Monday, May 21, 2012

Lean Six Sigma Applied to condition Care

Lenox Hill Radiology And Medical Imaging - Lean Six Sigma Applied to condition Care
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One of the key principles of Lean reasoning is to eliminate delays which consume up to 95% of the total cycle time. If you've ever been a inpatient in a hospital urgency room or bed, you know there are lots of delays. Over the years, condition care has made gigantic strides in reducing cycle time in assorted aspects of care. inpatient surgeries are one example: arrive in the morning and leave in the afternoon. No bed required. But there is still room for improvement.

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How is Lean Six Sigma Applied to condition Care

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Goal: Accelerate the Patient's taste of condition Care

Emergency Room

Lean reasoning focuses on a key metric called takt time. Takt means rhythm. For the sake of easy analysis, let's say that your Er handles:

• 120 patients/day
• That would equate to 5/hour
• Or one every 12 minutes

Unfortunately, patients don't arrive in a rhythmic fashion, they arrive in waves. The biggest wave is between 3pm and 9pm due to rush hour traffic accidents, parents picking up sick kids from daycare and so on. The smallest wave is regularly 3am to 9am. So let's say patients arrive 2-3/hour at off-peak times and 10/hour at peak times.

That's one every six minutes at peak times.

Staffing

Most Ers of this size, at peak demand, have:

1 Triage Nurse to value walk-in patients by level of acuity
Takt Time: 6 minutes/patient

1-2 Registrars to deal with guarnatee and hospital paperwork
Takt Time: 6-12 minutes/patient

2 M.D.s (one off-peak)
Takt Time: 12 minutes/patient (some less, some more based on acuity) One trauma inpatient can thoroughly consume one or both M.D.s.

1 Lab technician to obtain blood samples (60% of patients want lab work)
Takt Time: 10 minutes/patient

1 Nurse for every two patients (sometimes with 1:1 nursing for traumas)
Takt Time: 12 minutes/patient alternating

Lab work often takes 45-60 minutes start to finish. Many of these patients will also need some sort of curative imaging (X-Ray, Ct scan, etc.) Which also takes 45-60 minutes.

Transfer Time

Estimate that 25% of Er patients will be converted to inpatients. That means 30/day or 5/unit. Traumas go to Icu. Chest pain patients go to telemetry. The rest go to medical/surgical beds.

How long does it take to move an admitted inpatient to an inpatient bed? Shouldn't be any longer than 30 minutes althougth most hospitals run longer than this. Why? Trying to sync up the Er and floor nurse to give "report" on the patient's condition and diagnosis.

Solution: Fax or voice mail the narrative and transport the inpatient to the floor as soon as a bed is ready.

Hospital Beds

Most hospitals of this size have at least:

•1 Icu (6-12 beds)
•1 Telemetry unit for monitoring heart patients (12-20 beds)
•2 Medical/Surgical unit (15-30 beds)
Length of stay (e.g., takt time) in most of these units is 2-3 days.

Patients also arrive from the operating room (3-5 per day) and direct admissions from local physcian offices (3-5 a day).

On a peak day, any unit can admit 10 or 12 patients and removal 10-12. The sum of these two is called the "bed turn" rate (20-24).

Delayed Discharge

How long does it take to removal a inpatient once the order is written?
Takt time: 2-6 hours. (Delays for lab, radiology, oxygen, curative equipment, house or other transportation.) Target: 60 minutes.

Solutions:

1. Get physicians to removal "pending" improved results 24 hours in advance. This allows nurses to do the paperwork and "teaching" required to put in order the inpatient for ongoing recovery at home.
2. Prioritize removal lab/radiology work ahead of other inpatients and after Ed/Or.
3. Set up home condition requirements (e.g., oxygen, walker, etc.) in advance.
4. Get at least two phone numbers of house members who can pick up the inpatient while the time when they are most likely to be discharged (when the doctors do their rounds).

Dirty Beds How long does it take to clean a bed after a inpatient leaves?
Takt time: 20-30 minutes (delay in starting 15-90 minutes).

Solution: Eliminate the delay. Are you staffed for peak bed turnover times? Probably not.

Here's my point:
Take the pulse of your hospital or business. What's your rhythm? What's your takt time?

If are a hospital and you don't know the answers to these questions, you might reconsider our new inpatient Throughput / length of Stay Time Tracking principles only 7 plus S&H. The principles includes templates for:

• Ed Los
• Ed Whiteboard
• Floor Los
• Meal Delivery Tracking Times
• Bed Cleaning Times
• Registration Wait Times

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