OR Process Improvement Candice K. Bergsneider, MT Deborah - PowerPoint PPT Presentation

T HE CLEVELAND C LINIC F OUNDATION OR Process Improvement HIMSS 2000 April 12, 2000

OR Process Improvement Candice K. Bergsneider, MT Deborah Atsberger, RN MSN Jaye A. Wolfe

Agenda ● Introduction ● Background ● Pre-plan Assessment ● Project Design and Implementation ● Evaluation ● Conclusions

Learning Objectives ● Plan for a successful project by carefully defining the scope ● Describe the composition of a multi-disciplinary team, its roles and responsibilities ● Define a workflow that provides the map for re- engineering patient tracking ● Design measurement strategies that monitor initial implementation and monitors ongoing compliance for continual process improvement

BACKGROUND

History ● In past, many patients were hospitalized before surgery ● Now, many patients arrive the day of surgery ● Increase in overall number of surgical patients

Average Number of Cases Per Day Per Year 200 150 100 50 0 92 93 94 95 96 97 98 99

Complexity of Environment ● Three admitting sites ● Three pre-operative nursing units ● Sixty operating rooms in four buildings ● Three post anesthesia care units ● Five intensive care units

Patient Information ● Multiple phone calls to locate patients ● Communication of status of patient’s readiness for surgery ● Patient status information for family members

Key Criteria ● Maintaining high OR utilization ● Patient and family satisfaction ● Efficient utilization of personnel time

PRE-PLAN ASSESSMENT

Operating Room Management Group (ORMG) ● Chairman of Surgery ● Chairman of Anesthesiology ● Chief Information Officer ● Director of OR Nursing

ORMG Key Issues ● Delays in OR start time ● Inefficient use of nursing personnel to locate patients ● Inefficient use of receptionists’ time in locating patients ● Family members unsure if surgery has started

Development of Multi-Disciplinary Team ■ OR nursing specialist ■ OR clinical analyst ■ Anesthesiology system manager ■ IT project manager ■ IT systems analyst ■ Admission/Discharge/Transfer/Registration (ADT/R) system manager ■ Surgical waiting area administrator ■ Pre-operative supervisor

Flow Considerations ● Types of surgical admissions ■ Already in-house (Inpatient) ■ Admitted on same day as surgery (TCI) ■ Admitted and discharged on the same day (Outpatient)

Exceptions to Process ● Special Populations ■ Pediatrics ■ Psychiatrics ■ Gastrointestinal

Exceptions to Process ● Special preparatory procedures ■ Laboratory tests ■ Radiology exams ■ Radiological Procedure ■ Special anesthesiology procedures ■ Physician Consult

PROJECT DESIGN AND IMPLEMENTATION

Process Design In/Out Surgical and Same Day Admission Patients Same Day Admit SDS Waiting Room Out Patient Admi t Location changed by Location changed by Location changed by SDS Receptionist Admitting Personnel Admitting Personnel SDS Pre-surgical Unit Location changed by SDS Unit Secretary Induction/Operating Room Location changed by Patient Transporter SDA to Hospital PACU Out Patients H ome Location changed by Location changed by Location changed by PACU Secretary PACU Secretary PACU Secretary

Pre-Determined Outcome Evaluation Measures ● SDS Call Study ● Usage Statistics ● System Credibility Study

DESIGN IMPLEMENTATION

Surgery Tracking Log FADAI471 CLEVELAND CLINIC FOUNDATION 12/13/99 10:43 INQSTL SURGERY TRACKING LOG A489918 STEP S. OPLOC. TIME PATIENT NAME CLINIC NBR SUBTYPE PHYSICIAN 1 M020-01 10:20 PAVLOV,DOUG,MR 2-225-807-2 IO R. DANE READY 2 M020-02 10:26 CARPENTER,RICHARD,K,MR 2-059-750-5 IO J. COOK ARRIVAL 3 M020-04 9:48 RAND,JOSHUA,MR 2-181-960-0 IO A. GUTHRIE ARRIVAL 4 M020-05 10:41 TRAVENTONO,FRANK,A,MR 3-954-037-3 IO A. GUTHRIE ARRIVAL 5 M020-07 9:27 KLEIN,DARREL,MR 2-215-768-4 IO R. DANE ARRIVAL HOLD 6 M020-08 9:30 KINSKI,MARRY,M,MISS 1-805-592-0 IO A. WILSON ARRIVAL 7 M020-09 10:15 KONIK,CATHY,E,MISS 2-125-810-2 IO R. DANE ARRIVAL SELECTION NUMBER: STATUS: TEXT: CLINIC NUMBER: (ENTER SELECTION # FOR AVAILABLE BED AND CL#) PF4 HOLD PF5 FAMILY LOUNGE PF7 BKWD PF8 FRWD PF10 REFRESH NEXT RESPONSE: MENU NEXT KEY: DC905012 BOTTOM OF LOG *

Training ● Training based on PC expertise ■ Nurses, secretaries and receptionists had exposure in current job ■ Transporters were given basic PC skill training first ● All had to sign competency form ● Training manual

Budget ● Contract Programmer ● Equipment ● Training materials ● Personnel Cost for Training Time

Project Time Line June July August September ID Task Name 05/25 06/15 07/06 07/27 08/17 09/07 1 Hire Consultant(s) 2 Complete Design and Spec 3 Investigate Bar Code ORMG Presentation 4 ADT Tracking Changes 5 6 Test Prototype 7 Review Flow with Prototype 8 Communicate Changes

EVALUATION

Pre-Implementation SDS Call Study Average Calls Per Case 5 Before Go-Live 4 3 2 1 0 09/30/97 Outgoing Incoming

SDS Post-Implementation Call Studies 300 After System Compliance After Compliance Compliance Compliance Go-Live Familiarity Check One Year Check Check Check 250 200 150 100 50 0 10/22/97 12/09/97 01/27/98 10/20/98 04/20/99 07/22/99 08/10/99 Total Calls from 6AM to Noon Incoming Outgoing Cases

Patient Look-up March & April 1998 1600 April 6 - 1483 Patient Look-ups 1400 1200 1000 800 600 400 200 0 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / 2 4 6 8 0 2 4 6 8 0 2 4 6 8 0 1 3 5 7 9 1 3 5 7 9 1 3 5 7 9 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

System Credibility Check August 1999 80% 68.18% 70% 60% 50% 40% 30% 19.60% 20% 12.22% 1 0% 0% Correct Rms Out side OR Incorrect Rms

Key Obstacles ● Delays between patient’s OR departure and the new location update ● Delays between patient’s move into the OR from an induction room

RESULTS

Lessons Learned ● Design -> Budget ● Presentations to users and management ● Limited time and budget ● Physician representation

Lessons Learned ● Define expectations ● Careful analysis ● On-going compliance checking ● Non-computer user training ● Replacement system justification

Tangible Benefits ● “Where is my patient now?” ● 66% decrease in total number of calls per case ● 50% decrease in number of outgoing calls per case

Intangible Benefits ● JCAHO Compliance ● Staff Satisfaction ● Patient Satisfaction