Presentation_1048
- 1. Together, our Promise is YOUR HEALTH. LRH is committed to continuous improvement and in October 2013 a project to improve Patient Readiness for surgical cases was initiated. Patient Readiness is important as it promotes the safety of the patient, decreases delays, and improves the overall experience of the patient through their continuum of care. Lakeland Regional Health is a full service medical center and health system. As an 851 bed, not for profit medical center, Lakeland Regional Health (LRH) is the fifth largest hospital in the state of Florida and also operates the busiest single-site Emergency Department in the state. LRH has an average surgical case volume of over 1400 cases per month. IMPROVING PATIENT READINESS: Increasing patient safety and operating room efficiency RESULTS & IMPLICATIONS KEYS TO SUCCESS Patient Readiness is defined by LRH as having all documents and physician orders required for an elective surgery to be received by twelve noon the business day prior to the surgery date. Documents include History and Physical, Consent, Electrocardiograms, Labs, Medical Clearance, Cardiac Clearance, etc.…. Initial baseline metric for patient readiness at project start was 41% in October 2013 and as a result of process and policy redesign we have currently achieved and sustained over 80% each month since October 2014. In order to obtain metrics needed for analysis, a tracking board was utilized by the Pre-Admit Testing department to mark the date and time of when patient readiness documents and physician orders were received. In addition, at twelve noon the day prior to surgery, any remaining charts that were missing documents were checked again to determine if the patient’s chart was to be marked complete or incomplete on the tracking board. The project team utilized the metrics to provide physicians and their offices a scorecard which showed them the percent of their cases that were complete and met the patient readiness goal and the details of when each document required for the patient to have surgery was received by the Pre Admission Testing Department. A process hard-stop was initiated if documents and orders were not received for elective cases by twelve noon the business day prior to scheduled surgery date. If the case was marked incomplete by the Pre-Admission testing department it was sent to surgery leadership to determine if the case should be rescheduled. Pre-Admission testing also sends out reminder notifications to offices and physicians at 48 hours and 24 hours prior to scheduled surgery date in order to remind physicians and offices to send in their documents and place their orders on time. Objectives DESIGN PARTICIPANTS SMART LEAN: Practicing Thoughtful Activity & Execution of Accountability PURPOSE SETTING METHOD • 80% of all elective cases will meet Patient Readiness Goal • Decrease unnecessary delays to scheduled surgeries due to missing paperwork and/or physician orders • Increase patient safety • Decrease time interval from patient arrival to operating room • Reduce same day surgery cancellation rate Initial baseline metric for patient readiness prior to project start was 41% in October 2013 and we have achieved and exceeded our 80% Patient Readiness goal each month since October 2014. This successful projects demonstrates that changes can be made across the health system to standardize patient readiness processes for all providers and increase patient safety through their continuum of care. A multidisciplinary project team consisted of members from across the health system and included industrial engineers, physician leadership, surgical services leadership, data analysts, information technology analysts, and clinical analysts who worked to together on a 18 month redesign of our patient readiness processes. Team members met weekly and mapped current state, completed a gap analysis, and developed a date collection plan and future state workflow. In addition, team members developed technology and system improvements such as an electronic tracking board and physician scorecards in order to support the new workflow processes and hold physicians accountable. Executive Leadership Support DYAD collaboration between surgical services leadership and physician leadership Technology and System Improvements Industrial Engineering Principles SMART LEAN Methodology Standard Work PAT Patient Readiness Tracking Process Flow (draft 9.8.14) End Start HUC receives items on fax server or through red envelope courier for patient chart and names files (Patient Name & Surgery Date) Is patient chart complete? All items have been received AND orders are present HUC creates and/or adds to already created patient chart with items that have been received and marks tracking board that items have been received HUC places patient chart in queue for RN to review RN reviews chart including orders and makes any changes to tracking board if necessary (including backdating) RN marks Chart Complete on tracking board and places chart in file or on cart Is patient scheduled for surgery the next day? RN reviews any Incomplete chart starting at 12 noon the day prior and reviews chart including orders and makes any changes to tracking board if necessary (including backdating). Is patient chart complete? All items have been received AND orders are present RN marks Chart Complete on tracking board and places chart on cart RN marks Chart Incomplete on tracking board and marks any missing item as incomplete on tracking board and places chart on cart Delay for review (patient folder placed in file or on cart) NOTES: · HUC will not review parameters of EKG · Nurse will call (and/or email, tbd..) doctor’s offices to remind them of missing items · Nurse is responsible for reviewing all patient readiness items for accuracy · Tracking Board automatically documents initials of who checked item for internal review Is patient scheduled for surgery < 48 hours? RN creates patient chart Y N Y N N Y N Y Notification reminder sent to physician and their office at 24 hours prior to scheduled surgery date with details on what items are missing Jack Thigpen, MD, CSO; Tim Regan, MD, CQO, CMIO; Margie Voyles, RN, MS, CNOR; Cheryle Smith, RN, MSN; Cateria Davis, RN, BSN; Mary Beth Perry, RN, MSN, CPAN; Cindy Fitzpatrick, RN; Diane Campbell, RN, MSN, CSSBB; Sheena Butts, IE, CSSBB; Deborah Newbern, CHAM,CRCE-I; Jane Carlson, CHAM,CRCE-I; Derek Cyr, CPHIMS; Debbie Walker, RT(R); Ever Glendenning, RN, BSN, CPAN; Renee Mountcastle, RN, BSAST, CNOR, IT Sheena M. Butts, CSSBB, Industrial Engineer 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Patient Readiness GOAL: 80%