ahead of time or later. To save time, convert a task done within the process (internal) to a task done outside of the process (external). Example To reduce turnover time between CABGs, prepare the instrument table while the prior case is still in progress. The nursing staff can set up the instrument table in a separate room so that it is completely ready to go, and then place sterile drapes over it. When the prior case is completed, the dirty table is removed from the room, housekeeping cleans the floor, and the pre-prepared table is moved in. All the scrub nurse has to do is remove the sterile drapes. In this way, a task typically done within the process of room turnover preparation of the back table is converted to a task done outside of the process. 12 Eliminate Things That Are Not Used Cease to supply unwanted or rarely used items. As they examine routine practices, clinicians discover that some items they had assumed were necessary for example, certain surgical instruments are rarely if ever used. Similarly, inventories often contain items that are rarely if ever used for example, certain heart valves that can easily be replaced by other, more commonly used items in the inventory. Eliminating items that are not used and standardizing items that are used can lead to significant reductions in inventories. Examine cardiac surgery inventories systematically and eliminate things that are not used. Examine case carts after case completion to identify instruments that are rarely if ever used. Eliminate unnecessary tests. Eliminate routine preoperative pulmonary function tests and bleeding times. The results of these tests are not used.
13 Part 4 Change Concepts for Improving Adult Cardiac Surgery Reduce or Eliminate Overuse Do not provide or utilize resources beyond the amount required to satisfactorily complete a task. In health care, overuse may include providing patients with advanced diagnostic technologies that have not been shown to lead to better outcomes. Reducing or eliminating overuse reduces costs as well as the risk of adverse events related to unnecessary care. Identifying overuse is not always easy; often, clinicians assume that diagnostic or treatment modalities provide some benefit to the patient, even in the absence of supporting data. Reduce excess postoperative ventilatory support. Despite the common practice of keeping postoperative patients intubated for 12 hours or more, there is no data to support such a practice. Many centers have developed systems capable of safely extubating patients within 4 to 6 hours of the completion of surgery. Their data demonstrate that providing less ventilator support to patients, even those with underlying pulmonary disease, is associated with either equivalent or improved patient outcomes. Reduce excessive use of Swan Ganz catheters. Many organizations have found that the routine use of Swan Ganz catheters is not necessary for all patients undergoing cardiac surgery. However, organizations continue this practice because they assume, without supporting data, that managing patients successfully requires this level of hemodynamic monitoring. Several programs have successfully reduced their use of Swan Ganz catheters by using predefined criteria to determine which patients are likely to benefit from additional hemodynamic monitoring, taking into account the increased risk and cost.
14
Optum Anesthesia. Completely integrated anesthesia information management system
Optum Anesthesia Completely integrated anesthesia information management system 2 Completely integrated anesthesia information management system Optum Anesthesia Information Management System (AIMS) helps
More informationReducing Harm Improving Healthcare Protecting Canadians MEDICATION RECONCILIATION IN THE ICU. Change Package.
Reducing Harm Improving Healthcare Protecting Canadians MEDICATION RECONCILIATION IN THE ICU Change Package January 2012 Background The ultimate goal of medication reconciliation is to prevent adverse
More informationAnesthesiology 302 Introduction to Anesthesia Goals and Objectives
Anesthesiology 302 Introduction to Anesthesia Goals and Objectives I. The student will be able to perform an appropriate preoperative evaluation, including history, physical exam, and appropriate use of
More informationStrategies to Achieve System-Wide Hospital Flow
M15 This presenter has nothing to disclose Strategies to Achieve System-Wide Hospital Flow Katharine Luther and Pat Rutherford IHI s 26th Annual National Forum on Quality Improvement in Health Care December
More informationWebinar: Practical Approaches to Improving Patient Pre-Op Preparation
Webinar: Practical Approaches to Improving Patient Pre-Op Preparation Your Presenters Michael Hicks, MD, MBA, FACHE Chief Executive Officer EmCare Anesthesia Services Lisa Kerich, PA-C Vice President Clinical
More informationImproving Mott Hospital Post-Operative Processes
Improving Mott Hospital Post-Operative Processes Program and Operation Analysis Submitted To: Sheila Trouten, Client Nurse Manager, PACU, Mott OR Jesse Wilson, Coordinator Administrative Manager of Surgical
More informationPutting It All Together: Strategies to Achieve System-Wide Results
1 Putting It All Together: Strategies to Achieve System-Wide Results Katharine Luther, Lloyd Provost, Pat Rutherford Hospital Flow Professional Development Program April 4-7, 2016 Cambridge, MA Session
More informationInpatient Flow Real Time Demand Capacity: Building the System
Inpatient Flow Real Time Demand Capacity: Building the System Roger Resar, MD, Kevin Nolan, and Deb Kaczynski We would like to acknowledge the conceptual contributions of Diane Jacobsen, Marilyn Rudolph,
More informationuncovering key data points to improve OR profitability
REPRINT March 2014 Robert A. Stiefel Howard Greenfield healthcare financial management association hfma.org uncovering key data points to improve OR profitability Hospital finance leaders can increase
More informationROLE OF THE ANESTHETIST IN ORGANIZING AMBULATORY SURGERY. Dr. Paul Vercruysse M.D. Belgium
ROLE OF THE ANESTHETIST IN ORGANIZING AMBULATORY SURGERY Dr. Paul Vercruysse M.D. Belgium DISCLOSURES - Conflicts of interest? I am an anesthesiologist... TRADITIONAL ROLE OF THE ANESTHESIOLOGIST EVOLVING
More informationGetting the right case in the right room at the right time is the goal for every
OR throughput Are your operating rooms efficient? Getting the right case in the right room at the right time is the goal for every OR director. Often, though, defining how well the OR suite runs depends
More informationImproving Hospital Performance Through Clinical Integration
white paper Improving Hospital Performance Through Clinical Integration Rohit Uppal, MD President of Acute Hospital Medicine, TeamHealth In the typical hospital, most clinical service lines operate as
More informationNEW INNOVATIONS TO IMPROVE PATIENT FLOW IN THE ED AND HOSPITAL OCTOBER 12, Mike Williams, MPH/HSA The Abaris Group
NEW INNOVATIONS TO IMPROVE PATIENT FLOW IN THE ED AND HOSPITAL OCTOBER 12, 2010 Mike Williams, MPH/HSA The Abaris Group Outline Page 2 1. Top Innovations ED and Hospital 2. Top Barriers 3. Steps to Eliminate
More informationAirStrip ONE Cardiology
AirStrip ONE Cardiology A Synchronized View of the Vital Patient Data Needed to Improve Care Heart disease is the leading cause of death in the U.S. The associated costs exceed $100 billion annually. AirStrip
More informationInstitutional Handbook of Operating Procedures Policy
Section: Admission, Discharge, and Transfer Institutional Handbook of Operating Procedures Policy 9.1.29 Responsible Vice President: EVP & CEO Health System Subject: Admission, Discharge, and Transfer
More informationClick to edit Master subtitle style
Operating Room Turnover Analysis and Improvement Click to edit Master title style Click to edit Master subtitle style Reza Maleki and Melissa Kram Department of Industrial and Manufacturing Engineering
More informationThe PCT Guide to Applying the 10 High Impact Changes
The PCT Guide to Applying the 10 High Impact Changes This Guide has been produced by the NHS Modernisation Agency. For further information on the Agency or the 10 High Impact Changes please visit www.modern.nhs.uk
More informationUniversity of Michigan Health System Program and Operations Analysis. Analysis of Pre-Operation Process for UMHS Surgical Oncology Patients
University of Michigan Health System Program and Operations Analysis Analysis of Pre-Operation Process for UMHS Surgical Oncology Patients Final Report Draft To: Roxanne Cross, Nurse Practitioner, UMHS
More informationAn academic medical center is practicing wasteology to pare time, expense,
Quality improvement Practicing wasteology in the OR An academic medical center is practicing wasteology to pare time, expense, and hassle from its OR processes. Using lean thinking, the center is streamlining
More informationBeth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine Rotation: Post Anesthesia Care Unit (CA-1, CA-2, CA-3)
Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine Rotation: Post Anesthesia Care Unit (CA-1, CA-2, CA-3) Goals GOALS AND OBJECTIVES To analyze and interpret
More informationSURGICAL SAFETY CHECKLIST
SURGICAL SAFETY CHECKLIST WHY: INFORMATION, RATIONALE, AND FAQ May 2009 Building a safer health system INFORMATION, RATIONALE, AND FAQ May 2009 - Version 1.0 The aim of this document is to provide information
More informationKey Objectives To communicate business continuity planning over this period that is in line with Board continuity plans and enables the Board:
Golden Jubilee Foundation Winter Plan 2016/2017 Introduction This plan outlines the proposed action that would be taken to deliver our key business objectives supported by contingency planning. This plan
More informationThe Impact of Emergency Department Use on the Health Care System in Maryland. Deborah E. Trautman, PhD, RN
The Impact of Emergency Department Use on the Health Care System in Maryland Deborah E. Trautman, PhD, RN The Future of Emergency Care in the United States Health System Institute of Medicine June 2006
More information2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Process
Quality ID #426: Post-Anesthetic Transfer of Care Measure: Procedure Room to a Post Anesthesia Care Unit (PACU) National Quality Strategy Domain: Communication and Care Coordination 2018 OPTIONS FOR INDIVIDUAL
More informationPost-operative "Fast-Track" pathways for lung resection. Dennis A. Wigle Division of Thoracic Surgery Mayo Clinic
Post-operative "Fast-Track" pathways for lung resection Dennis A. Wigle Division of Thoracic Surgery Mayo Clinic Post-operative "Fast-Track" pathways for lung resection Dennis A. Wigle Division of Thoracic
More informationClinical Program Cost Leadership Improvement
Clinical Program Cost Leadership Improvement December 2017 Presbyterian recently developed a rapid-cycle process for integrating sustainable cost and quality improvements within clinical programs. Population
More informationWelcome to Baylor Scott & White Hillcrest. A Perioperative Services Orientation
Welcome to Baylor Scott & White Hillcrest A Perioperative Services Orientation What does "Perioperative" mean? When a patient is cared for in the Perioperative setting, they receive care preoperatively,
More informationUsing Lean, Six Sigma to Improve Surgical Services James Pearson J.O.P. Consulting
Using Lean, Six Sigma to Improve Surgical Services James Pearson J.O.P. Consulting How many times have we heard that it s easy to apply Lean and Six Sigma techniques to hospital processes, and specifically
More information1. Introduction. 1 CMS section
1. Introduction Anesthesiology is the practice of medicine including, but not limited to, preoperative patient evaluation, anesthetic planning, intraoperative and postoperative care and the management
More informationSame day emergency care: clinical definition, patient selection and metrics
Ambulatory emergency care guide Same day emergency care: clinical definition, patient selection and metrics Published by NHS Improvement and the Ambulatory Emergency Care Network June 2018 Contents 1.
More informationOnline library of Quality, Service Improvement and Redesign tools. Discharge planning. collaboration trust respect innovation courage compassion
Online library of Quality, Service Improvement and Redesign tools Discharge planning collaboration trust respect innovation courage compassion Discharge planning What is it? A specific targeted discharge
More informationSARASOTA MEMORIAL HOSPITAL PERIOPERATIVE DEPARTMENT POLICY
PS1070 SARASOTA MEMORIAL HOSPITAL PERIOPERATIVE DEPARTMENT POLICY TITLE: ADMISSION/DISCHARGE CRITERIA: POST ANESTHESIA CARE UNITS (PACU) EFFECTIVE DATE: REVIEWED/REVISED DATE: POLICY TYPE: Job Title of
More informationEmergency Medicine Programme
Emergency Medicine Programme Implementation Guide 8: Matching Demand and Capacity in the ED January 2013 Introduction This is a guide for Emergency Department (ED) and hospital operational management teams
More informationJust Culture Toolkit Scenarios
Just Culture Toolkit Scenarios In order to promote a just culture where staff is comfortable in reporting errors or near misses, healthcare organizations must adopt a disciplinary system theory approach.
More informationUniversity of Michigan Health System. Inpatient Cardiology Unit Analysis: Collect, Categorize and Quantify Delays for Procedures Final Report
Project University of Michigan Health System Program and Operations Analysis Inpatient Cardiology Unit Analysis: Collect, Categorize and Quantify Delays for Procedures Final Report To: Dr. Robert Cody,
More informationUniversity of Michigan Health System. Program and Operations Analysis. CSR Staffing Process. Final Report
University of Michigan Health System Program and Operations Analysis CSR Staffing Process Final Report To: Jean Shlafer, Director, Central Staffing Resources, Admissions Bed Coordination Center Amanda
More informationWelcome to Scott & White Memorial Hospital. Perioperative Services
Welcome to Scott & White Memorial Hospital Perioperative Services What is a Perioperative Nurse? A perioperative nurse is a nurse who provides patient care, manages, teaches, and studies the care of patients
More informationENVIRONMENT Preoperative evaluation clinic. Preoperative evaluation clinic. Preoperative evaluation clinic. clinic. clinic. Preoperative evaluation
Goals and Objectives, Preoperative Evaluation Clinic Rotation, CA-1 and CA-2 year UCSD DEPARTMENT OF ANESTHESIOLOGY PREOPERATIVE EVALUATION CLINIC ROTATION GOALS AND OBJECTIVES, CA-1 and CA-2 YEAR PATIENT
More informationZ: Perioperative Nursing Specialty
Z: Perioperative Nursing Specialty Alberta Licensed Practical Nurses Competency Profile 263 Major Competency Area: Z Perioperative Nursing Specialty Priority: One Competency: Z-1 HPA Authorizations and
More informationNew data from Minnesota hospitals offers more insight into preventing
Patient safety Preventing pressure ulcers: New lessons from Minnesota New data from Minnesota hospitals offers more insight into preventing pressure ulcers during long surgical procedures. Data collected
More informationNational Programme to Prevent Central-Line Associated Bacteraemia. Project Charter October 2011 to April 2013
National Programme to Prevent Central-Line Associated Bacteraemia Project Charter October 2011 to April 2013 1. Overview Central-Line Associated Bacteraemia (CLAB) prevention is one of the most important
More informationSupervision of Residents/Chain of Command
Supervision of Residents/Chain of Command Creighton University Department of Surgery Residency Training Program Chain of command for Surgery residents at CUMC PGY1: The intern on call covers the two general
More informationBeth Israel Deaconess Medical Center Perioperative Services Manual. Guidelines for Perioperative Handoffs from OR to receiving units.
Beth Israel Deaconess Medical Center Perioperative Services Manual Title: Guidelines for Perioperative Handoffs from OR to receiving units. Policy #: PSM 100-102A Purpose: This guideline provides a standard
More informationAdult: Any person eighteen years of age or older, or emancipated minor.
Advance Directives Policy and Procedure Purpose To provide an atmosphere of respect and caring and to ensure that each patient's ability and right to participate in medical decision making is maximized
More informationTHERE MUST BE A BETTER WAY.
THERE MUST BE A BETTER WAY. Eliminating the Patient Transfer: No Lift/No Transfer Solutions at Focus Hand and Arm Surgery Center By Patricia Haraldson R.N., C.A.S.C. From my earliest experiences as a nurse,
More informationBergen Community College Syllabus-VET-219. Prerequisites: Admission into the professional segment of the Veterinary Technology Program
Bergen Community College Syllabus-VET-219 Course Title: Course Number: Surgical Assistance and Anesthesia VET-219 Program Affiliation: Veterinary Technology Credits: 3 Classroom Hours: 2 Laboratory Hours:
More informationDomain 5 Cardiothoracic Standards RCoA Accreditation 2017
1 PRIORITY The Care Pathway 5.4.1.1 The process for preoperative assessment presenting for cardiac and thoracic patients (including thoracic aortic) is defined within the patient pathway. 1 A clinical
More informationHow to Increase OR Throughput and Profitability
How to Increase OR Throughput and Profitability Twin Peaks Group, LLC October 2008 Dan C. Krupka Peter J. Logue Shashikant Sathaye* Warren S. Sandberg # *Advisor # Department of Anaesthesia and Critical
More informationHendrick Medical Center significantly lowers turnover times with the help of OR Benchmarks Collaborative
Care Providers Hospitals and Healthcare Organizations Healthcare Analytics Hendrick Medical Center significantly lowers turnover times with the help of OR Benchmarks Collaborative As a not-for-profit institution
More informationGuidelines for the Preoperative Process
Guidelines for the Preoperative Process Preparation of Patients for Procedural Sedation and Anesthesia. Department of Anesthesiology Thomas May, MD Witold Waberski, MD Department of Internal Medicine Aized
More informationYour facility is having a baby boom. The number of cesarean births is
Clinical management Ensuring a comparable standard of care for cesarean deliveries Your facility is having a baby boom. The number of cesarean births is exceeding the obstetrical unit s capacity. Administrators
More informationDisclosure. Do One More Case. Focusing on turnover time will improve OR throughput. Myths in Economics of Anesthesia Confirmed, Plausible, or Busted?
Disclosure ECG Consultants Technical Advisor Focus on Staffing Models Amr Abouleish, MD, MBA Department of Anesthesiology The University of Texas Medical Branch Galveston, Texas aaboulei@utmb.edu throughput.
More informationEmergency Department Throughput
Emergency Department Throughput Patient Safety Quality Improvement Patient Experience Affordability Hoag Memorial Hospital Presbyterian One Hoag Drive Newport Beach, CA 92663 www.hoag.org Program Managers:
More informationCritical Care, Critical Choices: The Case for Tele-ICUs in Intensive Care
Critical Care, Critical Choices: The Case for Tele-ICUs in Intensive Care April 29, 2011 Waltham, MA Presented by Lisa Payne Simon, MPH Cheryl H. Dunnington, RN, MS 1 FAST Initiative Overview 2004-2010
More informationFinal Report. Karen Keast Director of Clinical Operations. Jacquelynn Lapinski Senior Management Engineer
Assessment of Room Utilization of the Interventional Radiology Division at the University of Michigan Hospital Final Report University of Michigan Health Systems Karen Keast Director of Clinical Operations
More informationTotal Joint Partnership Program Identifies Areas to Improve Care and Decrease Costs Joseph Tomaro, PhD
WHITE PAPER Accelero Health Partners, 2013 Total Joint Partnership Program Identifies Areas to Improve Care and Decrease Costs Joseph Tomaro, PhD ABSTRACT The volume of total hip and knee replacements
More informationHOW 5S ORGANIZING BOOSTS MONEY, TIME, AND PATIENT OUTCOMES
HOW 5S ORGANIZING BOOSTS MONEY, TIME, AND PATIENT OUTCOMES WHAT IS 5S? THE CORE OF LEAN PHILOSOPHY Lean concepts have revolutionized the industrial world. Originating in Japan, and popularized by Toyota,
More informationDelivering surgical services: options for maximising resources
Delivering surgical services: options for maximising resources THE ROYAL COLLEGE OF SURGEONS OF ENGLAND March 2007 2 OPTIONS FOR MAXIMISING RESOURCES The Royal College of Surgeons of England Introduction
More informationClinical Fellowship: Cardiac Anesthesia
Anesthesia and Perioperative Medicine Western University Cardiac Anesthesia Program Director Dr. Anita Cave Please visit the Cardiac Anesthesia Fellowship site for most up-to-date information: http://www.schulich.uwo.ca/anesthesia/education/fellowship/fellowships_offered/cardiac_anesthesia.html
More informationSURGICAL RESIDENT CURRICULUM FOR THE DIVISION OF CARDIOTHORACIC SURGERY
SURGICAL RESIDENT CURRICULUM FOR THE DIVISION OF CARDIOTHORACIC SURGERY Residency Years Included: PGY1_X_ PGY2_X_ PGY3 PGY4 PGY5 Fellow I. The Clinical Mission of the Division of Cardiothoracic Surgery
More informationReducing the Risk of Wrong Site Surgery
Joint Commission Center for Transforming Healthcare Reducing the Risk of Wrong Site Surgery Wrong Site Surgery Project Participants The Joint Commission s Center for Transforming Healthcare aims to solve
More informationIntroduction to Perioperative Nursing
C H A P T E R 1 Introduction to Perioperative Nursing LEARNER OBJECTIVES 1. Define the three phases of the surgical experience. 2. Describe the scope of perioperative nursing practice. 3. Discuss application
More informationSurgery Road Map. General practices. Road map sections
Surgery Road Map MHA s road maps provide hospitals and health systems with evidence-based recommendations and standards for the development of topic-specific prevention and quality improvement programs,
More informationImproving operating room efficiency through the use of lean six sigma methodologies. Teodora O. Nicolescu
Improving operating room efficiency through the use of lean six sigma methodologies Teodora O. Nicolescu Author detail: Teodora O. Nicolescu, MD Associate Professor Department of Anesthesiology The University
More informationEliminating Common PACU Delays
Eliminating Common PACU Delays Jamie Jenkins, MBA A B S T R A C T This article discusses how one hospital identified patient flow delays in its PACU. By using lean methods focused on eliminating waste,
More informationSCIP-Inf-2, SCIP-Inf-3, SCIP-Inf-4, SCIP-Inf- 9, SCIP-Inf-10, SCIP-VTE-1, SCIP-VTE-2 Anesthesia End Time 5
Release Notes: Alphabetical Data Dictionary Version 3.3 Surgical Care Improvement Project (SCIP) - Data Dictionary The General Abstraction Guidelines explain the different sections of the data element
More informationEnhancing Efficiency and Communication in Perioperative Services Through Technology
Enhancing Efficiency and Communication in Perioperative Services Through Technology Linda Yoder, RN, BSN, MBA, Clinical Director, Perioperative Services, GI Lab, Cross Creek Ambulatory Center Every driver
More informationFor Vanderbilt Medical Center Carolyn Buppert, NP, JD Law Office of Carolyn Buppert
For Vanderbilt Medical Center Carolyn Buppert, NP, JD Law Office of Carolyn Buppert www.buppert.com Describe the services in critical care that nurse practitioners perform that are billable Discuss what
More informationAnesthesia Elective Curriculum Outline
Department of Internal Medicine Texas Tech University Health Sciences Center Odessa, Texas Anesthesia Elective Curriculum Outline Revision Date: July 10, 2006 Approved by Curriculum Meeting September 19,
More informationNews. Ventilation procedures for intensive care air transports. Critical care
NO. 11 News Critical care Ventilation procedures for intensive care air transports Critical Care News is published by Maquet Critical Care. Maquet Critical Care AB 171 95 Solna, Sweden Phone: +46 (0)10
More informationLEAN Transformation Storyboard 2015 to present
LEAN Transformation Storyboard 2015 to present Rapid Improvement Event Med-Surg January 2015 Access to Supply Rooms Problem: Many staff do not have access to supply areas needed to complete their work,
More informationTips and Tools for Learning Improvement. Developing Changes
Tips and Tools for Learning Improvement Developing Changes What are changes in improvement? Making improvement requires change. Changes are any possible solutions to problems identified by improvement
More informationJOHNS HOPKINS HEALTHCARE Physician Guidelines
Page 1 of 7 ACTION New Procedure Amending Procedure Number: Superseding Procedure Number: Repealing Procedure Number: REFERENCES: AMPT Committee ASA Guidelines CMS Guidelines I. GENERAL ANESTHESIA PROCEDURE:
More informationABO SELF-DIRECTED IMPROVEMENT IN MEDICAL PRACTICE ACTIVITY (CLINICAL)
ABO SELF-DIRECTED IMPROVEMENT IN MEDICAL PRACTICE ACTIVITY (CLINICAL) Topic Title of Project: Reduction in the Rate of Perioperative Incidents Related to the Intraoperative Time- Out Procedure Project
More informationSection IX Operating Room
Section IX Operating Room Summary of Recommendations Approach Data Collection and Synthesis Key Findings Perioperative Services Main OR & PACU Women s and Children s Ambulatory Care Center Central Processing
More informationCA-3 Curriculum for Cardiac Anesthesia West Virginia University Department of Anesthesiology
CA-3 Curriculum for Cardiac Anesthesia West Virginia University Department of Anesthesiology Description of Rotation or Educational Experience This rotation is a continuation of the CA-2 Cardiothoracic
More informationGetting a zero deficiency rating on a recent Joint Commission survey and bringing
Leadership Perioperative services overhaul proves effort is worth the time Getting a zero deficiency rating on a recent Joint Commission survey and bringing sterile processing in house are 2 of many improvements
More informationImproving Clinical Flow ECHO Collaborative Change Package
Primary Drivers (driver diagram) Change Concepts Change Ideas Examples, Tips, and Resources Engaged Leadership Develop culture for transformation Use walk-arounds and attendance at team meetings to talk
More informationPosition Paper on Anesthesia Assistants: An Official Position Paper of the Canadian Anesthesiologists Society
Can J Anesth/J Can Anesth (2018) Appendix 5 Position Paper on Anesthesia Assistants: An Official Position Paper of the Canadian Anesthesiologists Society Background Medical and surgical care has become
More informationApplying Critical ED Improvement Principles Jody Crane, MD, MBA Kevin Nolan, MStat, MA
These presenters have nothing to disclose. Applying Critical ED Improvement Principles Jody Crane, MD, MBA Kevin Nolan, MStat, MA April 28, 2015 Cambridge, MA Session Objectives After this session, participants
More informationSurgical Treatment. Preparing for Your Child s Surgery
Surgical Treatment Preparing for Your Child s Surgery If your child needs an operation, it will be performed at a hospital that has special expertise in heart surgery for children. This may be a hospital
More informationContinuous Quality Improvement Made Possible
Continuous Quality Improvement Made Possible 3 methods that can work when you have limited time and resources Sponsored by TABLE OF CONTENTS INTRODUCTION: SMALL CHANGES. BIG EFFECTS. Page 03 METHOD ONE:
More informationSURGICAL RESIDENT CURRICULUM FOR NORTH CAROLINA JAYCEE BURN CENTER. Residency years included: PGY1 _X PGY2 PGY3 _X PGY4 PGY5 Fellow
SURGICAL RESIDENT CURRICULUM FOR NORTH CAROLINA JAYCEE BURN CENTER Residency years included: PGY1 _X PGY2 PGY3 _X PGY4 PGY5 Fellow I. Clinical Mission of the North Carolina Jaycee Burn Center The clinical
More informationAnalysis of Cardiovascular Patient Data during Preoperative, Operative, and Postoperative Phases
University of Michigan College of Engineering Practicum in Hospital Systems Program and Operations Analysis Analysis of Cardiovascular Patient Data during Preoperative, Operative, and Postoperative Phases
More informationThe PCT Guide to Applying the 10 High Impact Changes. A guide from NatPaCT
The PCT Guide to Applying the 10 High Impact Changes A guide from NatPaCT DH INFORMATION READER BOX Policy HR/Workforce Management Planning Clinical Estates Performance IM&T Finance Partnership Working
More informationUsing Telemedicine to Improve Outcomes and Collaboration Within Hospitals and Health Systems
American Hospital Association Leadership Summit Using Telemedicine to Improve Outcomes and Collaboration Within Hospitals and Health Systems Please note that the views expressed by the conference speakers
More informationSeven day hospital services: case study. University Hospital Southampton NHS Foundation Trust
Seven day hospital services: case study University Hospital Southampton NHS Foundation Trust March 2018 We support providers to give patients safe, high quality, compassionate care within local health
More informationClinical and Financial Successes at Advocate Health Care Utilizing our
Clinical and Financial Successes at Advocate Health Care Utilizing our Tele-ICU Program June 2, 2016 Cindy Welsh, RN, MBA, FACHE VP for Critical Care and Medical Professional Affairs Advocate Health Care
More informationOnline library of Quality, Service Improvement and Redesign tools. Process templates. collaboration trust respect innovation courage compassion
Online library of Quality, Service Improvement and Redesign tools Process templates collaboration trust respect innovation courage compassion Process templates What is it? Process templates provide a visual
More informationFEATURE. Back to. A Fresh Look at Asepsis BASICS. Alecia Cooper, RN, BS, MBA, CNOR 14 THE OR CONNECTION
FEATURE Back to A Fresh Look at Asepsis BASICS Alecia Cooper, RN, BS, MBA, CNOR 14 THE OR CONNECTION PATIENT SAFETY A Back to Basics series should start with the principles of asepsis. What does asepsis
More informationPrinciples In developing these recommendations the Consensus Panel first established the following principles for anesthesia outcomes capture:
Outcomes of Anesthesia: Core Measures The following Core Measures are the consensus recommendations of the Anesthesia Quality Institute (AQI) and the Multicenter Perioperative Outcomes Group (MPOG). They
More informationShaping Demand: Managing Elective OR Schedules and Predicting Downstream Demand
This presenter has nothing to disclose. Shaping Demand: Managing Elective OR Schedules and Predicting Downstream Demand Flow Symposium Nov. 2016 Frederick C. Ryckman, MD Professor of Surgery / Transplantation
More informationAndrew Shin MD Claudia Algaze MD
Andrew Shin MD Claudia Algaze MD Cost Volume-Driven Healthcare Value-Driven Healthcare Quality Massive variation in clinical practice High rates of inappropriate care Unacceptable rates of preventable
More informationUnplanned Extubation In Intensive Care Units (ICU) CMC Experience. Presented by: Fadwa Jabboury, RN, MSN
Unplanned Extubation In Intensive Care Units (ICU) CMC Experience Presented by: Fadwa Jabboury, RN, MSN Introduction Basic Definitions: 1. Endotracheal intubation: A life saving procedure for critically
More informationNeurocritical Care Fellowship Program Requirements
Neurocritical Care Fellowship Program Requirements I. Introduction A. Definition The medical subspecialty of Neurocritical Care is devoted to the comprehensive, multisystem care of the critically-ill neurological
More informationCarol J. Peden BSC, MB ChB, MD, FRCA, FFICM, MPH Royal United Hospital, Bath
Carol J. Peden BSC, MB ChB, MD, FRCA, FFICM, MPH Royal United Hospital, Bath Up to 25,000 surgical deaths per year 5-10% of surgical cases are high risk 79% of deaths occur in the high risk group Overall
More informationCauses and Consequences of Regional Variations in Health Care Resources in Ontario
Causes and Consequences of Regional Variations in Health Care Resources in Thérèse A. Stukel, Ph.D. DA Alter, R Saskin, DM Rothwell Institute for Clinical Evaluative Sciences, Health Services Restructuring
More informationHow Allina Saved $13 Million By Optimizing Length of Stay
Success Story How Allina Saved $13 Million By Optimizing Length of Stay EXECUTIVE SUMMARY Like most large healthcare systems throughout the country, Allina Health s financial health improves dramatically
More informationAchieving Hospital-wide Patient Flow
WHITE PAPER Achieving Hospital-wide Patient Flow The Right Care, in the Right Place, at the Right Time AN IHI RESOURCE 20 University Road, Cambridge, MA 02138 ihi.org How to Cite This Paper: Rutherford
More informationA Step-by-Step Guide to Tackling your Challenges
Institute for Innovation and Improvement A Step-by-Step to Tackling your Challenges Click to continue Introduction This book is your step-by-step to tackling your challenges using the appropriate service
More information