Cath Lab Digest - November 2007 - (Page 35)

NOVEMBER 2007 PROCESS IMPROVEMENT 35 Working to Eliminate Bottlenecks: Florida Hospital’s Cardiac Cath Lab Achieves Greater Efficiency and Higher Satisfaction 1 1 Table 1. About Florida Hospital • Acute-care health care system with 3,025 beds throughout central Florida. • Part of the comprehensive network of 17 hospitals of the Adventist Health System — Florida Division. • 13 Centra Care urgent care centers. • Busiest system in U.S. — with more than one million annual patient visits. • Recognized by U.S. News & World Report as one of “America’s Best Hospitals” for the past six years. Barry Egolf, RN, Cath Lab Supervisor, Gengie Nail, BSRS, Quality Assurance Coordinator, 2 Michael Donoghue, Consulting Manager, 2 Carolyn Pexton, Director of Communications 1 Florida Hospital, Orlando, Florida; 2 GE Healthcare, Waukesha, Wisconsin I n 2006, Florida Hospital, recognized as one of the top cardiac centers in the country, launched a special project focused on process improvement within their cardiac catheterization laboratory. Florida Hospital’s cardiac cath lab has seven labs with 52 staff members and a minimum of 93 physicians utilizing their lab each year. The cath lab sees approximately 7500 events annually (each event may have several procedures). As volumes had increased at the Flordia Hospital cath lab, frequent delays and bottlenecks had become more common, prompting a growing chorus of complaints from physicians and patients. Patients would be upset about having to wait too long for an available lab, and the physician might be frustrated and forced to cancel a case because the lab did not have enough staff at a certain time. Working with an outside consulting group, GE Healthcare Performance Solutions (Waukesha, WI), the hospital decided to take a close look at their current situation and identify opportunities for improvement. Using a detailed analysis of workflow and scheduling patterns, the cath lab began to establish targets and develop an action plan that would help them achieve and sustain their goals. At a high level, the project encompassed three main objectives: 1. Improving room turnover defined as “gloves off to next patient ready for stick”; 2. Optimizing the scheduling process; 3. Raising physician satisfaction. Gathering Information To make sure this effort would have the right level of input and buy-in, a cross-functional team was formed. The team began to interview a number of key stakeholders in the hospital. In addition to cardiologists, cath lab staff and administration, they interviewed individuals in support areas such the Health Care Research Unit (HCRU), Critical Care Unit (CCU), Primary Care Unit (PCU), Transport and others. Through this process, some key themes began to emerge. First, there were favorable attributes that could be leveraged, including the hospital’s positive reputation, strong leadership, information technology (IT) support, highly competent staff and cardiologists, and an enterprise-wide commitment to excellence. Regarding specific opportunities for improvement, feedback indicated that department metrics and performance were not always aligned with physician expectations. There was a general feeling that cases rarely started on time and that patient wait time was excessive. Difficulties with scheduling, paperwork, transport and inpatient flow were identified as some of the primary issues impacting the delivery of services in a timely and efficient manner. The team also noted that room turnover responsibilities were not well-defined. A lack of predictability in scheduling had made coordination of physicians, patient transport, patient floors and HCRU staff very difficult. There were issues with coverage during lunch hours and there were not enough staff to keep the labs running smoothly from 7am to 6pm. Some cardiologists expressed a preference to have a block of time in the same lab rather than moving from room to room. The unpredictability in the schedule made it difficult for physicians to plan their Table 2. Project Benefits Summary • Median lab turnover (gloves off to next patient ready) decreased by 20%, from 61 minutes to 49 minutes. • Lab utilization in rooms 1-6 increased from 60% to 69%. • Annualized technologist labor savings of $300K. • Increased physician satisfaction due to improvement in lab. • Increased patient and physician satisfaction due to schedule predictability. • Increase in staff and physician productivity. • Preferred scheduling rules for high-volume physicians. Figure 1. Adding a “roving coordinator” to guide physicians and patients to the right place decreased room turnover time by 20%. day. Patients and families were also dissatisfied with delays. In addition to collecting this “voice of the customer” information, the team went through value stream mapping, a “lean manufacturing” flow chart process originating with Toyota, in order to understand the overall flow and where there might be nonvalue added steps in the process. The team gathered data to measure current process capability and determine which areas to focus on first. Regression analysis (a type of statistical analysis where a dependent variable is assumed to be a linear

Table of Contents Feed for the Digital Edition of Cath Lab Digest - November 2007

Henry Ford Heart and Vascular Institute Treating Patients with Complex Vascular Disease with a Multi-Disciplinary Approach Improving Patient Compliance with Antiplatelet Medications Clinical Editor’s Corner Cath Lab Nurse/Tech Vascular Access and Closure Using the StarClose® Device The Clinical and Economic Impact of Measuring Fractional Flow Reserve FFR and Choosing an Optimal Revascularization Strategy Finally! The New Registered Cardiac Electrophysiology Specialist (RCES) Credential Use of a Mobile Lab to ‘Test the Waters’ at a Rural Hospital Remembering a Cardiac Cath Lab History ACVP• Membership Page What Do You Think? The Ten-Minute Interview with… Ernie Livingston, RN, BSN SICP* Chapter Updates Who’s in Charge? Working to Eliminate Bottlenecks: Florida Hospital’s Cardiac Cath Lab Achieves Greater Efficiency and Higher Satisfaction Preserving Left Ventricular Function during Percutaneous Coronary Intervention Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab Making the Most of Your First Impression: Interviewing Tips and Techniques CEU Education Center Clinical & Industry News Meetings Calendar

Cath Lab Digest - November 2007

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