Clinical Safety & Effectiveness Session # 14

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Clinical Safety & EffectivenessSession # 14

CT Mays Delay Project

DATE

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Background• Mays CT began with 175 patients per day.• The clinic operates from 6:30am to 11:00pm.Monday

through Friday. • Due to institutional objectives to increase patient volumes

we have increased the schedule to 210 patients per day. (Thankfully not all of them show up)

• The existing scheduling template does not allow for any hic-ups in the schedule without backing up patient care. This is a daily challenge.

Background

• Several previous attempts at reducing the patient delays have identified barriers but most of which could not be achieved. – Adding staffing– Adding more interview rooms– Reduce the interview time per patient– Reducing the number of patients

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Our Aim Statement

“To improve operational effectiveness and efficiency in the CT Mays Section by reducing average delay time (patient procedure start time –appointment time) from ~48 minutes to 20 minutes by June 30,2011.”

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Baseline DataBaseline

Extensive baseline data was extracted from the Radiology Information System (RIS) by the division’s information analyst to determine baseline: •Average patient delays •Average appointments per day•CT Mays scheduling template•Room utilization

Data collection timeline– Baseline data June-Dec 2010– Midway evaluation Jan-March 2011– Final data extraction-April-June 24th 2011

Fishbone

Project Plan• Standardization of processes for all staff in CT– Operational definitions

• Improve teamwork– Team Huddles for each shift to discuss workload, previous shift

concerns and impact on operations as well as staff expectations– Work with OPI to leverage small wins and further team

development and employee empowerment

• Improve functionality of Online protocols– Flow chart and fishbone diagram were shared with the EMR

development team to tackle numerous bottlenecks

Project Plan Cont’d• Getting the patient ready for the interview process sooner

– Utilize all nursing staff, regardless of assignment to interview the first patients. – Utilizing all available rooms to interview first patients including prep rooms if

open– Streamline PR1– Adjust staffing schedule to accommodate early patients

• Template reorganization– Adding time specifically for completing assessment tool– Loading no-oral contrast procedures from 6:10-8:40 appointments

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Original Scheduling Template

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7:00 A

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7:20 A

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7:40 A

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8:00 A

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8:20 A

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8:40 A

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9:00 A

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9:40 A

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10:40 A

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11:00 A

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11:40 A

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12:00 P

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12:20 P

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12:40 P

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1:20

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40 PM

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S1

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S5

Can be any patient typeAll slots are based on scan time appointments, prep is populated automatically

Day end on Friday

Can only be non-drinking patient

Some patients such as Lymphoma require a 40 minute block

Byy manager's discretion only

If a time is manually entered such as 2:10, it takes up both the 2:00 and 2:20 slots

Revised Scheduling TemplateACB CT Scheduling Template

7:00 A

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7:20 A

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7:40 A

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8:00 A

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8:40 A

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10:40 A

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11:00 A

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11:20 A

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11:40 A

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12:00 P

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12:20 P

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12:40 P

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1:00 P

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1:20 P

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1:40 P

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2:00 P

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2:20 P

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2:40 P

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3:20 P

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6:00 P

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7:00 P

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7:40 P

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8:00 P

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8:20 P

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8:40 P

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Schedule 1

Schedule 2

Schedule 3

Schedule 4

Schedule 5

Can be any patient type

All slots are based on scan time appointments, prep is populated automatically

Day end on Friday

Can only be non-drinking patient

Some patients such as Lymphoma require a 40 minute block

By Manager’s Discretion Only

If a time is manually entered such as 2:10, it takes up both the 2:00 and 2:20 slots

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6/22/20116/6/20115/18/20115/2/20114/14/20113/29/20113/11/20112/23/20112/7/20111/20/20111/3/2011

100

75

50

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ApptDate

Sam

ple

Mean

__X=47.3

__X=44.0

__X=43.6

__X=28.4

1/3/2011 4/1/2011 5/2/2011 6/1/2011

6/22/20116/6/20115/18/20115/2/20114/14/20113/29/20113/11/20112/23/20112/7/20111/20/20111/3/2011

150

100

50

ApptDate

Sam

ple

StD

ev

_S=51.3

_S=58.2

_S=51.7

_S=43.7

1/3/2011 4/1/2011 5/2/2011 6/1/2011

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Tests performed with unequal sample sizes

Xbar-S Chart of ACB CT Delay

ROI

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Qualified Benefits• ~19 minute improvement in getting patients’ scans started on

schedule.• Improved Morale / Staff Satisfaction• Improved work relations about everyone, especially between shifts• Improved Communication

$19,479Morning patients will be asked to come in earlier temporarily

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Actions Based on Results•Continue to evaluate the scheduling template

–to maximize the effective use of the resources available– and minimize patient delays.

•Continue to foster teambuilding with the assistance of OPI/ team development program.

–Continue team huddles to keep all team members appraised of operational issues and keep lines of communication open–Roll out all CS&E changes from Mays CT to the other CT areas in Main and the ROC.

•Continue to collaborate with Dr. McEnery and the EMR team– to eliminate the bottlenecks associated with the CT online protocol –to roll out an electronic version of the Patient Record 1 (PR1) assessment tool.

•Incorporate findings from the flow chart and fishbone into the Future CT Mays area redesign project

–to accommodate actual growth and workflow..

Ongoing / Future Plans

• Team Building-------------Ongoing• Simplified PR1s-----------August 2011• Data follow-up------------Quarterly through FY12• Template follow-up------Quarterly through FY12• Redesign of Mays CT-----In planning phase• Online PR1s-----------------2013

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Key Learning

• Variation should be considered when determining workload capabilities

• Employees WANT details and communication• Don’t underestimate team “storming”• Without standardized definitions, everyone had

their own version• Synergy in huddles

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Special Thanks • Team Members

– CS&E Participant –Jerry Montalvo (Team Lead) CT supervisor– CS&E Participant –Martha Riley CQI Coordinator– Team Member-Alice Benson-ANM– Team Member-Maria Mallari-RN– Team Member –Paulose Mathai-CT Coordinator– Team Member-Dan Morrissey-CT supervisor– Team Member-Ashley Raglin-PSC– Team Member-Leonora Sumodobila-ANM– Team Member-Elsy Thomas-RN– Team Member-Dea Tulio-ANM– Team Member-Cynthia Williams-PSC supervisor– Team Member-Wendy Benedict-Sr. Information Analyst– Facilitator-John Terrell-Sr. Industrial Engineer– Carlos

• Sponsor– Joseph Steele M.D., Associate Professor, Diagnostic Imaging, Deputy Division Head of

Operations

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Thank you!