1. CARDIOLOGY CLINIC FLOW
Mollie R. Mullaney RN, BSN, CCRN-K • John McNeil, Continual Improvement Consultant
282 Washington Street, Hartford, CT 06106, © 2016 Connecticut Children’s Medical Center. All rights reserved. 16-688 New 10-16WWW.CONNECTICUTCHILDRENS.ORG
BACKGROUND
Cardiac surgeries are fed by a process of new patient referrals and consultations,
often requiring echocardiograms.
Concerns for cardiac defects may be raised prenatally or from clinical concerns
Many patients may require only a single visit, but some require lifelong evaluations
Patients prefer
- Timely visit access (days instead of weeks)
- Single visit interactions, rather than evaluations and diagnostic studies on separate days.
We used a single work shop event to make the process of scheduling and visits flow
“like a well-oiled machine”
This in turn will enable and promote improved new patient throughput and surgical
growth in our current, and potential, geographies
AIM
Cardiology at Connecticut Children’s has increased their physician number and
specialties offered, open a redesigned we central clinic in Hartford, and have been
expanding their outreach clinics in number and geographic locations
To allow for increases in growth and ability to supply exceptional service, the process
of arranging a clinic must be seamless and reproducible.
We have not yet achieved our goal.
Our AIM is to implement a number of Lean methods to
- Reduce waste (resources and time)
- Increase synchronization
- Ease planning
- Allow for flexibility for patients and staff.
We set a goal of immediate improvement within 30 days, growing to new levels by
the end of 2016
METHODS
Our schedule:
- Review of the current and historical clinic setup (planning stage occurred 3 weeks prior to
workshop)
- Determination of future goals were set (both short and long term).
- Rapid Process Improvement Workshop lead by JWA and CCMC staff
Representatives from each clinic role were represent for the event
- This allowed for immediate feedback regarding improving flow, and actual feasibility at
implementation
Lean concepts deployed:
- Meeting task (pace)
- Level loading
- Self-scheduling
- Echo pacing
- Open scheduling
- Visual management of the schedule.
Our desired outcomes were improvements in patient backlog, access time, single
visit interactions, length of visit, and visit volume compared to previously determined
budget/plan.
Our initiatives:
- Level load physicians in order to manage over and under booking throughout physicians
over time.
- Rationalize schedules for physicians and clinics
- Adjust daily schedules to allow for “urgent add-ons”, as well as accommodate for last
minute changes
- Match daily resources, specifically echo machines and technicians, with the physician spots
and needs
CREDITS
Many thanks to the team who provided time and energy during and after our Rapid
Process Improvement Workshop (RPIW) event.
- Karen Koproske
- Mollie Mullaney, RN
- Michelle LaRocque
- Camilla Biancamano
- Brooke Davey, MD
- Frederic Bernstein, DO
- Nataly Collado
- MacDara Tynan, MD
- The entire Cardiology staff
RESULTS
Since March we have.
- Determined physician availability by date and week
- Created a system to cross cover missing physicians in critical specialties/locations
- Created a separate echocardiogram schedule run independently from the physicians
schedule.
Our new schedule went live on August 1st and already we have seen…
- Less patient backlog for visits
- More availability of urgent patient spots
- Improved patient satisfaction
- Improved physician and staff satisfaction
- Decreased staff downtime by creating a level-loaded schedule
DISSEMINATION
This improvement took place in the Hartford campus Cardiology clinic. It built upon
the RPIWs from other areas such as Nephrology and elements have already been
applied in other locations such as Hem/Onc and in the emerging Flow project.
Cardiology is current-
ly strong in Central
Connecticut
(patient home zips)
Visual Management of Provider
Schedule using Lego®
Bricks
Prior Schedule 79 echos per week, highly
variable, “chaotic”
Tight-Packed, Level-Loaded, Echo-paced
schedule 80 echos per week, 43-80 non-
echo MD appts per week.