1. Together, our Promise is.
YOUR HEALTH.
PURPOSE
DESIGN
SMART LEAN
SETTING
• 80% of all elective cases will meet Patient Readiness Goal
• Decrease unnecessary delays to scheduled surgeries due
to missing paperwork and/or physician orders
• Increase patient safety
• Decrease time interval from patient arrival to operating
room
METHOD
RESULTS & IMPLICATIONS
IMPROVING PATIENT
READINESS:
Increasing patient safety and
operating room efficiency
Sheena M. Butts, CSSBB, Industrial Engineer
LRH is committed to continuous improvement and in October 2013 a
project to improve Patient Readiness for surgical cases was initiated.
Patient Readiness is important as it promotes the safety of the patient,
decreases delays, and improves the overall experience of the patient
through their continuum of care.
OBJECTIVES PARTICIPANTS
Patient Readiness is defined by LRH as having all documents and physician orders
required for an elective surgery to be received by twelve noon the business day prior
to the surgery date. Documents include History and Physical, Consent,
Electrocardiograms, Labs, Medical Clearance, Cardiac Clearance, etc.…. Initial
baseline metric for patient readiness at project start was 41% in October 2013 and as
a result of process and policy redesign we have currently achieved and sustained over
80% each month since October 2014. In order to obtain metrics needed for analysis, a
tracking board was utilized by the Pre-Admit Testing department to mark the date and
time of when patient readiness documents and physician orders were received. In
addition, at twelve noon the day prior to surgery, any remaining charts that were
missing documents were checked again to determine if the patient’s chart was to be
marked complete or incomplete on the tracking board. The project team utilized the
metrics to provide physicians and their offices a scorecard which showed them the
percent of their cases that were complete and met the patient readiness goal and the
details of when each document required for the patient to have surgery was received
by the Pre Admission Testing Department. A process hard-stop was initiated if
documents and orders were not received for elective cases by twelve noon the
business day prior to scheduled surgery date. If the case was marked incomplete by
the Pre-Admission testing department it was sent to surgery leadership to determine if
the case should be rescheduled. Pre-Admission testing also sends out reminder
notifications to offices and physicians at 48 hours and 24 hours prior to scheduled
surgery date in order to remind physicians and offices to send in their documents and
place their orders on time.
Jack Thigpen, MD, CSO; Tim Regan, MD, CQO, CMIO; Margie Voyles,
RN, MS, CNOR; Cheryle Smith, RN, MSN; Cateria Davis, RN, BSN;
Mary Beth Perry, RN, MSN, CPAN; Cindy Fitzpatrick, RN; Diane
Campbell, RN, MSN, CSSBB; Sheena Butts, IE, CSSBB; Deborah
Newbern, CHAM,CRCE-I; Jane Carlson, CHAM,CRCE-I; Derek Cyr,
CPHIMS; Debbie Walker, RT(R); Ever Glendenning, RN, BSN, CPAN;
Renee Mountcastle, RN, BSAST, CNOR, IT
Lakeland Regional Health is a full service medical center and health
system. As an 851 bed, not for profit medical center, Lakeland
Regional Health (LRH) is the fifth largest hospital in the state of
Florida and also operates the busiest single-site Emergency
Department in the state. LRH has an average surgical case volume of
over 1400 cases per month.
A multidisciplinary project team consisted of members from across the health
system and included industrial engineers, physician leadership, surgical services
leadership, data analysts, information technology analysts, and clinical analysts
who worked to together on a 18 month redesign of our patient readiness
processes. Team members met weekly and mapped current state, completed a
gap analysis, and developed a date collection plan and future state workflow. In
addition, team members developed technology and system improvements such
as an electronic tracking board and physician scorecards in order to support the
new workflow processes and hold physicians accountable.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Patient Readiness
GOAL: 80%
Initial baseline metric for patient readiness prior to project start was 41% in
October 2013 and we have achieved and exceeded our 80% Patient
Readiness goal each month since October 2014.
This successful project demonstrates that changes can be made across the
health system to standardize patient readiness processes for all providers
and increase patient safety through their continuum of care.
KEYS TO SUCCESS
 Executive Leadership Support
 DYAD collaboration between surgical services leadership and
physicians
 Technology and System Improvements
 Industrial Engineering Principles
 SMART LEAN Methodology
 Standard Work
PAT Patient Readiness Tracking Process Flow (draft 9.8.14)
End
Start
HUC receives
items on fax server
or through red
envelope courier
for patient chart
and names files
(Patient Name &
Surgery Date)
Is patient chart
complete? All items
have been received
AND orders are
present
HUC creates and/or
adds to already
created patient chart
with items that have
been received and
marks tracking board
that items have been
received
HUC places
patient chart in
queue for RN to
review
RN reviews chart
including orders
and makes any
changes to
tracking board if
necessary
(including
backdating)
RN marks Chart
Complete on
tracking board
and places chart in
file or on cart
Is patient scheduled
for surgery the next
day?
RN reviews any
Incomplete chart
starting at 12 noon the
day prior and reviews
chart including orders
and makes any changes
to tracking board if
necessary
(including backdating).
Is patient chart
complete? All items
have been received
AND orders are
present
RN marks Chart
Complete on tracking
board and places
chart on cart
RN marks Chart
Incomplete on
tracking board and
marks any missing
item as incomplete on
tracking board and
places chart on cart
Delay for review
(patient folder
placed in file or
on cart)
NOTES:
· HUC will not review parameters
of EKG
· Nurse will call (and/or email,
tbd..) doctor’s offices to remind
them of missing items
· Nurse is responsible for
reviewing all patient readiness
items for accuracy
· Tracking Board automatically
documents initials of who
checked item for internal review
Is patient scheduled
for surgery < 48
hours?
RN creates patient
chart
Y
N Y
N
N
Y
N
Y
Notification reminder
sent to physician and
their office at 24 hours
prior to scheduled
surgery date with details
on what items are
missing