Operations Presentation on the General Surgery Clinic at Boston Medical Center
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An operations management analysis of the surgical clinic at Boston Medical Center, quantifying current processes and giving recommendations for improving future performance.
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Chapter 11 Risk Management inSelected High-Risk Hospital Dep
Chapter 11: Risk Management in
Selected High-Risk Hospital Depts
High Risk Depts. in Hospitals
All clinical depts. in hospitals have potential for risk, but some are greater than others:
Emergency Room
Obstetrics and Neonatology
Surgery and Anesthesia
Diagnostic Imaging
Treat highly vulnerable patients in often chaotic settings where the results of errors can be catastrophic and costly
Emergency Medicine
Which Definition?
AMA – any condition clinically determined to require immediate medical care
Federal Legislation – condition manifested by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably be expected to result in serious jeopardy to an individual’s health, serious impairment to bodily functions or serious dysfunction of any body organ or part
Clinicians –view emergencies as life-threatening situations
The mere existence of an ER implies a duty to treat any patient who arrives
Emergency Medicine Issues
Emergency Medical Treatment and Active Labor Act (EMTALA)
Pre-hospital services
Dept Capabilities and Staffing
Triage Process
Emergency Medicine Issues
Medical Records Documentation and Consent
Support Services
Departures, Discharges and Transfers
Risk Management
Obstetrics and Neonatology
Lawsuits in this category are usually the most expensive
Advanced technology has improved survival rates for infants but led to increased risks for facilities
Ethical Dilemmas
Standards and Guidelines
Levels of Care
Level 1 – least intensive and designed to treat low-risk mothers and babies
Level 2 – must be able to manage high-risk mothers, high-risk fetuses and small, sick neonates
Level 3 – must be able to monitor and maintain critical functions of mothers and neonates the nurse to patient ratio is more intensive as well
Obstetrics and Neonatology
Obstetrics and Neonatology
Prenatal and Perinatal Care
Intrapartum Period
Delivery
Neonatal Resuscitation and Management
Maternal Exam Post Delivery
Family Attendance Issues
Obstetrics and Neonatology
Medical Record Documentation
Neonatal Services
Infant Transport
Infant Abduction
Surgery and Anesthesia
Surgery and Anesthesia claims are usually co-dependent
Increased number of surgeries performed in outpatient or ambulatory settings with decrease in number of claims
Paid malpractice claims are higher in the outpatient setting
Handout Case Study
10
Surgery and Anesthesia
Negligence and Malpractice
Surgical Services Staff
Preoperative Assessment and Treatment
Intraoperative Risks
Postoperative Recovery
Documentation
Handout Case Study
11
Surgery and Anesthesia
Intraoperative Risks
Sedation and Anesthesia
Wrong Site, Wrong Procedure, Wrong Person
Implants
Retained Foreign Bodies
Patient Burns and Pressure Injuries
Surgical Fires
Handout Case Study
12
Diagnostic Imaging
Creating images of the human body utilizing various methods:
X-rays
Computed tomography (CT)
Interventional radiography
Ultrasound
Magnetic resonance imagine (MR ...
DNB EM :Good academics in emergency training progam
An expert discusses strategies for implementing a good academic emergency medicine training program. Key aspects include:
- Strong selection process and induction training to prepare students.
- Focused clinical rotations, electives, life support courses, procedures, and skills training to build proficiency.
- Daily teaching, case discussions, bedside learning and faculty coverage to mentor students.
- Evaluations, research, workshops and conferences to assess progress and support continued learning.
- Exit exams to ensure students have achieved expected competencies before completing the program.
Interview Workshop Fall 2016
This document provides information and advice for students preparing for health professional school interviews. It outlines the purposes of interviews, common question types including typical, healthcare-specific, behavior-based, and non-traditional applicant questions. Interview formats like one-on-one, panel, and multiple mini-interviews are described. Tips are provided on proper attire, preparing for different types of interviews at various Michigan schools, and following up after interviews. Contact information is included for advisors available to assist students.
Interview Workshop Fall 2015
This document summarizes an interview workshop for health professional school applicants. It outlines the common purposes and styles of interviews, provides examples of typical and healthcare-specific questions, and gives advice on preparing for and having a successful interview. Specific details are provided about interview formats and processes for medical and dental schools in Michigan. The workshop aims to help applicants understand what to expect and how to make the best impression during their interviews.
Access to Health Care and Andersen Model
The document discusses the Andersen Model of health care access. The model conceptualizes access as being determined by population characteristics (contextual and individual factors) that predispose people to use services or enable/impede their use. These include demographic, social, health beliefs, and enabling resources factors. The model also considers people's need (perceived and evaluated by professionals) and how this influences health behaviors and outcomes. It provides a framework for examining equitable access to care based on need rather than social characteristics or enabling resources.
Roshan ( ethical and legal aspect in pediatric surgery0
This document discusses the ethical and legal aspects of pediatric surgery. It begins by stating that ethics, surgery, and law are interrelated, with ethics guiding what we should do and law dictating what we must do. It then discusses the core principles of medical ethics - beneficence, non-maleficence, autonomy, and justice. Key issues in pediatric surgical ethics that are examined include informed consent, confidentiality, and research. The importance of maintaining excellent surgical standards, disclosing errors to patients, and respecting patient autonomy are also emphasized. Throughout, the document stresses that pediatric surgeons must practice according to strong ethical principles in order to best serve their patients.
EPRD16 - Pamela Mazzocato - How does lean work in emergency care
Pamela Mazzocato discusses how lean practices can be used to improve emergency care by reducing waste and inefficiency. Two case studies are described where lean was used: 1) At Danderyd Hospital, lean reduced the time to surgery for hip fractures from 24.8 to 20 hours and increased the percentage of patients operated on within 24 hours from 47% to 83%. 2) At Karolinska University Hospital, lean reduced non-value adding time and variation, increasing the percentage of patients ready to leave the emergency department within 4 hours by up to 29% and decreasing the waiting time for first physician assessment by up to 56%. Lean focuses on continually improving processes to increase value for patients.
Incorporating CanMEDS in Residency Training Final 1
The document discusses incorporating the CanMEDS competency framework into residency training at the Department of Medicine at King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia. It outlines that the department has established a CanMEDS syllabus subcommittee and developed a CanMEDS-based training proposal. Future plans include restructuring the subcommittee to include more residents and faculty trainers, developing "CanMEDS micro-teams" of faculty and residents for each competency, and conducting train-the-trainer workshops to build educational curricula around the competencies. The goal is to implement competency-based medical education and improve training outcomes for residents.
Using patient stories to create a culture that cares: MD Anderson & Gelb - Be...
Experience Mapping is an in-depth qualitative research technique that utilizes a visual cue (the experience map) to help physicians, patients, staff, and other influencers recall specific episodes in their journey. It provides: Assessment of the total experience, expectations- before first encounter, activities and Touchpoints, changes in attitudes, if any
Framework for action: experience stewards who are responsible for delivery, steward can appreciate the relationship of their actions to the rest of the journey, interactions or “touchpoints” are categorized at each step
· After A review of the current literature regarding the challe.docx
·
After A review of the current literature regarding the challenges faced by many hospital systems as a result of emergency department overcrowding, a qualitative study of by means of a written questionnaire to determine factors or potential factors that influence a health care consumers decision to access care at an emergency room.
As the population ages emergency departments will continue to experience overcrowding from many factors, among them overutilization due patients seeking non-urgent care. Increased use of emergency departments In terms of financial viability it will be essential to understand factors affecting how patients perceive their medical condition, and further the accessibility to the appropriate level of care. The purpose of this study is to determine and evaluate the factors that contribute to the overutilization of emergency departments for non-urgent needs.
The study is targeted to patients in a rural North Carolina county with approximately 26,000 residents. Study participants will be those seen in the local emergency department that averages 1300 visits per month. Each participant will be required to complete a consent form and provide demographic data. Organizational approval for this study will be obtained at the facility level from the Assistant Vice President for the facility. Additionally. The Institutional Review Board (IRB) consent must be obtained.
During the data collection process, the surveyor will approach each participant separately and seek their consent for participation in the survey. During this encounter, the survey will collect the appropriate demographic information. Participant's names will not be disclosed in an attempt to preserve their anonymity
Introduction: My name is Teresa Cochran. I am a Director of Nursing and also a graduate student seeking a Master’s in Business Administration. I am currently completing a survey of factors that contribute to patient’s utilization of Emergency Services and I would like to ask you a few questions.
Questionnaire
I.
1. What is the reason for your visit to the Emergency Department today?
a. Chest pain
b. Accident
c. Respiratory distress
d. Diarrhea/vomiting
e. Other _____________________________________
2. How many times per year do you come to the Emergency Department?
a. 0-2
b. 3-5
c. 6-8
d. >9
3. What, if any of the following factors may influence your decision to come to the Emergency Department:
a. No available appointment at primary care
b. Second opinion
c. Receive better care in ED than at doctor’s office
d. No transportation
e. Convenience
f. Other___________
4. Do you have a doctor you see on a regular basis?
a. Yes
b. No
5. How many times do see your doctor per year?
6. 0-2
7. 3-5
8. 6-8
9. > 9
10. Before you came to the ED did you call your primary care physician? Why or Why not?
11. What prevents you from getting health care at your primary care provider?
12. What is your age? Gender?
13. Employment statu.
Example Dissertation Proposal Defense Power Point Slide
Vincent Bridges will defend his dissertation proposal on examining the effectiveness of medical assistant programs at three Midwestern schools in meeting stakeholder needs. The proposal will cover the problem background, purpose of the study, research questions, and literature review. Bridges will use a qualitative survey methodology to collect data from 20-25 healthcare professionals on their organizations' use of medical assistants and program competencies. The data will be analyzed for themes to provide feedback to the schools on curriculum alignment with industry needs.
Emergency Medicine within all Four Years of Medical School
This document discusses opportunities to integrate emergency medicine education throughout the four years of medical school. It outlines how EM education can be incorporated in pre-medical, pre-clinical, clinical, and longitudinal phases of medical education. Examples provided include EM lectures, simulation cases, electives, research, shadowing, and learning communities that span all four years. The goal is to ensure all medical students receive basic EM training and exposure to help prepare them for independent practice and residency.
Integrating EM into All 4 Years of Medical School
Explain importance of early, consistent EM education for all medical students.
Discuss opportunities to engage & have impact throughout the 4 year curriculum.
Highlight learning communities, the “How to be a doctor course”, and EMIG.
Evaluate factors that influence a student’s choice of specialty as related to above.
Interview Workshop Fall 2017
This document provides information and guidance for students preparing for health professional school interviews. It outlines the purpose of interviews, common question types and topics, proper attire, and tips for preparing and participating in interviews. Interview formats vary by school but may include one-on-one, panel, or multiple mini-interviews. Questions assess fit, motivation, maturity, and handling of ethical issues. Schools evaluate applicants on criteria like communication skills and knowledge of their field. Mock interviews are available to help students practice their interview skills.
Breast Cancer Navigation
This document outlines steps for effective breast cancer navigation using the nursing process theory. It discusses the role of a navigator, identifying barriers patients face, and developing strategies to address them. A case study example illustrates how to assess an elderly patient's physical, emotional, support system, knowledge, financial, and healthcare barriers. Attendees then brainstormed ways for navigators to reduce different barriers. The presentation emphasizes that navigators cannot work alone and need a multidisciplinary team including non-clinical navigators, financial counselors, dietitians, and social workers to best support patients.
Facing Up The Challenge Sep 27 2007
This document discusses challenges around obtaining informed consent from vulnerable populations in medical research. It explores two case studies: research in emergency settings where patients may be temporarily incompetent, and research with cancer patients where illness can impact competency. For both cases, it examines difficulties around ensuring understanding while obtaining consent, and proposes alternatives like deferred consent or waiving consent with additional protections. Throughout, it emphasizes finding the right balance between individual autonomy, beneficence, and justice when conducting research with vulnerable groups.
Provision of dental services to care homes
The document summarizes a pilot program to provide NHS dental services to care homes in Northamptonshire. It outlines the needs assessment conducted which found high rates of dental issues among residents. The pilot involved local dental practices providing oral health assessments, treatment, and training to care home staff. Issues that arose included complex data collection, variable cooperation from homes, and challenges providing the service within the specified payment structure and timeframe. Evaluation of the pilot was underway to help determine future dental care programs for care home residents.
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Health Insurance Information Needs: How Librarians Can Help
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Chapter 11 Risk Management inSelected High-Risk Hospital Dep
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DNB EM :Good academics in emergency training progam
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Roshan ( ethical and legal aspect in pediatric surgery0
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Using patient stories to create a culture that cares: MD Anderson & Gelb - Be...
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· After A review of the current literature regarding the challe.docx
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Example Dissertation Proposal Defense Power Point Slide
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Emergency Medicine within all Four Years of Medical School
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A Classical Text Review on Basavarajeeyam
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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Light House Retreats: Plant Medicine Retreat Europe
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Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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Operations Presentation on the General Surgery Clinic at Boston Medical Center
- 1. General Surgery ClinicBMC Operations Team 4 Asad Butt EszterHamori DineshKurian Cristina Pedroza Joel Samen
- 2. Boston Medical Center (BMC) “Exceptional care without exception” Private Non-profit Located in South End BU’s Teaching Hospital
- 5. …And Medical Care Competitors
- 9. Attendings
- 10. Residents
- 11. Students
- 12. Patients
- 14. Consultation Process Staff´s Perspective Medical Assistant Resident Doctor
- 15. Consultation Process Staff´s Perspective Attending Doctor Wound Care Ostomy Nurse (Specialist)
- 16. Why You Wait at the Doctor
- 17. Issues with the Process Throughput Time Machinery Measure Variability in Demand Non-English Speaking Patients Patient Type Case Type Small Number of Translator Phones Attendings Effectiveness vs. Efficiency On the Job Learning Shared Resources Availability Staff Training Program Manpower Method
- 18. Absenteeism Machinery Measure Socioeconomic Factors Transportation Lack of Escort Can´t Skip Work No Car Access to Public Transportation No Children Care Limited Parking Limited / No-Coverage Uncomfortable Seating Dark, Boring, Narrow Clinic Premises Insurance Coverage Materials Method
- 19. Expectation Misalignment Measure Measure Data Collection Market Research Customer Satisfaction Survey Benchmark Lack of Process Statistics No Written Procedures Disconnection with Top Management Role Ambiguity No Targets Set Service Guidelines Staff Working As a Silo Method Manpower
- 20. Quality of Service: Process Specifications
- 21. Quality of Service: Process Expectations Doctor Patient Misalignment Expectation: To be simultaneously effective and efficient Short time with each patient Expectation: Spend approximately 39 minutes with medical staff 25 Minutes with Medical Staff
- 22. Recommendations
- 23. Recommendation: Address No-Show Rate
- 24. Recommendation: Reduce Schedule Variability
- 25. Recommendation: Decrease Throughput Time
- 27. Recommendation: Improve Waiting Experience
- 28. Creating a Better Patient Experience Happier Patients
- 30. Appendix: Resident Time with Patient
- 31. Appendix: Attending Time with Patient
Editor's Notes
- No issues with Material
- No issue with ManpowerMaterialsMachineryManpowerMethodMeasure
- Talk about how the data was collectedOur data points to a wide variation in the time it takes to complete each step in the process, largely because the process is different for each patient and because a lot is dependent on constantly changing variables, including available doctor and room capacity.Steps from check-in to triage to examination to consultation – point to wide variation along the way. Generally, long times both to wait for resident examination and for the examination itself.
- Though our discussions with doctors and patients, we noticed that there were some differences between the amount of time a doctor expects to spend with a patient and the amount of time a patient expects to spend with a doctor. Because of their long list of patients, doctors aim to do the best job possible while simultaneously being efficient. This leads to them trying to spend a short period of time with each patient.The patient, on the other hand, expects that it will take a long period of time in order for the doctor’s examination to be thorough. According to our survey, patients expect to spend about 39 minutes with the medical staff, including triage, examination, and consultation. In reality, they spend about 23 minutes on average with the medical staff. This difference between the patient’s expectation, the doctor’s expectation, and the actual experience leads to a misalignment between the expectations of stakeholders.