Cath Lab Digest - February 2008 - (Page 31)

31 used extensively in the health care field. The cycle consists of small-scale tests of planned actions, followed by assessment and improvement of the initial plan. Once you have your goal set (i.e., decrease procedure room turnaround time) and have identified changes that you can make to help achieve this goal, the PDSA cycle can test these changes. Begin by identifying one aspect of the procedure room turnaround process that could be altered in order to save time and develop a plan to implement the change. Once you have implemented the change, you need to collect data that will help you determine that the change is achieving the results you expected. The next step is to analyze the data, compare what you find against what you expected to happen, and summarize what you learned. Finally, use what was learned to improve the planned action. Figure 2 is a sample worksheet from the American Heart Association that uses the PDSA methodology for implementing “Get with the Guidelines.” No matter what method you use to flowchart your process, this endeavor can help you analyze the turnaround procedure by breaking it down into individual events. You can then closely review these events, the time it take to accomplish them and determine if there are other methods by which some of these events can be accomplished in order to shave minutes off your turnaround time. Improving processes is strongly linked to improving outcomes. Improving the throughput process can improve efficiencies and ultimately give back minutes or hours that can be added to the daily schedule, ultimately allowing a greater number of patients to be scheduled. ■ Rose Czarnecki can be contacted at rczarnecki@hcvconsult.com References 1. Norland S. Containing Costs in the ED: Tired of High Cost Associated with Slow Patient Throughput in the ED? Find out What Several Hospitals Have Done to Improve Their Patient Flow and Optimize Department Performance, Healthcare Financial Management. Healthcare Financial Management 2005. Available at: http://findarticles.com/p/ articles/ mi_m3257/is_4_59/ai_n136 21279. Accessed January 15, 2008. 2. Scalise D. Improving Patient Throughput. Hospitals & Health Networks/AHA (Hosp Health Netw) 2006 Nov;80(11):49-54. This article was peer-reviewed by members of the Cath Lab Digest Editorial Board. • We have one cath lab staff assigned each day as a lead, a position that rotates through all staff on a daily basis. This person makes staff assignments and takes care of sending for patients, pre-medicating patients and arranging for beds after procedures. The lead is also responsible for adjusting staffing when emergencies come in. • The lead also is in constant touch with the nursing supervisor and leads on the nursing units to keep the flow of patients moving. • Each staff person is assigned a room by the lead on a daily basis. The tasks of crash cart check, narcotics check, quality analysis on O2 sat machines and ACT machines, and temperature logs for contrast and refrigerated meds are usually done by the nurse assigned to the room. Stocking supplies is done by all the staff in the room and our inventory person. We have found this helps to keep rooms always stocked and ready. • Interestingly, we initially thought that the physicians held up cases by frequently being late. After some study, we found physicians were not really the main source of long turnaround times. Of course, some physicians were indeed late, but the impact was not as large as we first estimated. As a result of the way we have organized our lab, we can come up with a crew quickly for emergencies and when cases run late and a fourth room needs to be opened. We also have cross-trained staff to make each staff person more flexible in terms of what they can be assigned to do in each room. It has worked well and the flow is much improved. We encourage other cath labs who are trying to improve their turnaround times to first look closely at their current practices and do a time study to determine where their problems are. Once the problems are identified, you can develop a plan to correct them. Get input from your staff on what the problems are and solutions that may help to remedy them. Do another time study once you have instituted these changes and see if the turnaround times improve. Commentary: An Evaluation of Cath Lab Turnaround Time Annie Ruppert, RN, BSN, Sharp Memorial Hospital San Diego, California This well-written article by Rose Czarnecki, RN, BSN, MPM, highlights some good points that may lead to long turnaround times between patients. Years ago, our lab looked at turnaround times and changed many of the practices we had in place in order to improve our times. We went from a 30-35 minute turnaround time to approximately 20 minutes. Some of the following changes we implemented to improve our turnaround times may be helpful to other cath labs seeking to decrease their times as well: • We opened a 5-bed staging area where all sheaths are pulled. Interventional patients are monitored there for 4 hours after hemostasis (in an attempt to decrease groin complication rates). The staff in the staging area pick up and return patients to their rooms, thus freeing up cath lab staff. Cath lab staff also do not have to pull sheaths and hold pressure. The staging area direct admits patients to the cath lab when there is a bed issue. All of our outpatient cardioversions, transesophageal echos (TEEs), tilt table and outpatient cardiac biopsies done by echo go through this area also. We also recover interventional radiology patients when there is a staffing issue in radiology. • The cath lab staff used to clean the rooms after procedures, i.e., mopping the floor, etc., but an environmental staff person was assigned to the lab and holding area. This helped to decrease times spent cleaning the rooms. • We have an inventory person who checks and orders all the supplies for the lab. She checks supplies in each cath lab daily. Annie Ruppert can be contacted at annie.ruppert@sharp.com. http://findarticles.com/p/articles/mi_m3257/is_4_59/ai_n13621279 http://findarticles.com/p/articles/mi_m3257/is_4_59/ai_n13621279 http://cardiacservicesinc.com http://findarticles.com/p/articles/mi_m3257/is_4_59/ai_n13621279 http://cardiacservicesinc.com

Table of Contents Feed for the Digital Edition of Cath Lab Digest - February 2008

Cath Lab Digest - February 2008 Bay Regional Medical Center ENDEAVOR IV: A Zotarolimus-Eluting Stent Versus a Paclitaxel-Eluting Stent in a Randomized Clinical Trial A 3D CT Vessel “Roadmap” Over Live Fluoroscopy for Chronic Total Occlusions Contents Clinical Editor’s Corner An Evaluation of Cath Lab Turnaround Time Commentary: An Evaluation of Cath Lab Turnaround Time Excerpts from Chapter 19. STEMI Interventions – Future Perspectives The Potential Clinical Utility of Intravascular Ultrasound Guidance in Patients Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents The Ten-Minute Interview with…Debbie Charlton, RN The Society of Invasive Cardiovascular Professionals (SICP) at Transcatheter Cardiovascular Therapeutics (TCT) 2007 The Cath Lab is a Business: Do You Have the Knowledge to Stay Afloat? Incidence and Predictors of Vascular Complications after Invasive Coronary Procedures: A Prospective Analysis Ask the Clinical Instructor: A Q&A Column for those New to the Cath Lab Volunteer Survey SICP* Section Meetings Calendar What Do You Think? CEU Education Center Clinical & Industry News Classifieds Advertisers Index

Cath Lab Digest - February 2008

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