Vidant Duplin Hospital: Testing Emergency Department improvements with Simulation

Hosted by:
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Testing Emergency Department
Improvements with Simulation –
A Quality Improvement Perspective
Presented by: Amanda D. Peterson & Raul Medina
Lean/Process Improvement Coordinators
Vidant Duplin Hospital, Kenansville, North Carolina

Background: Vidant Duplin Hospital
Vidant Health
System details:
• Eastern North Carolina
• One large academic medical center
• Seven community hospitals
Vidant Duplin Hospital
Hospital details:
• Rural, large agriculture focus
• Population, est. 58,505
• Licensed for 81 beds

Hosted by:
Implementing a Pharmacy Technician
into the Emergency Department for
Collecting Medication Histories
Prepared by: Amanda D. Peterson, MS, RDN, LDN
Lean Coordinator

Current Problem / Key Question to Answer
What was the motivation for the project?
• Currently, Emergency Department nurses obtain patient's medication
history
• Local observations suggest variation in medication reconciliation
processes
• Research suggests that >40% medication errors are due to
inaccurate medication histories
What were you trying to learn?
• Investigating the feasibility of integrating a pharmacy technician into
the Emergency Department to aid in collecting accurate information
via scripted patient interviews.

Process Details
Department: Emergency
Process Description: Scripted patient interviews for collecting
medication history
Major Steps:
1. Pull medication data from reconciliation software
2. Conduct patient interview to obtain medication history
3. Contact pharmacy to verify high-risk/high-alert medications
4. Verify information with patient
5. Mark medication history complete

Simulation Model
Based on research showing 40% of
medication histories collected have
errors.
x

Results / Key Findings
Pharmacy technician
• Peak ED hours: 3:00-11:00pm
• Working hours: 2:30pm to 11:00pm, Monday-Sunday
• Collects approx. 14 medication histories/day
– 10 admission consults/day
– 4 without orders to consult
• Collects approx. 14 medication histories/day
• Scripted patient interviews  more comprehensive, require more
time with the patient for accuracy
• Nurse collects medication if Pharmacy Technician is busy

Next Steps
How are you going to share the results with others?
• Hospital Executives and senior leadership
• Emergency Department and Pharmacy staff
• Share with other rural hospitals and across health system
• Support a project justification for grant-funding
How are you going to roll out the change? Does simulation
help with buy-in?
• New process and lack baseline data
• Pair simulation with current research to demonstrate the
magnitude of the problem

Next Steps
How will you use simulation going forward?
• Understand current resource utilization
• How patient interact with our health system
• Identify future needs
• Coordinate efforts
• Research

Lessons Learned
What did you like about simulation?
• The simulation approach mirrors research processes
(i.e. an iterative process)
• Offers flexibility to align with community context
• Models can be as simple or complex
What surprised you about using simulation?
• Relatively simple to build the model

Lessons Learned
How easy was it to use?
• Simul8 was relatively easy to use.
• Ability to access resources
• Regular check-ins with the instructor helped
• Helps to work with a colleague
How long did it take?
• Model development = 60 minutes
• Building the model in Simul8 = 20-30 minutes.
• Data input, investigating errors, etc. = 60-120 minutes

Hosted by:
ED Growth and LWOTS
Prepared by: Raul Medina MLS (ASCP)cm, CSSBB
Lean Coordinator

Current Problem / Key Question to Answer
What was the motivation for the project?
• Vidant Duplin Hospital is steadily growing
and ED utilization is increasing.
What were you trying to learn?
• How much growth can we have while still
maintaining a less than 2% LWOT rate?

Process Details
Department: ED
Process Description: ED Throughput
Major Steps:
1. Pre-registration
2. Triage
3. Treatment
4. Final registration
5. Departure

Simulation Model
Median time from arrival to
departure for acuities 1-5

Results / Key Findings
What were the results of the project? / What was
the “answer” or conclusion that you came to?
• Current LWOT rate: 1.7%
• We can increase by 10% (i.e. 86 patients per day)
without exceeding 2% LWOT rate.
• Should we increase by 10% we must decide if the
current process needs to be changed (i.e. provider
in triage) or increase the number of beds in the ED.

Next Steps
How are you going to share the results with others?
• Hospital Executives and senior leadership
• Emergency Department
• Share with other rural hospitals and across health system
How are you going to roll out the change? Does simulation
help with buy-in?
• There is no change currently,
• Should we increase by 10% simulation would be useful to
help us identify next steps (i.e. what needs to change)

Lessons Learned
What did you like about simulation?
• Learning how simulation works
• Hands-on experience
What surprised you about using simulation?
• Simulation models are not difficult to set-up, however, with the
individual attributes (e.g. queues, activities, resources), there
was a steep learning curve.

Lessons Learned
How easy was it to use?
• Fairly easy to set-up the model itself
• Difficult to know all the attributes
• Error checking
How long did it take?
• Watching the tutorials/help guides: 3-4 hours
• Building Simul8 model: approximately 4 hours
• Error checking: 1-2 hours

Vidant Duplin Hospital: Testing Emergency Department improvements with Simulation

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Vidant Duplin Hospital: Testing Emergency Department improvements with Simulation