Critical Care Alert: Six Sigma projects improve throughput
Critical Path Network
Six Sigma projects improve throughput
Goal is 80% of discharges by 2 p.m.
As part of its patient throughput initiative, Spartanburg (SC) Regional Health System set a goal of discharging 80% of patients by 2 p.m. and is conducting a series of Lean Six Sigma projects in an effort to reach that goal.
The team is conducting "100-day workouts," which means taking an area, analyzing the processes, and working to make changes over a 100-day period, says Angie Roberson, RN, BSN, CPUM, director of case management for Spartan-burg Regional. "The projects have allowed us to identify best practices from unit to unit and share them across the board. This process has afforded us the ability to look at the process and determine how we can do it better rather than looking at whose fault it is," she says.
The 100-day workouts aimed to alleviate overcrowded conditions that occur in the hospital's emergency center when beds aren't available in the hospital.
The hospital enlarged its emergency center several years ago, expecting it would take five to 10 years to reach capacity but it's already overcrowded, Roberson says. "In the emergency center, we know that wait time is the No. 1 driver of patient satisfaction," she says.
The team chose 2 p.m. as its discharge target because that's when the emergency center gets backed up if there aren't beds available for patients who are being admitted. "We chose 80% as a target because we don't want to stop late-afternoon discharges. We'd like to get higher than 80% but we know that some patients need to be here later in the day. We didn't want the message to go out that everyone had to be discharged by 2 p.m. or wait until the next day," Roberson explains.
At present, the hospital has reached 58% hospitalwide for the 2 p.m. discharge goal. Projects are under way in five units, with more coming on board in the future, Roberson says.
The units involved in the project have developed a tool to classify "mixed opportunities," discharges that occurred between 2 p.m. and 6 p.m., attributing them to one of five categories — case management-related; nursing-related; physician-related; patient-related; and system-related.
"We will analyze this data to help us refine opportunities for timely discharges and barriers to meeting our goals," Roberson says.
When the Six Sigma team looked at ways to improve discharge on two medical units, it determined early on that discharges were being delayed when patients had a discharge order that was pending based on the results of a test.
"Right away, we knew of an opportunity for improvement. We knew we did not have a coordinated process to notify imaging of the pending discharge status of the patient. Imaging got the request with all others and had no way to know that the case needed a priority order in order to expedite a discharge," Roberson recalls.
The team started by identifying the problem, then identifying where the roadblocks occurred. Robertson met with the director of imaging and the team brought in the frontline staff in the imaging department to develop a way to assign priority to patients whose discharge was pending based on the results of an imaging process.
"We wanted to make sure it wasn't just the directors discussing what was going on. We let all staff know that this wasn't an opportunity to take potshots at another department. It was a way to collaborate to solve a problem," she says.
The team discovered that nursing and imaging both have a piece of software they use on a daily basis. Now the imaging department receives information on pending discharges from nursing and gives those patients priority.
The team next worked with staff in two units in the heart center to find out what impediments there were to meeting the discharge goal.
One problem was that if a patient had a peripherally inserted central catheter (PICC line), guidelines called for the PICC team to pull the line.
"The PICC team was going all over the house inserting PICC lines so the patient had to stay on the unit until the PICC team could pull the PICC. The nursing staff is capable of pulling the PICC lines. We called in the managers of the PICC team and changed the process," Roberson says.
Another holdup was making follow-up physician appointments for patients before they leave. "This was a nice thing to do for the patient but we found out that it takes the staff several phone calls and a long time on hold before they get the appointment," she says.
Now when the hospital's nurse on call follows up with patients the day after discharge, they can view the patient's discharge information and ask if the patient has made a follow-up appointment. If not, they offer to make the appointment for them.
As part of its patient throughput initiative, Spartanburg (SC) Regional Health System set a goal of discharging 80% of patients by 2 p.m. and is conducting a series of Lean Six Sigma projects in an effort to reach that goal.Subscribe Now for Access
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