3. Room vacancy TAT
Business case/Need
(Business reasons for the project)
Decrease hospital financial loss through:
1. Admitting more patients planned to undergo inpatient surgical or
interventional procedures.
2. Admitting the ER cases of DAMA due to unavailable beds.
Purpose of Project
Decreasing waste time between discharging a patient and
admitting new patient into the same room.
4. Calculation of business case
Before improvement, the monthly loss of admissions from ER is
8 cases (DAMA).
Minimum invoice for a medical case in a regular ward without
any interventional procedure (just for observation) at our
hospital is 3000 L.E.
Hospital loss per month is 24000 L.E and annually is 288000 L.E.
If we could save 6 patients out of the 8 lost cases monthly, we
could save 216000 L.E. per year.
5. Project Scope
In scope:
1. All regular rooms.
2. Actual patient physical
discharge.
3. Admission processes that
takes place during the rush
hours (10 am to 3 pm)
Out of scope:
1. ICU Rooms.
2. Clinical and electronic
discharges.
3. Admission processes that take
place outside the rush hours.
6. Problem/opportunity:
Increased time taken for preparing the room to receive a new patient
to over 2 hours.
Increased waiting time of patients at admission office.
Increased financial loss for losing new patients whether planned to be
admitted for surgical or interventional procedures or ER DAMA cases.
Patient dissatisfaction.
7. Suppliers Inputs Process Outputs Customers
(Providers of the required
resources) (Resources required by the process) (Top level description of the activity) (Deliverables from the process)
(Anyone who receives a
deliverable from the process)
Patient Decision to leave
Collects his/her staff from the room
Vacant room (not ready) Ward secretary
Ward secretary Time
Marks the patient as physically discharged
Communicates H.K supervisor
Vacant room (not ready)
H.K supervisor
H.K supervisor Time
Checks the room
Communicates H.K staff
Supervise H.K staff
Vacant room (not ready)
H.K staff
Nurse aid
House keeper Cleaning material and equipment
Cleaning the room(Balcony, bathroom, walls, floors)
Clean room (not ready)
Nurse aid
Nurse aid
Clean sheets
Disinfectant materials and equipment
Disinfection of the bed
Replacing old bed sheets by clean new sheets
Ready bed
H.K supervisor
H.K supervisor Time
Supervision
Ready room to receive a new patient
Ward secretary
Ward secretary Time
Communicates admission office
Send room key to admission office
Ready room
Admission office
Admission office Time
Finishes paper work for the patient
Vacant room (ready)
Patient
SIPOC
8. Stake Holders
1. Ward secretary
2. Admission office
3. Housekeeping
4. Nurse aid
5. Infection control
6. Customer relation
7. Maintenance
8. Security
High level flowchart
Detailed flowchart
9. Sample size
1. Measurement done in all wards: 4th, 6th,
7th and 8th floors.
2. All measured rooms are regular rooms.
3. Measurements done at rush hours of
admission: from 9 am to 3 pm.
4. No stratification was done.
5. 30 cases were collected, 5 of them were
reserved for ICU patient.
11. What do we measure?
Patient leaves
room
H.K and N.A
start cleaning
H.K and N.A
finish
cleaning
New patient
into the room
End pointStart point
Interval 1 Interval 2 Interval 3
TIME
12. We did our measurements through 6 days in all regular
floors. We measured 30 processes as follows:
Number of regular rooms received patients 25
Number of regular rooms reserved for ICU patients 5
Total 30
Complete sheet of measured data: Room vacancy TAT baseline measurements.xlsx
4:23:003:43:003:03:002:23:001:43:001:03:000:23:00
6
5
4
3
2
1
0
Pt. out/New pt. in
Frequency
Histogram of Pt. out/New pt. in
Normal
Patient out/Start of
cleaning
Start of cleaning
/Room Ready
Room
ready/New
patient in
Whole process
25 59 36 124
Average of: (in minutes)
16. Delayed room vacancy TAT
Ward secretaryHouse Keeping
Admission officeNurse Aid
Not informed on time
Lack of communication
Waiting for
nurse
aid to
change sheets
Multiple discharges at the same time
Does not know on time that patient is out
of room
Overloaded
Overloaded by many jobs in floor
No enough clean sheets in floor
Multiple discharges in the same time
Bad communication between ward secretary and
Admission office employees
One porter for multiple admissions
Multiple admissions and Overload of paperwork
Wait for room key and send it back again
With porter to floor
Multiple discharges at the same time
Do not check for actual patient discharge
From room
Fish bone diagram clarifying the root causes for prolonging the
process of admission of a new patient into a vacant room
17. 1. Ward secretary can not readily know
that the patient has left the room.
2. Nurse aid does not have enough
clean sheets in the floor.
3. Nurse aid has many jobs to do and
sometimes he/she could not be
available when the patient is
discharged and the room is vacant.
4. Sending the room key to admission
office by ward secretary or by the
porter is an extensively time consuming
subprocess.
1. Patient cannot have his labs and
investigations from the ward secretary
unless he has actually left the room.
2. Nurse aid is to check for available
clean sheets in the floor store in the
beginning of the day shift.
3. Nursing office is to set the priority
for the nurse aid to be the room
preparation for vacant rooms.
4. Room keys are to be kept in the
floor (keys cupboard) by ward
secretary during the rush hour of
admission (9 am to 3 pm).
Significant causes of delay of
the process Remedies suggested
18. After applying the remedies, Re-measurement was done in all
normal/regular floors through 7 days, improvement of the all
intervals and the whole process was as follows:
Average of: (in minutes)
Pt. out/start
of cleaning
Start of
cleaning/Room
ready
Room ready/new
pt. in
Pt. out/new pt. in
8 36 8 54
Detailed data of measurement after applying
remedies for improvement: Room vacancy TAT
after improvement.xlsx
124
min
54
min
24. Back
The patient leaves the room
(Actual Physical Disharge)
The ward clerk
is informed and
informs
Housekeeping
supervisor
The housekeeping supervisor changes
the label on the door of the room from
green to red
The house keeper supervisor calls the
nurse aid
The nurse aid removes bed sheets
The house keeper waits the
security to open the balcony door
to clean it.
The house keeper Cleans the balcony
then the security closes the door
The house keeper cleans the room
The nurse aid cleans the bed and
disinfect it and cover the bed by new
sheets
Not
clean
Open it
Not
open
*
*
Process Map of
vacant room
TAT
The house keeper cleans the floor of the
room
The housekeeping supervisor
checks the room
Housekeeping supervisor changes the
door label to the yellow color and informs
the ward clerk that the room is ready
The ward clerk informs the admission
office
The admission office sends the patient
with the porter to the prepared room
The ward clerk delivers the patient to his
room
The patient enters the room
clean
Not
clean
*
A
