The Productive Operating Theatre
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The Productive Operating Theatre

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Leigh Anderson, Improvement Specialist, Auckland District Health Board delivered this presentation at the 2013 Operating Theatre Management conference in Sydney/Australia. The event offers attendees ...

Leigh Anderson, Improvement Specialist, Auckland District Health Board delivered this presentation at the 2013 Operating Theatre Management conference in Sydney/Australia. The event offers attendees insights into the latest programs and practices being implemented across the country & key strategies and methods to help improve your skills and knowledge as a Theatre Manager. For more information, please visit www.healthcareconferences.com.au.

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The Productive Operating Theatre Presentation Transcript

  • 1. slide A 1 Leigh Anderson RN MN Improvement Specialist Auckland District Health Board
  • 2. slide A 2 Today we will discuss How we use improvement methodologies to care for our patients through : • Working ‘Just In Time’ • Blood is a gift • Appropriate use of sharps bins • Improved communication
  • 3. slide A 3 The Productive Operating Room
  • 4. slide A 4
  • 5. slide A 5 Just In Time
  • 6. slide A 6 Just in Time
  • 7. slide A 7 Total resource wasted in 4 weeks $13,993  Main ‘offenders’ identified (consumables not staff !!)  Data was presented and workshops held at inservice time identified the root causes of the waste.  Surgeons were involved – solutions came from the entire team.
  • 8. slide A 8
  • 9. slide A 9 Results
  • 10. slide A 10 What next?  Staff have clearly told us that they need to know and understand the $ value of inventory and consumables  Roll out to other specialties
  • 11. slide A 11 Appropriate disposal of sharps
  • 12. slide A 12 Opportunity recognised with disposal of sharps  Safe handling - reduce blood and body incidents  How to use bins safely  What to do when a team member has  a blood incident  Rubbish in correct bins  Change bins when full to the line
  • 13. slide A 13 Sharps bin content before the project
  • 14. slide A 14 The big sharps sort………
  • 15. slide A 15
  • 16. slide A 16 Sep-11Jun-11Mar-11Dec-10Sep-10Jun-10Mar-10Dec-09Sep-09Jun-09Mar-09 45000 40000 35000 30000 25000 20000 15000 period DollarsperMonth $ w/out Project $ after project Variable Monthly Savings Amount paid per month going down by 11k per month as average, cumulative FY’12 of 69k and 202k for life of the project By using Sharp Bins correctly, we can help redirect up to $172K each year back into patient care
  • 17. slide A 17 Blood is a Gift
  • 18. slide A 18 Reducing blood product wastage
  • 19. slide A 19 Other Costs ……  Do we let this person know that on average we discard 40 units of Fresh Frozen Plasma & 16 units of Red Blood Cells every month? I don’t tell them that this is not a very nice process I donate platelets every 3 weeks
  • 20. slide A 20 Key audit findings 16014012010080604020 USL LSL * Target * USL 80 Sample Mean 92.9091 Sample N 22 StDev (O v erall) 32.6656 Process Data Z.Bench -0.40 Z.LSL * Z.USL -0.40 Ppk -0.13 C pm * O v erall C apability % < LSL * % > USL 63.64 % Total 63.64 O bserv ed Performance % < LSL * % > USL 65.36 % Total 65.36 Exp. O v erall Performance Process Capability of Hb PRIOR TO CHARTING (non precationary charting) Worksheet: All audit data.MTW; 26/07/2010 1601501401301201101009080706050 6 5 4 3 2 1 0 1601501401301201101009080706050 1 Hb PRIOR TO CHARTING NUMBEROFRBCUNITSCHARTED * Worksheet: All audit data.MTW; 27/07/2010 Panel variable: PRECATIONARY RBC UNITS CHARTED vs Hb PRIOR TO CHARTING 48 82 91 DC CM L2 L4 L8 L9 L9 PIC U Sum of RBC given in OR 1 2 3 25 20 6 1 Sum of PRECATIONARY 0 2 8 2 27 117 65 14 6 18 0 20 40 60 80 100 120 140 160 No.ofRBCUnits Charting per Protocol & RBC Used The analysis looked at charting where the Hb was >80g/Ltr. For patients not undergoing procedures this was 64% There were 104 times (77%) in the two week period where units were charted and the patient had an HB >100 g/Ltr The ratio of charting as per protocol to RBC used in theatre was 4.5:1
  • 21. slide A 21 Education
  • 22. slide A 22 Apr - 13Sep - 12Feb-12Jul-11Dec-10May-10Oct-09Mar-09Aug-08Jan-08 0.56 0.52 0.48 0.44 0.40 _ P=0.4253UCL=0.4503 LCL=0.4003 before phase I Phase II 11 1 1 1 1 1 1 111 1 1 RBC used / Patient screen tested Full life Project Oct-10to date #Units saved $Cost saved Patient (Hrs LOS reduced) Nurse hours released Bed day cost Nurse cost Consumable cost Total savings RBC (Red Blood Cell) 9,379 $2,444,548 37,516 7,034 $2,344,750 $236,730 $46,895 $5,072,922 FFP (Fresh Frozen Plasma) 3,295 $663,090 13,180 2,471 $823,750 $83,167 $16,475 $1,586,482 Total 12,674 $3,107,638 50,696 9,506 $3,168,500 $319,897 $63,370 $6,659,405 YTD2013Project Savings #Units saved $Cost saved Patient (Hrs LOS reduced) Nurse hours released Bed day cost Nurse cost Consumable cost Total savings RBC (Red Blood Cell) 4,091 $1,085,056 16,364 3,068 $1,022,750 $103,258 $20,455 $2,231,519 FFP (Fresh Frozen Plasma) 1,601 $327,356 6,404 1,201 $400,250 $40,410 $8,005 $776,021 Total 5,692 $1,412,412 22,768 4,269 $1,423,000 $143,668 $28,460 $3,007,541 Summary of savings: "Blood is a gift" Project to date and Year to date
  • 23. slide A 23 Improving Communication
  • 24. slide A 24 Management Operating Systems  staff survey detailed a need for improved communications between teams  MOS – established tool used within ADHB wards  Goal is to improve communication with a roll on effect of increased efficiency/OR usage  Links organisational and quality goals to daily care  Daily MDT meeting 10 minutes
  • 25. slide A 25 PAIN TEAM DAILY HUDDLE/SHIFT REPORTING BOARD Case Cancellation Session Cancellation On-time starts PERFORMANCE TARGET COUNTERMEASURECAUSECONCERN WHO WHEN COUNTERMEASURECAUSECONCERN WHO WHEN I S S U E S R I S K S Daily Weekly POSITIVESIMPROVEMENT PROJECTSEVENTS DATE _____________ Over runs STATUS TARGET ACTUAL YOU DECIDE ON THESE STAFF BRING THESE QUALITY TEAM/SOCIAL TEAM
  • 26. slide A 26
  • 27. slide A 27 Conclusion  We need to consider change so that we can care for the patient after next.  What is good for staff and patients is often good for business  Decisions and changes should be introduced by clinical staff so that we get it right  Thank you