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Quality Forum 2013BC Provincial Lean NetworkLean in BC: Local Stories &Interactive Discussion withPhysicians and Operation...
Lean in BC: Local Stories & InteractiveDiscussion with Physicians andOperational Leaders – Part 1:Leading the Transfer of ...
Objective• The aim of this initiative was  to streamline & standardize a  safe admission and handover  process of cardiac ...
Background
Background• Historically, post-op cardiac  surgery patients unstable• Identified need• Largest post-op group• Cluster/floc...
Current State                                                   Cardiac OR to PICU Handover of Care: Pre-Kaizen Average   ...
Solution• Team selection     PICU: staff nurse; charge nurse; quality & safety           lead (lead)     Cardiac OR: anaes...
SolutionSet and met 4 targets:  1. Determine characteristics of a safe patient     handover from OR4 to PICU  2. Define st...
Solution                                                  Activity                          Day 1   Day 2   Day 3   Day 4 ...
Results of Kaizen                                                          Cardiac OR to PICU Handover of Care:           ...
Results of Kaizen
Results of Kaizen (3 Years Post)                                                                        Cardiac OR to PICU...
Next Steps/Sustaining the Gains• Adopted for spinal surgery handover• Plans for spread to 100% of surgical teams for  2013...
Lessons Learned• A pull for change is easier to make  happen• Right people on the team• Value of senior leader on team• Cr...
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E9 Tracie Northway - Lean in BC: Local Stories & Interactive Discussion with Physicians and Operational Leaders

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E9 Tracie Northway - Lean in BC: Local Stories & Interactive Discussion with Physicians and Operational Leaders

  1. 1. Quality Forum 2013BC Provincial Lean NetworkLean in BC: Local Stories &Interactive Discussion withPhysicians and OperationalLeaders
  2. 2. Lean in BC: Local Stories & InteractiveDiscussion with Physicians andOperational Leaders – Part 1:Leading the Transfer of Care for CardiacPatients from Cardiac OR to Pediatric IntensiveCare Unit(Session E9)Tracie Northway, Manager, Strategic Implementation, BC Children’s & Sunny Hill Health CentreBarb Fitzsimmons, Senior Vice President, BC Children’s Hospital & Sunny Hill Health Centre
  3. 3. Objective• The aim of this initiative was to streamline & standardize a safe admission and handover process of cardiac patients from the Operating Room to the Paediatric Intensive Care Unit.
  4. 4. Background
  5. 5. Background• Historically, post-op cardiac surgery patients unstable• Identified need• Largest post-op group• Cluster/flock care• Chaos• No clear communication• Missed critical information• Delays in care http://img69.imageshack.us/img69/4634/chaosfieldhp0.jpg• Previous improvement attempts had failed
  6. 6. Current State Cardiac OR to PICU Handover of Care: Pre-Kaizen Average Defects per Handover (6 Handovers) 4.5 4.2 4.0 3.5 2.8Average Defects/Handover 3.0 2.5 2.0 1.5 1.5 1.5 1.3 1.2 1.0 0.7 0.5 0.0 Role crossover Tangled Supplies not where Increased Waiting for people Deviations from "Presence" at equipment/lines needed unexplained staff "norm" handover Defect Category (n=# of occurences over 6 handovers)
  7. 7. Solution• Team selection PICU: staff nurse; charge nurse; quality & safety lead (lead) Cardiac OR: anaesthesia assistant, anaesthetist; clinical resource nurse; perfusionist External: imPROVE facilitator (sub-lead); vice president; corporate executive assistant Content experts: PICU physicians; cardiac surgeons; respiratory therapist; professional practice leaders
  8. 8. SolutionSet and met 4 targets: 1. Determine characteristics of a safe patient handover from OR4 to PICU 2. Define standard work (process, roles and responsibilities) for a safe patient handover 3. Develop tools to guide & support standard work 4. Test standard work tools
  9. 9. Solution Activity Day 1 Day 2 Day 3 Day 4 Day 5Orientation to Lean principles Team goal setting for the week  Define “standard work” for Cardiac OR to PICU safe handover of care Development of Handover Tool Bed Set-up (crib) defined, prototyped & tested on admission Protocol for handover drafted Education for OR #4 Team and PICU staff admitting CVS Patient   Digital recording of admission   Debriefing with OR & PICU staff about admission   Review of debriefing notes   Areas for improvement discussed    Strategies brainstormed    Handover Tool (Checklist) revised & tested  Protocol for handover revised & tested  Admission recording reviewed, standard work documented & defects counted  Daily “report out” to Sensei Iwata    “Stamping” of project work by Sensei Iwata Practice for “Final Report Out” Team “Final Report Out” to Sensei Iwata, other teams, sponsors and administration Creation of sustainment plan Ongoing
  10. 10. Results of Kaizen Cardiac OR to PICU Handover of Care: Comparison of Pre-Kaizen to RPIW Average Defects per Handover 4.5 4.2 4.0 3.5Average Defects/Handover 3.0 2.8 Pre Kaizen (6 Handovers) 2.5 Kaizen Wk (3 2.0 Handovers) 1.5 1.5 1.5 1.3 1.2 1.0 1.0 0.7 0.5 0.3 0.0 0.0 0.0 0.0 0.0 0.0
  11. 11. Results of Kaizen
  12. 12. Results of Kaizen (3 Years Post) Cardiac OR to PICU Handover of Care: Comparison of Pre-Kaizen to RPIW to 2 Years Post Kaizen 4.5 4.2 4.0Average Defects per Handover 3.5 3.0 2.8 2.5 2.0 1.5 1.5 1.5 1.3 1.2 1.0 1.0 0.7 0.5 0.3 0.1 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Role crossover Tangled Supplies not Increased Waiting for Deviations from "Presence" at equipment/lines where needed unexplained staff people "norm" handover Defect Category Pre Kaizen (6 Handovers) Kaizen Wk (3 Handovers) 2 yrs Post-Kaizen (19 Handovers)
  13. 13. Next Steps/Sustaining the Gains• Adopted for spinal surgery handover• Plans for spread to 100% of surgical teams for 2013-2014 • Agreement from Surgical Council • Improvement planning group meeting
  14. 14. Lessons Learned• A pull for change is easier to make happen• Right people on the team• Value of senior leader on team• Create a process dependent protocol; not person dependent• Don’t reinvent the wheel• Live quality improvement cycle; be responsive

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