Chris DeFlitch, MD, FACEP Penn State Hershey Medical Center Connected (CIS) Physician Champion Founder, Penn State Partners for Healthcare Engineering Director & Vice-Chair, Dept of Emergency Medicine Healthcare Engineering with Physician Directed Queuing (PDQ) (PDQ) TM TM Success Stories-Triage and Process with EDIS
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Chris DeFlitch, MD, FACEPPenn State Hershey Medical Center
Connected (CIS) Physician ChampionFounder, Penn State Partners for Healthcare Engineering
Director & Vice-Chair, Dept of Emergency Medicine
Healthcare Engineering with Physician Directed
Queuing (PDQ)(PDQ)TMTM
Success Stories-Triage and Process with EDIS
HEALTHCARE TODAYHEALTHCARE TODAY
BOARDERS No Beds for ED Patients HALLWAY Patients Ambulance DIVERSION Dissatisfied Providers Dissatisfied Patients Regulatory Issues
Define Capacity as Bed
Emergency Department (50,000)Emergency Department (50,000)
Traditional Targets 37 patient stations
(1350 visits/station) 44K sq ft 0 stations short <1% LWOTS 0 Hallway beds 0 Boarders Satisfied Providers Satisfied Patients Patients Safe Right Care, Right
Location
Reality Capacity for 28,500 20 open stations
(2589 visits/station) 24K sq ft 17 stations short >7% LWOT Hallway care 10+ Boarders Dissatisfied Providers Dissatisfied Patients Safety, Regulatory? Some Care, Any Location
When analyzed, it is clear that queuing systems are ubiquitous in healthcare.
“One mans WAIT is another mans WORK”
Value-Added Activity Value-Added Activity
Must be performed to meet customer needs
Adds form or feature to service
Enhances service quality
Customers willing to pay for this work
If you STOP the activity, would your customer complain? If yes, then it’s likely Value-Added.
George ML. Lean Six Sigma Pocket Toolbook. 2005
WASTE (non-value added)WASTE (non-value added) Handling beyond what
is minimally required to move work
Rework to fix errors Duplicative work Wait Idle time Delays Unnecessary motion Over processing (too
many steps to complete the job)
If you STOP activity, would any customer know the difference? If not, then it’s probably Non-Value-Added.
George ML. Lean Six Sigma Pocket Toolbook. 2005
Clinical Value AnalysisClinical Value Analysis
Clinical Value Streaming - TRIAGEClinical Value Streaming - TRIAGE
Clinical Value Streaming- CP TriageClinical Value Streaming- CP Triage
“Healthcare is the only industry I have ever heard of that actually has a name for a major category of waste. You have waiting rooms. Most organizations outside of healthcare would go bankrupt if they thought like this”.
“Healthcare is the only industry I have ever heard of that actually has a name for a major category of waste. You have waiting rooms. Most organizations outside of healthcare would go bankrupt if they thought like this”. Page 33 Lean-Six Sigma for Healthcare
Caldwell et al
“Infuse care into the queue (waiting) ….define capacity to CARE not a bed”“Infuse care into the queue (waiting) ….define capacity to CARE not a bed”
Penn State Healthcare Engineering TeamDeFlitch et al
Critical to Healthcare Engineer Critical to Healthcare Engineer
Burning Platform Defined CRITICAL Resource(s) &
interdependencies Boarders Ancillaries Information Providers Minimal Space
WITHOUT Adding Resources
Physician (or MLP) Determines Queue
passively Listens to RN traditional
“triage” Delegates Procedures Initiates work-up when no
beds
Triage Nurse(s) Arrives patient Manage Minor Emergency
Room Not Available, Walk In Room Not Available, Walk In
Visitors to Hospital
Private Complex Dx Queues
FullReg
Triage
PDQ
Room Not Available, Ambulance Room Not Available, Ambulance
Visitors to Hospital
Private Complex Dx Queues
FullReg
Triage
PDQ
Next Venues of Healthcare EngineeringNext Venues of Healthcare Engineering
Service Line Flow (Neurosurg) Peri-Op Processing (Operative Suites) Hospital Capacity Management Other Interdependent ED flows Informatics Project Management Quality Outcomes (MRSA, Diabetes) Process Simulation with OSGi
Future of HEALTHCARE ENGINEERINGFuture of HEALTHCARE ENGINEERING
Process simulation models Explicitly represent variability Predict interdependency Manage complex systems in a computer
Predict system performance under varying inputs (loads)
Compare alternative system designs Determine the effects of alternative