This report from the Commonwealth Fund describes recent experiences of leading hospitals in implementing electronic health records.
The authors describe the application of operational planning and capacity management methods to improve patient care, improve revenue, and lower costs. Article
The authors conducted a retrospective cohort study to describe a model to provide real-time, updated forecasts of patients' intensive care unit length of stay using naturally generated provider orders. The study was based on more than 2,000 admissions to a pediatric intensive care unit. The model was designed to be integrated within a computerized decision support system to improve patient flow management.
Physicians at Denver Health provide a presentation on reducing readmissions using a lean approach. Denver Health has been applying lean methods to clinical and nonclinical improvement for more than seven years and is nationally recognized for performance in patient safety and outcomes among large teaching institutions.
In this graduate-level-directed project, the workload of nursing shift directors (NSD) has been analyzed. The purpose of the study is to create a baseline metric of the existing process; collect operational data and analyze ways to improve the work efficiency by eliminating the non-value-added tasks from the daily workload; automate some of the tasks performed by NSD; and monitor and provide control methodologies for sustainability.
A value stream activity mapping inpatient flow at Hennepin County Medical Center in Minnesota showed that patients, nurses, physicians, testing departments, and therapists were unaware of the plan for the day for inpatients and often competed for patients' time. Through changing workflow and electronic information-sharing, collisions-of-care were reduced, interdepartmental coordination improved, and the patient experience was enhanced.
An AHRQ Healthcare Innovations article describes how a sepsis alert program at Christiana Care has reduced mortality by over 70 percent and average length of stay by almost 50 percent. Key features of the initiative are prompt screening and early administration of the appropriate antibiotic.
A multidisciplinary group at Presbyterian Healthcare Services teamed together to meet the Joint Commission National Patient Safety Goal and to reduce the central line infection rate to less than 1 per 1,000 patient days. The team used a Lean Sigma improvement methodology to identify a number of countermeasures including checklists, education, defined observer, and a standardized central line kit. In the first six months of the project, the central line infection rate was reduced to .22 infections per 1,000 patient days.
Nursing leaders at Our Lady of Lourdes Medical Center in Camden, New Jersey, engaged staff to improve patient and employee satisfaction and reduce staff turnover on a medical-surgical unit using the Transforming Care at the Bedside (TCAB) model developed by Robert Woods Johnson Foundation and the Institute for Healthcare Improvement. The team focused on a set of directed methodologies and conducted a number of experiments that resulted in dramatic improvement.
The authors delivered a presentation and paper at the 2011 SHS Conference providing a comprehensive case study of how the Sir Mortimer B. Davis-Jewish General Hospital in Montreal, Quebec, moved from a paper surgical request process to a web based system. The lessons learned described by the authors will be valuable for anyone undertaking a similar large scale IT change.
Students at Worcester Polytechnic Institute and in coordination with UMass' Center for Innovation and Transformational Change examined how lean tools can eliminate non-value added work, improve resource management, and create lean flow at the UMass Memorial Hospital. After implementing a number of changes, the team saw a reduction in patient throughput time, elimination of defects in the chart tracking process, and a decrease in stocked inventory.
Part 1 & Part 2From Internet Archive website, these films are essentially a summary of work analysis films which were taken by Frank B. Gilbreth between 1910 and 1924 showing a number of industrial operations from which the motion study technique was developed.This movie is part of the collection: Prelinger Archives.Producer: Presented by James S. Perkins in collaboration with Dr. Lillian M. Gilbreth & Dr. Ralph M. BarnesSponsor: Chicago Chapter of the Society for the Advancement of Management
In this presentation at the 2011 Society for Health Systems conference, Cindy Hafer provides a comprehensive look at how Nationwide Children's Hospital in Cincinnati is moving to eliminating all preventable harm to patients through a comprehensive safety initiative.
At a recent Premier Breakthroughs Conference and Exhibition, clinical and performance improvement staff at the 370-bed Good Samaritan Hospital in Suffern, New York presented a case study of improvement on a nursing unit using the TCAB model.
Pharmacy leaders at Elkhart General Hospital, in Elkhart, Ind., applied a number of lean concepts resulting in lower operational costs and improved patient care. Examples of improvements cited in the Modern Medicine e-zine article were to redeploy two pharmacists to clinical roles, consolidate unit medications, and reduce batching of IV medications.
A recent study in the Annals of Surgery found that high quality hospitals deliver lower cost care to trauma patients, according to a news release by the University of Rochester Medical Center.
Vision based recognition of hand gestures is being researched at Purdue University to control a robotic scrub nurse and access images during surgical cases. The research could lead to short case lengths and reduced infections according to the Purdue University News website.
A case study for reducing workplace noise on a pediatric nursing unit and maintaining appropriate noise levels.
Replenishment of IV fluids and medications can be more methodical than repeated visual inspections.
One hospital details improvements to their medical equipment retrieval, cleaning, and distribution process.
Using Lean Six Sigma tools, a hospital redesigns and implements new ICU protocols for patients on mechanical ventilation. The article details how the initial sustainability effort failed, but was brought back into long-run control.
Physician and Nursing roles and responsibilities within a PICU are redefined using lean tools to decrease LOS while increasing outcomes.
Pressure Ulcer, Falls, Catheter-Associated UTI, Central Line Infection, and Objects Left in Surgery are addressed using process improvement methodologies.
Using examples from several clinical lab redesigns, the sequence of steps utilized during a lean improvement effort are described.
This article studies the work processes of nurses involved in the administration of medication. The goal is to reduce errors and improve efficiency.
A CT scan department has its demand smoothed.
One implementation of Rapid Response Teams is discussed.
Improvement projects in surgery, nursing, and the ED are discussed. The process of moving a hospital towards adoption of Lean Six Sigma is also described.
Pharmacy decision-making is discussed, with focus on controlling costs.
Detailed description of a lean project to improve TAT in the CT Scan department.
The surgical admitting process is targeted with a lean event. Current and future state is described, the process of improvement is shown, and results are discussed.
Three successful lean projects are discussed in detail. Specimen Labeling, Surgery and Endoscopy Pre-Op, and Inpatient Nursing Crash Cart projects all demonstrate significant improvement.
The authors propose a methodology for shortening the time gap between discovery of new evidence-based clinical results and hospital (provider) utilization of the new practice.
Clinical improvement results are discussed for glucose control, rapid response teams, vent bundles, and bloodstream infection projects.
A study is done to improve the communication between and expense of the nursing staff associated with all imaging modalities.
A Lean Six Sigma project focusing on ICU throughput times is completed. Lessons learned and successes are shared.
CPOE is implemented and results discussed.
A 848-bed hospital is experiencing long LOS and targets ancillary service availability as one potential source of improvement. The project discussed tracks the data, demonstrates immediate results, and suggests future improvements.
A lean project generated proposals for rescheduling the providers' workload. During testing of the proposals, daily departmental volume was completed significantly earlier in the day.
4 lean projects were performed - pharmacy, lab, outpatient clinic, and telemetry unit. Each project was meticulously documented in the presentation. Pre- and post- metrics are included, as well as a discussion of sustainability.
Lean projects at Kaiser Permanente are detailed and discussed. The report is a system-level presentation showing many departmental improvements.
Lean improvements within the radiology suite and laboratory workspace yield notable improvements. Project benefits are discussed.
Root cause analysis was conducted to determine reasons for bed sores. This presentation and paper is the result of their team's effort. Sustainability and ongoing improvements are discussed.
System-wide implementation of Lean Six Sigma has resulted in many successes. This presentation discusses the rationale for their overall strategy.
The IHI Bundle was implemented; metric changes are documented and discussed. Several nursing practices were also changed.
Medicare's changes to payment require a higher degree of awareness from hospitals nationwide. This presentation addresses some of the concerns and discusses mitigation efforts currently underway.
Pressure Ulcers are a known issue with long hospitalizations. This presentation deals with several issues surrounding eliminating their occurrence.