This document summarizes a project to improve wait times for chemotherapy patients at a VA hospital. The team analyzed the current chemotherapy process, identified problems through interviews and time studies, and developed recommendations in three key areas. They recommend standardizing scheduling, preparing some drugs in advance, improving communication between departments, and installing signal lights. Their recommendations aim to reduce the maximum wait time from 89 to 30 minutes for 80% of patients through process improvements. The team also suggests implementing an electronic tracking system for continued monitoring and improvement.
Improvement & Transformation TTO project Final Report Out Jan 16Nick Holding
The document summarizes process improvement efforts to reduce turnaround times for patient discharge medications (TTOs) and discharge summaries at a hospital. Key findings include:
- TTO lead times were reduced by 67% (3 hours) through testing various changes over two kaizen events.
- One ward saw patient discharge delays reduced by an average of 10 hours per day.
- Changes could release up to 300 hours of bed time per day across inpatient units.
- Areas of focus included ordering, picking, delivering, and producing TTOs and discharge summaries more efficiently.
Variability of clinical chemistry laboratory resultsAdetokunboAjala
Understanding the concepts associated with variability of laboratory results would help laboratorians improve the quality of laboratory service as well as aid the drive towards harmonization of laboratory quality practices.
Pre analytic and postanalytic test managementVarsha Shahane
The document discusses principles of pre-analytic, analytic, and post-analytic test management. It covers test selection and evaluation, requisition and test menu formats, and report formatting. The three phases of quality assurance - pre-analytic, analytic, and post-analytic - are described in detail, including factors influencing each phase like specimen handling, equipment calibration, and report review. Quality control procedures are also outlined to ensure test accuracy and reproducibility.
QUALITY
Conformance to the requirements of users or customers satisfaction of their needs and expectations.
Total Quality Management
A management approach that focuses on processes and their improvement.
This document discusses quality improvement of laboratory services in Chhattisgarh, India. It begins by outlining common diseases in the region like tuberculosis, HIV, leprosy, and waterborne illnesses. The importance of laboratory diagnosis for proper disease management is emphasized. Major bottlenecks in laboratories include insufficient staffing and resources as well as a lack of coordination between doctors and laboratories. Steps to improve quality include implementing standard operating procedures, conducting internal and external quality control, ensuring proper documentation, and training laboratory personnel. The overall goals are to support high-quality healthcare through accurate and reliable test results.
Improvement & Transformation TTO project Final Report Out Jan 16Nick Holding
The document summarizes process improvement efforts to reduce turnaround times for patient discharge medications (TTOs) and discharge summaries at a hospital. Key findings include:
- TTO lead times were reduced by 67% (3 hours) through testing various changes over two kaizen events.
- One ward saw patient discharge delays reduced by an average of 10 hours per day.
- Changes could release up to 300 hours of bed time per day across inpatient units.
- Areas of focus included ordering, picking, delivering, and producing TTOs and discharge summaries more efficiently.
Variability of clinical chemistry laboratory resultsAdetokunboAjala
Understanding the concepts associated with variability of laboratory results would help laboratorians improve the quality of laboratory service as well as aid the drive towards harmonization of laboratory quality practices.
Pre analytic and postanalytic test managementVarsha Shahane
The document discusses principles of pre-analytic, analytic, and post-analytic test management. It covers test selection and evaluation, requisition and test menu formats, and report formatting. The three phases of quality assurance - pre-analytic, analytic, and post-analytic - are described in detail, including factors influencing each phase like specimen handling, equipment calibration, and report review. Quality control procedures are also outlined to ensure test accuracy and reproducibility.
QUALITY
Conformance to the requirements of users or customers satisfaction of their needs and expectations.
Total Quality Management
A management approach that focuses on processes and their improvement.
This document discusses quality improvement of laboratory services in Chhattisgarh, India. It begins by outlining common diseases in the region like tuberculosis, HIV, leprosy, and waterborne illnesses. The importance of laboratory diagnosis for proper disease management is emphasized. Major bottlenecks in laboratories include insufficient staffing and resources as well as a lack of coordination between doctors and laboratories. Steps to improve quality include implementing standard operating procedures, conducting internal and external quality control, ensuring proper documentation, and training laboratory personnel. The overall goals are to support high-quality healthcare through accurate and reliable test results.
Here are the steps to calculate sensitivity, specificity, positive predictive value, negative predictive value, and efficiency for the given diagnostic test:
* True Positives (TP) = Number of HIV+ samples correctly identified as positive by the test = 120 - 15 = 105
* True Negatives (TN) = Number of HIV- samples correctly identified as negative by the test = 300 - (120 + 4) = 176
* False Positives (FP) = Number of HIV- samples incorrectly identified as positive by the test = 4
* False Negatives (FN) = Number of HIV+ samples incorrectly identified as negative by the test = 15
Sensitivity = TP / (TP + FN) = 105 / (105
Total Quality Management (TQM) by Dr Anurag YadavDr Anurag Yadav
Total quality management principles aim to improve patient care through monitoring laboratory work to detect deficiencies and correct them. Errors can occur in preanalytical, analytical, and postanalytical phases, and quality control procedures help control variables and ensure accuracy. Calibration, precision, accuracy, linearity, and detection limits are important analytical concepts, and factors like equipment, reagents, personnel, and documentation must be controlled and monitored to minimize errors and ensure quality.
External quality assurance in clinical trace element labs Chris Harrington
Information on how EQA works in clinical trace element laboratories from the perspective of an ISO 17043 accredited EQA provider: UKNEQAS for Trace Elements, Guildford, UK.
This presentation describes the key performance indicators to assess the quality of work in microbiology department. The KPIs in common use are mentioned and other indicators are summarized.
This document provides an overview of quality control in clinical biochemistry laboratories. It discusses that quality control aims to ensure test results are correct by minimizing errors. Errors can occur in the pre-analytical, analytical, and post-analytical phases. The pre-analytical phase, involving sample collection and handling, accounts for most errors. Laboratories use internal quality control methods like calibration, controls, and Levey-Jennings charts daily, as well as external quality assurance programs, to monitor performance and identify errors. Maintaining quality control is important for generating accurate, reliable test results.
Preanalytical quality control practices in clinical laboratoryDr. Rajesh Bendre
Preanalytical variables contribute maximally to lab errors. However, these variables are most difficult to control as they include human dependency for phlebotomy skills & pretest patient conditioning. Quantifying & monitoring these variables is also more challenging. Use of checklists, continuous training, competency assessments, internal audits & clinician education for appropriate test utilization form some of the tools for improving the preanalytical processes.
Quality in clinical laboratory is a continuous journey of improving processes through team work, innovative solutions, regulatory compliance with final objective to meet the evolving needs of clinicians & patients.
Using reference materials to meet validation & verification requirements for ...Candy Smellie
Using reference materials can help clinical laboratories meet validation and verification requirements for molecular diagnostic tests. Credit Valley Hospital uses Horizon Diagnostics' pooled DNA reference standards at a 2.5% mutant allele frequency as a low positive control in their EGFR diagnostic assays. Including this control helps eliminate false positive results and provides a qualitative reference to confidently identify true low level positives. This reduces the risks of false negative or false positive reports, improving patient outcomes by ensuring accurate molecular testing results.
Basics of laboratory internal quality control, Ola Elgaddar, 2012Ola Elgaddar
Total Quality Management (TQM) is a continuous approach to improve quality and performance. It requires integrating quality functions throughout an organization with involvement from management, employees, suppliers, and customers. For medical laboratories, quality control has three main stages - pre-analytical, analytical, and post-analytical. Analytical quality control involves internal quality control (IQC) using control materials and external quality assessment (EQA) to monitor quality and compare results between laboratories. IQC follows procedures like plotting daily control results on Levey-Jennings charts and evaluating them using Westgard rules to detect errors.
The issue of laboratory quality has evolved over more than 4 decades since the 1st recommendation for quality control were published in 1965
Now, quality control is seen as only one part of a total laboratory control program
Quality also includes:
a) Total Quality Management (TQM)→ an activity to improve pt. care by having the lab monitor, its work to detect deficiencies & subsequently correct them
This document provides an overview of quality management tools and resources for laboratory quality management systems. It discusses the Clinical and Laboratory Standards Institute's (CLSI) Laboratory Quality Management System (LQMS) Certificate Program, which is an online training course covering the 12 quality system essentials. The program aims to impart the knowledge and skills needed to implement and sustain a quality management system in a clinical laboratory. The document also summarizes common quality management tools like check sheets, control charts, Pareto charts, scatter plots, and Ishikawa diagrams; and provides examples of their use in quality control. Additional online resources on quality management topics are listed.
Data Analysis Of An Analytical Method Transfer ToDwayne Neal
To provide the basis for a PDA task force discussion to arrive at a consensus of best industry practices for data analysis of method transfers. The discussion is also relevant to method validation activities.
The document discusses quality management basics for histology laboratories. It defines key terms like quality control, quality assurance, and quality management systems. It outlines the components of an effective quality management system, including identifying errors, assessing processes, and using tools like root cause analysis. The document provides examples of how laboratories can implement quality improvement initiatives using a team-based approach.
This document discusses quality control and quality assurance in microbiological laboratory investigations. It emphasizes the importance of standard operating procedures, internal quality assessment, and external quality assessment. Quality control occurs at multiple stages of analysis, including pre-analytical (specimen collection and transport), analytical (reagents, equipment, procedures), and post-analytical (reporting and interpretation of results). A quality control officer oversees quality control in the department through regular monitoring, assessment, communication, and analysis of quality control data.
Quality control in clinical biochemistryAshok Katta
This document discusses quality control in clinical biochemistry laboratories. It explains that laboratory tests play an important role in clinical diagnosis and treatment decisions. Therefore, test results must be reliable and accurate. Quality control involves measures to ensure test accuracy, including internal quality control procedures done daily in the lab and external quality assessment involving evaluation by an outside agency. Proper quality control is essential to producing test results that healthcare providers can trust in making decisions for patients.
This document discusses quality assurance in haematology. It defines quality and introduces the concepts of quality control and quality assurance. Quality control aims to minimize errors through statistical sampling and verification of consistent performance. Quality assurance ensures reliable test results through adherence to standards within and outside the laboratory. This includes internal quality control, external quality assessment, and standardization using reference materials and methods. Several examples are provided of potential pre-analytical errors in sample collection, transport, and handling that can affect test results. Adherence to proper procedures is emphasized to avoid issues like hemolysis, clotting, and dilution.
This document provides an overview of laboratory quality management and outlines the essential components of a quality management system for laboratories. It discusses that quality management is a continuous journey, not a destination. It then describes the key quality system essentials which include organization, facilities and safety, personnel, equipment, and processes for management, work, and measurement. The relationship between technical and managerial activities is important for ensuring high quality and effective laboratory operations.
This document outlines recommendations for maximizing reimbursement through a colorectal bundle at Advocate Lutheran General Hospital. It discusses establishing a perioperative surgical home to standardize evidence-based practices across pre-op, intra-op, and post-op phases of care. This includes assembling a multidisciplinary team, collecting baseline data, developing clinical pathways, and implementing protocols like ERAS to reduce costs and improve outcomes for colorectal surgeries.
The document summarizes a project to develop a healthcare decision support system (HRDSS) that will optimize patient scheduling and case management. The HRDSS will manage key performance indicators like average wait time and physician availability. It will interface with EMR systems and use algorithms and an alert system to validate schedules and tune the system. Primary stakeholders include hospitals, doctors' offices, and clinical and administrative users. The system design will include data elements on patients, medical staff, and departments to optimize patient flow and minimize wait times using techniques like Monte Carlo simulation and queuing theory. Reports will provide relevant data and metrics to stakeholders.
Here are the steps to calculate sensitivity, specificity, positive predictive value, negative predictive value, and efficiency for the given diagnostic test:
* True Positives (TP) = Number of HIV+ samples correctly identified as positive by the test = 120 - 15 = 105
* True Negatives (TN) = Number of HIV- samples correctly identified as negative by the test = 300 - (120 + 4) = 176
* False Positives (FP) = Number of HIV- samples incorrectly identified as positive by the test = 4
* False Negatives (FN) = Number of HIV+ samples incorrectly identified as negative by the test = 15
Sensitivity = TP / (TP + FN) = 105 / (105
Total Quality Management (TQM) by Dr Anurag YadavDr Anurag Yadav
Total quality management principles aim to improve patient care through monitoring laboratory work to detect deficiencies and correct them. Errors can occur in preanalytical, analytical, and postanalytical phases, and quality control procedures help control variables and ensure accuracy. Calibration, precision, accuracy, linearity, and detection limits are important analytical concepts, and factors like equipment, reagents, personnel, and documentation must be controlled and monitored to minimize errors and ensure quality.
External quality assurance in clinical trace element labs Chris Harrington
Information on how EQA works in clinical trace element laboratories from the perspective of an ISO 17043 accredited EQA provider: UKNEQAS for Trace Elements, Guildford, UK.
This presentation describes the key performance indicators to assess the quality of work in microbiology department. The KPIs in common use are mentioned and other indicators are summarized.
This document provides an overview of quality control in clinical biochemistry laboratories. It discusses that quality control aims to ensure test results are correct by minimizing errors. Errors can occur in the pre-analytical, analytical, and post-analytical phases. The pre-analytical phase, involving sample collection and handling, accounts for most errors. Laboratories use internal quality control methods like calibration, controls, and Levey-Jennings charts daily, as well as external quality assurance programs, to monitor performance and identify errors. Maintaining quality control is important for generating accurate, reliable test results.
Preanalytical quality control practices in clinical laboratoryDr. Rajesh Bendre
Preanalytical variables contribute maximally to lab errors. However, these variables are most difficult to control as they include human dependency for phlebotomy skills & pretest patient conditioning. Quantifying & monitoring these variables is also more challenging. Use of checklists, continuous training, competency assessments, internal audits & clinician education for appropriate test utilization form some of the tools for improving the preanalytical processes.
Quality in clinical laboratory is a continuous journey of improving processes through team work, innovative solutions, regulatory compliance with final objective to meet the evolving needs of clinicians & patients.
Using reference materials to meet validation & verification requirements for ...Candy Smellie
Using reference materials can help clinical laboratories meet validation and verification requirements for molecular diagnostic tests. Credit Valley Hospital uses Horizon Diagnostics' pooled DNA reference standards at a 2.5% mutant allele frequency as a low positive control in their EGFR diagnostic assays. Including this control helps eliminate false positive results and provides a qualitative reference to confidently identify true low level positives. This reduces the risks of false negative or false positive reports, improving patient outcomes by ensuring accurate molecular testing results.
Basics of laboratory internal quality control, Ola Elgaddar, 2012Ola Elgaddar
Total Quality Management (TQM) is a continuous approach to improve quality and performance. It requires integrating quality functions throughout an organization with involvement from management, employees, suppliers, and customers. For medical laboratories, quality control has three main stages - pre-analytical, analytical, and post-analytical. Analytical quality control involves internal quality control (IQC) using control materials and external quality assessment (EQA) to monitor quality and compare results between laboratories. IQC follows procedures like plotting daily control results on Levey-Jennings charts and evaluating them using Westgard rules to detect errors.
The issue of laboratory quality has evolved over more than 4 decades since the 1st recommendation for quality control were published in 1965
Now, quality control is seen as only one part of a total laboratory control program
Quality also includes:
a) Total Quality Management (TQM)→ an activity to improve pt. care by having the lab monitor, its work to detect deficiencies & subsequently correct them
This document provides an overview of quality management tools and resources for laboratory quality management systems. It discusses the Clinical and Laboratory Standards Institute's (CLSI) Laboratory Quality Management System (LQMS) Certificate Program, which is an online training course covering the 12 quality system essentials. The program aims to impart the knowledge and skills needed to implement and sustain a quality management system in a clinical laboratory. The document also summarizes common quality management tools like check sheets, control charts, Pareto charts, scatter plots, and Ishikawa diagrams; and provides examples of their use in quality control. Additional online resources on quality management topics are listed.
Data Analysis Of An Analytical Method Transfer ToDwayne Neal
To provide the basis for a PDA task force discussion to arrive at a consensus of best industry practices for data analysis of method transfers. The discussion is also relevant to method validation activities.
The document discusses quality management basics for histology laboratories. It defines key terms like quality control, quality assurance, and quality management systems. It outlines the components of an effective quality management system, including identifying errors, assessing processes, and using tools like root cause analysis. The document provides examples of how laboratories can implement quality improvement initiatives using a team-based approach.
This document discusses quality control and quality assurance in microbiological laboratory investigations. It emphasizes the importance of standard operating procedures, internal quality assessment, and external quality assessment. Quality control occurs at multiple stages of analysis, including pre-analytical (specimen collection and transport), analytical (reagents, equipment, procedures), and post-analytical (reporting and interpretation of results). A quality control officer oversees quality control in the department through regular monitoring, assessment, communication, and analysis of quality control data.
Quality control in clinical biochemistryAshok Katta
This document discusses quality control in clinical biochemistry laboratories. It explains that laboratory tests play an important role in clinical diagnosis and treatment decisions. Therefore, test results must be reliable and accurate. Quality control involves measures to ensure test accuracy, including internal quality control procedures done daily in the lab and external quality assessment involving evaluation by an outside agency. Proper quality control is essential to producing test results that healthcare providers can trust in making decisions for patients.
This document discusses quality assurance in haematology. It defines quality and introduces the concepts of quality control and quality assurance. Quality control aims to minimize errors through statistical sampling and verification of consistent performance. Quality assurance ensures reliable test results through adherence to standards within and outside the laboratory. This includes internal quality control, external quality assessment, and standardization using reference materials and methods. Several examples are provided of potential pre-analytical errors in sample collection, transport, and handling that can affect test results. Adherence to proper procedures is emphasized to avoid issues like hemolysis, clotting, and dilution.
This document provides an overview of laboratory quality management and outlines the essential components of a quality management system for laboratories. It discusses that quality management is a continuous journey, not a destination. It then describes the key quality system essentials which include organization, facilities and safety, personnel, equipment, and processes for management, work, and measurement. The relationship between technical and managerial activities is important for ensuring high quality and effective laboratory operations.
This document outlines recommendations for maximizing reimbursement through a colorectal bundle at Advocate Lutheran General Hospital. It discusses establishing a perioperative surgical home to standardize evidence-based practices across pre-op, intra-op, and post-op phases of care. This includes assembling a multidisciplinary team, collecting baseline data, developing clinical pathways, and implementing protocols like ERAS to reduce costs and improve outcomes for colorectal surgeries.
The document summarizes a project to develop a healthcare decision support system (HRDSS) that will optimize patient scheduling and case management. The HRDSS will manage key performance indicators like average wait time and physician availability. It will interface with EMR systems and use algorithms and an alert system to validate schedules and tune the system. Primary stakeholders include hospitals, doctors' offices, and clinical and administrative users. The system design will include data elements on patients, medical staff, and departments to optimize patient flow and minimize wait times using techniques like Monte Carlo simulation and queuing theory. Reports will provide relevant data and metrics to stakeholders.
Performance Improvement Project in OPD.pptxNANCY ALSEBAIY
This document summarizes a performance improvement project conducted by a team at a pediatric cardiovascular hospital outpatient department. The team aimed to decrease the outpatient department cycle time for patients with initial assessments by 30% between March and June 2022. Through analyzing value-added and non-value added activities, they identified causes of long wait times including reception processes, transportation of lab samples, and inventory issues. The team implemented solutions like an online appointment system, redesigning forms, and opening an in-patient lab to reduce non-value added time by half, meeting their goal.
Big data analytics to step change in pathology servicesRichard Littlewood
The authors analyzed data from over 1.2 million pathology tests conducted by an NHS healthcare trust over 2 years to identify opportunities to optimize performance. They found that while the laboratories had sufficient installed testing capacity, observed performance was below potential levels. Process mapping revealed blocks in sample registration and validation that limited throughput. Recommendations included controlling demand, scheduling routine inpatient tests, and using overnight hours for primary care work to better utilize capacity across laboratories and reduce turnaround times.
This document discusses perspectives on multiple choice question (MCQ) assessment. It provides general thoughts on how MCQs can be used formatively or summatively. It then describes processes for designing, establishing validity and reliability, and providing feedback for MCQs. Specific examples are given from the NCLEX-RN test plan to illustrate steps in writing MCQs, including selecting areas of focus, writing stems and keys/distractors. Case scenarios are also used to demonstrate how to write MCQs assessing different nursing concepts.
Much is being discussed about evidence based Ayurveda or Ayurveda doesn't has quality standards, neither has protocols or SOPs for drugs, treatment, hospitals and its procedural specialties like Panchkarma and Ksharsutra.
Now Department of ayush engaged quality council of India and NABH for voluntary certification of quality for- ASU products on the basis of third party evaluation. NABH- National accreditation board for health services laid down certain accreditation standards for Ayurveda Hospitals.
This document discusses optimizing bronchial hygiene therapy through 4 measures: 1) implementing a therapist-driven protocol program, 2) involving patients in selecting techniques, 3) establishing therapeutic and clinical objectives, and 4) using a combination and variety of techniques. It emphasizes that no single technique is best and therapists should work with patients to find the most suitable methods. The goal is to deliver individualized respiratory care through diagnostic evaluation and modifying therapy based on patients' immediate needs and symptoms.
Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, organised by the European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015
Keynote Presentation "Meaningful Use Stage 2 and Meaningful Use Audit Insight"
Think far beyond just threshold increases. The differences between Meaningful Use (MU) Stage 1 and Stage 2, including the 2014 Clinical Quality Measures, are technically and clinically challenging. And just when you thought you could safely look at Stage 1 in the rearview mirror, here come the audits! I will highlight the Stage 1 and Stage 2 differences and talk about the challenges they have initiated at Tenet. I will touch on the impact of Quality measures and will also provide you with insight into the basics of MU Audits and will take you through the actual audit experience at Tenet.
Learning Objectives:
∙ Review the program and measure changes from Stage 1 to Stage 2 and how the changes are being managed at Tenet
∙ Provide insight into the 2014 Clinical Quality Measures chosen by Tenet, the challenges posed, solutions that work and a little about the overall
impact of Quality measures
∙ Discuss Meaningful Use Audits, covering the basics as well as providing the benefit of the Tenet experience
The document discusses various management techniques that can be used to improve healthcare delivery and lower costs. These include PDCA (Plan-Do-Check-Act) cycle, Six Sigma, balanced scorecard, Lean methodology, business process reengineering, and benchmarking. Case studies are provided that demonstrate how these techniques were used to reduce prolonged hospital stays, delays in lab and ultrasound reports, and surgical infections.
This document outlines a business continuity plan for a laboratory. It includes the laboratory's vision and mission, which is to provide high quality services. The plan's purpose is to maintain operations if a critical incident occurs. Objectives are to minimize impacts, ensure continuity, and identify roles. A SWOT analysis identifies strengths like experienced staff and weaknesses like financial limitations. Risks like fires and equipment failures are assessed. Priorities are patient safety and quick recovery. Roles define the director's leadership and staff responsibilities to be aware of and participate in the plan. The plan will be activated in an emergency, tested annually, and reviewed yearly.
The document summarizes a study conducted by students at Boston University to analyze patient flow and improve efficiency at the Boston Medical Center (BMC) Infectious Disease clinic. The study observed 91 patients in the front of house areas and 38 patients in back of house clinic areas, tracking task times. It found variation in time patients spent with doctors. Recommendations included reducing this variation, shifting tasks to less specialized workers, shifting patient demand to less busy times, and continuing to collect clinic data. The overall goal was to improve volume, safety, satisfaction and reduce costs at the clinic.
The document discusses "core measures", which are evidence-based guidelines established by CMS and the Joint Commission for treating patients with certain diagnoses. The core measure patient groups include CHF, pneumonia, AMI, surgical care improvement, psychiatry, and patient satisfaction. Hospitals must follow specific treatment protocols for these patients and are audited to ensure compliance. Identifying core measure patients early and using established protocols and tools is key to improving outcomes and quality measures.
Presentation given to Pharmacy Technician students on career profiles: Aseptic Unit- Jennifer O\'Meara, Ward ased Technician (WBT) - Caroline McLoughlin, Clinical Trials - Sharon Curran-Rae & Purchasing - Yvonne Sheehan
Designing an effective IVF program requires a patient-centered approach, not just a focus on technology. The key factors to consider include:
1) The types of treatment offerings and how they impact costs and space requirements.
2) Dimensions of service quality like patient-centeredness, timeliness, safety, effectiveness and efficiency.
3) Design choices for layout, interiors, equipment and protocols that influence patient experience, embryo safety, and effectiveness of treatments.
4) Ensuring the infrastructure for airflow, electricity, and gas supports the clinical needs while maintaining quality, safety and cost-effectiveness.
1. Chemotherapeutic Agent Process Improvement ProjectVeteran’s Affairs Ann Arbor Hospital College of Engineering, University of Michigan Problem Solving Engineering Molly Beggs, Austin Kloske, Brittany Morales, Kyle Valentine, C. Paoro Yin-Blair 1
4. Project Background Team: Problem Solving Engineering (PSE) Client: Veteran’s Affairs (VA) Ann Arbor Healthcare System, Chemotherapy Outpatient Clinic Project Name: Chemotherapeutic Agent Process Improvement Project Three primary areas involved: the Chemotherapy Outpatient Clinic, the Pharmacy, and the Technician Lab 4
5. Project Definition Problem: chemotherapy patients experience long wait times, sometimes up to 8 hours Project goal: minimize patient wait time in chemotherapy outpatient clinic Patient wait time: duration of time from when patient arrives to outpatient clinic to time drug is administered PSE goal: reduce wait time to 30 minutes or less for 80% of patients 5
8. Summary of Activity Data Collection: Conducted expert interviews with 5 nurses, 4 pharmacists, and 3 technicians Collected historical data (arrival times and cancellation rates) Gathered relevant chemotherapeutic agent details (i.e. cost, shelf life) Conducted 65 hours of time studies of the process Benchmarked with the University of Michigan Hospital Data Analysis Determined current state Microsoft Excel and Minitab 15 Statistical Software to analyze data Utilized Lean Principles: Process Mapping to identify the current state of the process Cause and Effect Diagrams to identify problem areas for improvement Pareto Analysis to detect areas with the greatest opportunity for improvement Determined feasibility of recommendations and implementation methods 8
13. Benchmarking withUniversity of Michigan Cancer Center Met with Cancer Center Pharmacist at University of Michigan Hospital 30 Minute incremental scheduling blocks Chair Scheduling Light signaling system Standardized treatment forms Electronic Tracking System 13
15. Criteria for Recommendations Reduction of primary quality metric (Total Patient Wait Time) Benchmarking of similar processes Consider employee interest and input Transferability of recommendations to a new location Potential solutions will not add or subtract major resources (facilities, equipment, labor) and have little to no cost Recommendations were ultimately divided into three areas: Chemotherapy Outpatient Clinic, Pharmacy, and Technician Lab 15
16. A. Chemotherapy Outpatient Clinic Standardized Scheduling Procedure Chair Scheduling Importance of Scheduling Document Removal of Clinic’s side of Pass-Way Door 16
17. Recommendation A1: Standardized Scheduling Procedure Description: A standard procedure for RN’s to schedule patients Benefit: Allow RN’s to have an appropriate number of patients per block of time and thus giving patients adequate attention, reduces overall wait time for patients, and helps pharmacy prepare agents Support: Patients often arrive in batches which cause bottlenecks and increase wait time Implementation: Distribute the Standardized Scheduling Procedure work document to all RN’s, education of new procedure Cost: Time spent on education (~ 1 hour) 17
18. Recommendation A2:Chair Scheduling Description: Scheduling patients per chair in the clinic Support: Scatter plot of patient arrival time Benefit: Reduce wait time for chairs, proper allocation of patients per RN, allow for appropriate attention to patients Implementation: Education of procedure to RNs Cost: time spent on education and scheduling 18
19. Recommendation A3: Importance of Scheduling Document Description: A paper document for patients that explains why they need to arrive on time to appointments Support: Patients do not follow scheduling policies without strict enforcement Benefit: Aids the scheduling procedure, because for scheduling to be effective, patients must arrive on time Implementation: Point nurse will include this document in patients initial briefing session and go over it with each patient Cost: Time spent explaining to patients (~ 5 minutes) 19
20. Recommendation A4: Removal of 1 Side of Pass-Way Door Description: Complete removal of door on clinic’s side of pass-through Support: Large variance in delivery time from dumbwaiter to pass-way door and large variance in time from pass-way door to administration of agent Benefit: Reduce wait time for patients Implementation: Facility maintenance will remove the door Cost: Facility maintenance 20
21. B. Pharmacy Standardized Chemotherapy Order Forms Standardized Work Policy Prepare Chemotherapy in Advance Access to CPRS Templates Signal Lights 21
22. Recommendation B1: Standardized Chemotherapy Order Forms Description: Create and implement a set of standardized order forms Forms will be unique to each treatment Easier to fill out patient and dosage information Support: Per pharmacists’ request and UM Benchmarking Benefit: PSE can reasonably estimate an improvement of 5 minutes per order form Implementation: Pharmacists have begun work on new templates, once complete (2-3 weeks) begin use Cost: No cost 22
23. Recommendation B2: Standardized Work Policy Description: Patient files should be completed the evening before the patient is to be seen Currently happens a majority of the time; should be enforced Especially important for Monday’s files Support: The step for pharmacists to complete paperwork has a larger variation when the forms are not completed beforehand Benefits: Uncompleted files take average of 12 minutes to complete the paperwork At least 10 minutes can be removed from patient wait time Saves more time if doctor consent is missing Implementation: Create a policy that pharmacists must complete files the day before patients are expected (immediate implementation) Cost: No Cost 23
24. Recommendation B3: Prepare Chemotherapy in Advance Description: Prepare certain chemotherapeutic agents in advance Support: The total time in the Technician Lab can be removed from the patient’s wait time Benefits: Can decrease patient wait time by 20-30 minutes Implementation: Determine if any chemotherapeutic agents should be made ahead and treat them as preorders (can be implemented as soon as agents are chosen) Cost: Expected costs of common chemotherapeutic agents Assumed 15% cancellation rate Estimated average cost per dose of each chemotherapeutic agent 24
25. Recommendation B4: Access to CPRS Templates Description: Pharmacists/Computer Technicians need access to the CPRS templates Some prescription templates are unclear Only doctors have access to change templates Support: Many instances of confusion between doctors and pharmacists cost up to 30 minutes Benefits: Can save about a half hour of clarification time Implementation: Grant access to CPRS templates (immediate implementation) Cost: None 25
26. Recommendation B5: Signal Lights Description: Place a signal light in the Outpatient Pharmacy with two light switches Support: If phones are busy the Outpatient Pharmacy is not called Benefits: Can reduce an average of 5 minutes for the chemotherapeutic agent to reach the Outpatient Clinic Implementation: Install a light in the outpatient pharmacy and indicator light switches next to the dumbwaiter on both floors Cost: $19.70 for two switches 26
27. C. Technician Lab Tubing and Draining IV Bags in Advance Signal Lights Posted Policies Standard Work Instructions Folder Racks White Board 27
28. Recommendation C1: Tubing & Draining IV Bags in Advance Description: Attach tubing and remove extra solution so IV bag is ready for CA at time of patient arrival Support: Median processing time of 6 minutes Benefit: Shorter lead time, free IV technician Implementation: Write standard work instruction, pharmacists share folders with technicians prior to patient arrival (Next 2-4 weeks) Cost: (0.15)*($4.90)*($0.62) = $0.50 / CA = (Cancelation Rate)*(Tubing Cost)*(Bag Cost) 28 Drain appropriate amount of fluid. Mark bag and hang in queue. Attach tubing to IV bag Select correct tubing and close drip chamber
29. Recommendation C2:Signal Lights Description: Replace pharmacy intercom system with ‘Drug Ready’ signal lights Support: CA’s commonly wait up to 15 minutes to be checked Benefit: Reduce chances for Pharmacists to forget announcement or not hear announcement Implementation: Install two new light fixtures above pharmacy desk, install two new light switches in Technician Lab Cost: $28.11 + electrician time 29
30. Recommendation C3: Posted Policies Description: Summarize and post all work policies relating to technician lab Support: Certain policies are currently passed between techs as hearsay (i.e. CA’s that must be produced in chemo hood) Benefit: Less time loss over discussion, Eliminate time loss due to CA’s taking space in chemo queue Implementation: Organize, Outline, Write, Post (Next 2-6 weeks) Cost: Lead Technician Time 30
31. Recommendation C4:Standard Work Instructions Description: Clear descriptions of common tasks (not to replace 797 logs) Support: Current lack of standardized training Benefit: Increase confidence between technicians Implementation: Photograph, write, print, post, review, update, repeat (Next 1-6 weeks) Cost: Lead Technician Time 31
32. Recommendation C5:Wall-Mounted Folder Rack Description: Rack to hold chemo folders in queue Support: Congestion related to larger queues Benefit: More counter space, reduce mixing queue order Implementation: Order, Hang (Next 2 weeks) Cost: $28.68 32 Pre-makes Preps
33. Recommendation C6:White Board Description: Wall mounted whiteboard in main IV room (36”x24”) Support: Techs often do not transition between shifts Benefit: Less information would be lost across shifts Implementation: Order and hang white board (Next 2 weeks) Cost: $43.59 33
35. Future State of Process 35 Prior to Patient Arrival Post Patient Arrival
36. Future StateExpected Patient Wait Time Reduction 36 Expected distribution Recommendations will reduce expected maximum wait time from 89 minutes to 30 minutes for 80% of patients. Current distribution
39. Implement an electronic tracking system similar to the system used by UMHS in the near future
40. All departments would be kept up to date on patient and medication information relative to their appointment times
41.
Editor's Notes
The University of Michigan healthcare system (UMHS) was selected for the purposes of this project because it is widely accepted as one of the best-in-class healthcare systems in the country. US News and World Report has named UMHS to the "Honor Roll of America's Best Hospitals” for 14 straight years.This meeting re-enforced many of the recommendations we planned to make to the VA Hospital
Molly: Make sure you refer to slide 11 for scatterplot graph
Molly: Five minutes is NOT part of patient wait time, but time point nurse must spend
Molly:Through observations, nurses do not hear when agent was passed throughHelp RN’s prioritize tasks in the most effective manner
PSE feels it is vital the VA hospital’s continued success to adopt an electronic tracking system similar to the system used by UMHS. Continual improvement methods such as lean and six sigma are no longer monopolized by the manufacturing industry. If fact Toyotas approach to reducing any waste in the process is widely being used in Healthcare systems across the Country.An Electronic Tracking system would keep all departments in the loop and up to date on any patient, medication or schedule changes. It would also serve as a to gauge the Hospitals improvements and find locate opportunities for improvement.NO WAY TO TRACK OUR IMPROVEMENTS WITHOUT TRACKING
Austin: We hope this project will serve the maiden voyage for future relationships between the VA and UM IOE