Chris Gutmann, Director of Clinical Engineering The use of organized team efforts to facilitate change in culture backed by data. Using RTLS, Business.

Chris Gutmann, Director of Clinical Engineering

The use of organized team efforts to facilitate change in culture backed by data.

Using RTLS, Business Intelligence and Integrations to Improve Pump Management

In conjunction with Darcy Hennessey and Brooke Spadaccino (not presenting at HIMSS)

2

Project Goals

How will we achieve this?• Staff will readily release pumps when not in use• Pumps will be available when they call/request• Patients will arrive on units from procedure areas/OR’s /ED with

pumps in place, ( receiving unit staff will give back a pump)• Each area will have the appropriate “safety stock” for unexpected

situations • Identify the “safety stock" needed at entry points in the care

continuum

Multi Disciplinary Team:• Materials Management• Pharmacy• Information Services

• Nursing• Clinical Engineering• Operations Support

Ensure EVERY patient will have a pump when needed

3

Yale – New Haven Health System

k

Yale-New Haven Hospital

Bridgeport Hospital

Greenwich Hospital

NEMGYNHHS (Total)

Total Licensed Beds* 1,541 383 206 -- 2,130

Average Daily Census 1,173.4 267.0 142.4 -- --

Inpatient Discharges 80,503 18,454 12,439 -- 11,396

Outpatient Encounters 1,085,738 242,784 296,673 -- 1,625,195

Total Assets $2.8 billion $443 million $566 million $26 million $3.8 billion

Total Revenue** $2.4 billion $445 million $343 million $164 million $3.3 billion

Medical Staff*** 4,138 825 545 552 6,060Employees**** 11,436 2,512 1,754 1,091 18529*

2013 Yale New Haven Health System Profile

4

Y-NHH: A Tradition of Excellence

Nursing continually looks to for opportunities of systems redesign which solidify our team approach.

5

The history of Yale-New Haven Hospital extends back to 1826 when the General Hospital Society of Connecticut was chartered as the first hospital in Connecticut and the fourth voluntary hospital in the nation. The hospital rented temporary quarters and raised US$5,000 toward purchase of land and construction. A new 13-bed hospital opened in 1833 on seven and a half acres of land bordered by Cedar Street and Howard, Davenport and Congress avenues.

Yale – New Haven Hospital

2013:• 5 Million Square Feet owned and operated by YNHH

• 4 main pavilions = 2,000,000 ft2

— 60 Operating Rooms, 25+ procedure rooms— 1,120 Patient Beds— Level 1 Trauma in Pediatrics and Adult Emergency Medicine

• Park St. - Lab and Pharmacy = 130K ft2

• Physicians Building and Psych. Hospital = 100K ft2

• Yale School of Medicine adjacent/attached to hospital• Former Hospital of St. Raphael’s = 1,000,000 ft2

6

SOS Alert

Please call the SRC for pick-up

now.

688-9000

Continual crisis episodes sent routine alertsto the entire organization calling for pumps!

Continual issues add to the alarm fatigue…

Ensure EVERY patient will have a pump when needed. How will we achieve this?

• Staff will readily release pumps when not in use

• Pumps will be available when they call/request

• Patients will arrive on units from procedure areas/OR’s /ED with pumps in place, ( receiving unit staff will give back a pump)

• Each area will have the appropriate “safety stock” for unexpected situations

• Identify the “safety stock" needed at entry points in the care continuum

7

Participant/Process Representatives

Project Sponsor:• Sue Fitzsimons – Chief

Nursing Officer

Process Owner:• Carol Just - Director, Surgical

Services• Chris Gutmann – Director,

Clinical Engineering

Multi Disciplinary Team Members:• Clinical Engineering• Information Services• Materials Management• Nursing• Operations Support• Pharmacy

Project Goals

Project Description / Problem Statement

Cycle of distrust: Only broken when everyone cooperates

• System to Locate Pumps does not identify “pump in use”

• Inability to get a pump when needed induces lack of trust in process and hiding of pumps

• Hiding pumps lead to a shortage of pumps

Project Charter: Sigma Pump

Project Y / Key Metrics

• Sigma pump monthly call volume

• Sigma pump call volume by unit per month

• Average monthly Materials sigma pump job completion time

SIPOC / High Level Process Map for Unit

Customer CTQ’s

Process Scope: Start/end

Sigma pump equipment management including:

• Procurement

• Movement throughout the hospital

• Preventative maintenance

• Allocation for each clinical area

Process Scope: In/Out

In Scope:• York Street Campus, Saint Raphael

Campus

Out of Scope:• Bridgeport and Greenwich hospitals

Sigma pump needed but none

available

Call Service Response Center and/ or Off Shift Executive and/or Off Shift Nursing Leader to deliver pumps and/or go floor by floor in the

hospital to collect unused pumpsPump(s) received

Pump available when neededPlace pump(s) on patientRemove the pump(s) from

patient departing the unitStore the pumps in a safe

location in case they are need for the next patient

8

Defining the Available SupplyAvera

ge M

idnight Censu

s

900

850

800

750

700

_X=878.3

UCL=904.5

LCL=852.0

2008-09 2010 2011 2012 20131

1

YNHH Average Monthly Census (by Calendar Year)

1400 pumps purchased in 2009 no additions to date!

9

Sigma Pump Process Map

10

1375 (total)

- 452 (non-circulating)

= 923 Available

Vicious Cycle of Distrust:

• Total in fleet – 1375

• Entry Points buffer - 359– IR, HVC Labs, OR, PACU, – L&D & EDs– Oncology infusions

• Remote Locations - 31– Ambulatory, Psych – Dialysis, Pedi Clinic, Urgent care

• Maintenance Process - 17

• Pumps in Waiting - 45– Material’s pool for distribution

No equipmen

t churn

Patient criticality

not driving need

Equipment not

available

An episode of

delay

Staff Hoard

equipment

1500Crisis Calls per Month

Snapshot of audit on 1/26/2012

(5am contact census 923)

Do We Have Enough Pumps?

All Stakeholders need to buy-in to the process…

11

Defining the Demand

Data Collection through the call center for materials and Baxter pump data on infusions started at entry points over the course of a day.

12

Streamlining the Movement Process

13

Process for units:• Rounding 3x daily• Safety stock set as a profile

for each unit• 5S storage areas to define

storage location of “safety stock”

• Unused clean equipment placed in green bins

• Units looks in green bin or safety stock before calling materials for delivery

Process for EVS staff:• Clean equipment is placed

in green bin for pick up• (no clean pumps to be left

in rooms)

Process for SOS alert:• Unit leadership or

assigned staff person to round as soon as alert issued and check with all staff for unused sigma pumps

• Place unused sigma pumps in green bin and call SRC 688-9000 for pickup

Process for materials staff:• Check with charge RN that

safety stock (red tape with par number) is filled before removing sigma pumps from units

• Collect equipment from green bin

Streamlining the Movement Process

14

Driving Results through Culture Change

14

• In face of rising census the need to call the Service Response Center for pumps has decreased.

• A plateau in reducing the number of calls for sigma pumps and are look to reinforce rounding and pilot technology to continue the downward trend.

15

State Monitoring -> Utilization

Undergoing service at clinical engineering

In transit for use

In use at patient bedside

At Material’s storage location in WP

basement ready for shipment to unit

Not in use, in green bin or safety stock. Ready

for usage by next patient

Not in use, at patient bedside

16

Data Validation Pilot

Score Card:Unit Greens Reds

EP 7-7 12 12SP 6-1 23 4SP 6-4 16 2

Running Not Running Available DeliveredGreen > 2.4 hrs >12 hrsYellow >18 hrs >8hrs <18hrs

Red > 21.6 hrs >18 hrs

• Running: time between the “start infusion” button is pressed and the pump completes drug delivery or is stopped

• Not Running: amount of time the pump is not infusing

• Available: amount of time the pump is physically in green bin or safety stock

• Delivered: amount of time the pump travels from materials storage to a unit before used for an infusion

Asset ID Running Not Running Available Delivered

H50203G EP 7-7 99% 1.50% 0% 0%

H51356G EP 7-7 0% 100% 0% 0%

H53176G EP 7-7 0% 0% 0% 100%

H50273G EP 7-7 0% 100% 0% 0%

H50360G EP 7-7 57.97% 42.03% 0% 0%

H51378G EP 7-7 3.90% 96.10% 0% 0%

H51475G EP 7-7 45.77% 54.23% 0% 0%

H51035G EP 7-7 84.35% 15.65% 0% 0%

H50899G EP 7-7 63.68% 36.32% 0% 0%

H50202G EP 7-7 9.69% 90.31% 0% 0%

H50183G EP 7-7 100% 0% 0% 0%

H51179G EP 7-7 78.82% 21.18% 0% 0%

H50549G EP 7-7 0% 100% 0% 0%

H50537G EP 7-7 40.10% 59.90% 0% 0%

H50393G EP 7-7 0% 100% 0% 0%

H50551G EP 7-7 40.38% 59.62% 0% 0%

H51390G EP 7-7 41.17% 58.83% 0% 0%

H50821G EP 7-7 0% 0% 0% 100%

H50548G EP 7-7 0% 100% 0% 0%

H50703G EP 7-7 0% 100% 0% 0%

H50469G EP 7-7 0% 100% 0% 0%

H50904G EP 7-7 18.34% 81.66% 0% 0%

H50862G EP 7-7 0% 100% 0% 0%

H50534G EP 7-7 72.83% 27.17% 0% 0%

Asset ID Running Not Running Available Delivered

H50203G EP 7-7 99% 1.50% 0% 0%

H51356G EP 7-7 0% 100% 0% 0%

H53176G EP 7-7 0% 0% 0% 100%

H50273G EP 7-7 0% 100% 0% 0%

H50360G EP 7-7 57.97% 42.03% 0% 0%

H51378G EP 7-7 3.90% 96.10% 0% 0%

H51475G EP 7-7 45.77% 54.23% 0% 0%

H51035G EP 7-7 84.35% 15.65% 0% 0%

H50899G EP 7-7 63.68% 36.32% 0% 0%

H50202G EP 7-7 9.69% 90.31% 0% 0%

H50183G EP 7-7 100% 0% 0% 0%

H51179G EP 7-7 78.82% 21.18% 0% 0%

H50549G EP 7-7 0% 100% 0% 0%

H50537G EP 7-7 40.10% 59.90% 0% 0%

H50393G EP 7-7 0% 100% 0% 0%

H50551G EP 7-7 40.38% 59.62% 0% 0%

H51390G EP 7-7 41.17% 58.83% 0% 0%

H50821G EP 7-7 0% 0% 0% 100%

H50548G EP 7-7 0% 100% 0% 0%

H50703G EP 7-7 0% 100% 0% 0%

H50469G EP 7-7 0% 100% 0% 0%

H50904G EP 7-7 18.34% 81.66% 0% 0%

H50862G EP 7-7 0% 100% 0% 0%

H50534G EP 7-7 72.83% 27.17% 0% 0%Pilot participants: SP 6-1, SP 6-4 and EP 7-7

17

Dashboard Concept – Info @ Front Lines

Management Report

Pilot Studies on clinical units for profile setting of departments.

Actionable Data

Managers can view multiple floors to see a snapshot of the past 24 hours.

18

Demand is a function of Patient Acuity

SICU

ORTHO

Step Down

Not all units created equal…

Worked with units individually to understand flow and patient acuity mix to set the proper PAR levels.

19

Improved Utilization

SICU 69.6%

ORTHO 68%

Step Down 71.5%

Trust of the front line patient care groups feed a process which allows for less “stagnant” assets

SICU 50.6%

ORTHO 41.2%

Step Down 47.2%

Chris Gutmann, Director of Clinical Engineering

Questions?

In conjunction with Darcy Hennessey and Brooke Spadaccino (not presenting at HIMSS)