Cath Lab Digest - November 2007 - (Page 36)

36 PROCESS IMPROVEMENT NOVEMBER 2007 Table 3. Cardiac Cath Lab Project Team: Florida Hospital • Barry Egolf, Cath Lab Supervisor • Gengie Nail, Quality Assurance (QA) Coordinator • John Strickler, Cath Lab Evening Supervisor Streamlining the department has opened up new slots which can bring significant revenue to the hospital’s bottom line. to 69%. Access to care had improved by 15%, as they were now able to accommodate an additional three patients per day between the hours of 7am and 3pm with the increased capacity. There was a 50% improvement in the occurrences of “physician following self,” which positively affected satisfaction among the cardiologists, as their day was not interrupted. The cath lab achieved greater predictability in their scheduling process, making time in the hospital for physicians more productive. To maintain results and ensure continuous improvement, a control plan was developed, including digital “dashboards” (a software-based business management tool organizing important data from a variety of sources) to monitor progress on an ongoing basis. The dashboards included key metrics such as lab turnover, case volume and physician satisfaction. Changes in physician volume would be reviewed periodically and adjustments would be made accordingly. Metrics are posted each day and utilized as part of a discussion with lead technologists. The discussion centers on any obstacles that would impede improvement. “One of the most illuminating discoveries we made through this process is that at times it can be counterproductive to follow your intuition,” says Joel Sandler, Administrative Director of Cardiovascular Services at Florida Hospital. “For example, we thought that we should react to early finishes or cancellations by moving cases around to fill every space, but this actually created problems instead of solving them. It turned out that one small move in the schedule would trigger several other moves, ultimately making the schedule more unpredictable — not less!” enhanced ability to implement positive change in their environment. Leadership support and engagement of the team in the process were keys to success in this project. The physicians used to focus solely on the cath lab as the source of issues, but as they have participated more in the process, they are taking more of a global view and seeing how different aspects of care are interrelated. “I’m getting emails frequently now with ideas from the team as to how they can help make things better — incremental changes to keep the flywheel moving,” notes Joel. “This effort really spurred an overall positive shift in mindset to become more process-driven. We’ve had more constructive comments about processes to be improved instead of complaints about individuals.” “Bringing all stakeholders’ points of view to the table helped us understand our processes and identify the opportunities,” added John Strickler, Cath Lab Evening Supervisor. The improved schedule predictability has afforded Florida Hospital the ability to align themselves with outpatient cath labs. They can now provide a table-totable service for these outpatient cath labs as the needs for intervention arise. This closes the gap between the diagnostic analysis and the interventional process. Streamlining the department has opened up new slots which can bring significant revenue to the hospital’s bottom line. The changes have also been essential in ensuring optimal services for patients by creating a more efficient environment and avoiding delays in scheduling. By instituting a Roving Coordinator role, Florida Hospital is helping to facilitate the transition through the department. From waiting room to procedure to recovery, the Roving Coordinator will be available to assist the patient, family and staff. The team also created a schedule that best meets the needs of the cardiologist by individually matching their average case duration to procedure schedule time. ■ function of one or more independent variables) revealed that 91% of the variation in total case turnover time was found in the “empty room” sub-cycle. Additional findings are summarized below: • The average outpatient wait time from arrival in registration to procedure start was 145 minutes. • The median patient wait time in the waiting room was 35 minutes. • The median time in holding area was 84 minutes, driven primarily by the “patient ready to in room” sub-cycle (91% of variation). • 81% of outpatients were ready in the holding area for scheduled start. • Median case turnover, defined as “gloves off to next patient ready,” was 61 minutes. • Median “case end to patient out” time was 13 minutes. • Median “patient out to next patient in” time was 30 minutes. • Median “time in lab to case start” was 29 minutes (70% of variation in the “patient ready to case start” sub-cycle). • Only 1% of first cases started by 7am. • 12% of first-case patients were ready in the room by 7am. • 50% of cases started more than 30 minutes late. Setting Goals and Finding Solutions Based on physician expectations, the team set a 30-minute target for lab turnover time, from gloves off until next patient ready for stick. For scheduling, the team looked at preferred scheduling for high-volume physicians. They wanted to maximize opportunities for the physicians to follow themselves, and minimize schedule adjustments on the day of service. To raise physician satisfaction, the team focused on improving the predictability of scheduling, offering preferred scheduling and reducing the lab turnover time. In order to redesign the process for room turnover in the labs, a “Work-Out” was held to foster a greater sense of teamwork and grassroots involvement. A Work-Out is another lean manufacturing tool, which essentially asks those most closely involved with the actual work to rethink and redesign processes for greater efficiency. Participants discussed the issues and brainstormed potential solutions. Some of the key actions that were taken as a result of this session included creating a roving coordinator role, developing a readiness checklist for inpatient floors with training, and clearly defining roles and responsibilities for all technologists. Optimizing the scheduling process in the cardiac cath lab required reaching consensus across diverse groups and then consistently driving compliance. Efforts were made to develop new scheduling rules in order to increase the efficiency of physicians, staff and equipment. Changes were made to the daily process to better align schedules and provide greater predictability. The adjustments enabled ten physicians to have scheduling slots based on their personal preferences. The team realized that the key player responsible for coordinating physician and patient flow was also responsible for future scheduling and other tasks. They determined that this was not an optimal use of resources, so the role was split in two. As originally brainstormed, a “roving coordinator” now guides patients and physicians to the right place and someone else handles the future scheduling. Keys to Success Since this project is an ongoing journey involving continuous improvement, there are always new challenges to overcome, new targets to set and new discoveries to be made. Though the quest for excellence is never-ending, the cath lab team has been pleased with the outcome of this project and their Measuring the Impact Once the changes had been implemented, the team again collected and analyzed data to re-measure their performance. They found that lab utilization had increased from 60% The authors can be contacted at Carolyn.Pexton@med.ge.com

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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