Reduced isolation room turnover time using Lean methodology

AbstractObjective:To prevent environmental transmission of pathogens, hospital rooms housing patients on transmission-based precautions are cleaned extensively and disinfected with ultraviolet (UV) light. To do so consistently requires time and coordination, and these procedures must avoid patient flow delays and associated safety risks. We sought to improve room turnover efficiency to allow for UV disinfection.Design:A 60-day quality improvement and implementation project.Setting:A quaternary academic pediatric referral facility.Interventions:A multidisciplinary healthcare team participated in a 60-day before-and-after trial that followed the Toyota Production System Lean methodology. We used value-stream mapping and manual time studies to identify areas for improvement. Areas addressed included room breakdown, room cleaning, and wait time between cleaning and disinfection. Room turnover was measured as the time in minutes from a discharged patient exiting an isolation room to UV disinfection completion. Impact was measured using postintervention manual time studies.Results:Median room turnover decreased from 130 minutes (range, 93–294 minutes) to 65 minutes (range, 48–95 minutes; P < .0001). Other outcomes included decreased median time between room breakdown to cleaning start time (from 10 to 3 minutes; P = .004), room cleaning complete to UV disinfection start (from 36 to 8 minutes; P < .0001), and the duration of room cleaning and curtain changing (from 57 to 37 minutes; P < .0001).Conclusion:We decreased room turnover time by half in 60 days by decreasing times between and during routine tasks. Utilizing Lean methodology and manual time study can help teams understand and improve hospital processes and systems.

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The impact of computerized provider order entry on emergency department flow

CJEM ◽

10.1017/cem.2016.11 ◽

2016 ◽

Vol 18 (4) ◽

pp. 264-269 ◽

Cited By ~ 4

Author(s):

Andrew Gray ◽

Christopher M.B. Fernandes ◽

Kristine Van Aarsen ◽

Melanie Columbus

Keyword(s):

Emergency Department ◽

Patient Safety ◽

Improve Patient Safety ◽

Patient Flow ◽

Wait Time ◽

Order Entry ◽

Computerized Provider Order Entry ◽

Left Without Being Seen ◽

Before And After ◽

The Impact

AbstractObjectivesComputerized provider order entry (CPOE) has been established as a method to improve patient safety by avoiding medication errors; however, its effect on emergency department (ED) flow remains undefined. We examined the impact of CPOE implementation on three measures of ED throughput: wait time (WT), length of stay (LOS), and the proportion of patients that left without being seen (LWBS).MethodsWe conducted a retrospective cohort study of all ED patients of 18 years and older presenting to London Health Sciences Centre during July and August 2013 and 2014, before and after implementation of a CPOE system. The three primary variables were compared between time periods. Subgroup analyses were also conducted within each Canadian Triage and Acuity Scale (CTAS) level (1–5) individually, as well as for admitted patients only.ResultsA significant increase in WT of 5 minutes (p=0.036) and LOS of 10 minutes (p=0.001), and an increase in LWBS from 7.2% to 8.1% (p=0.002) was seen after CPOE implementation. Admitted patients’ LOS increased by 63 minutes (p<0.001), the WT of CTAS 3 and 5 patients increased by 6 minutes (p=0.001) and 39 minutes (p=0.005), and LWBS proportion increased significantly for CTAS 3–5 patients, from 24.3% to 42.0% (p<0.001) for CTAS 5 patients specifically.ConclusionsCPOE implementation detrimentally impacted all patient flow throughput measures that we examined. The most striking clinically relevant result was the increase in LOS of 63 minutes for admitted patients. This raises the question as to whether the potential detrimental effects to patient safety of CPOE implementation outweigh its benefits.

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Innovative Strategies for Decreasing Blood Collection Wait Times for Patients in Early-Phase Cancer Clinical Trials

Journal of Oncology Practice ◽

10.1200/jop.2015.007674 ◽

2016 ◽

Vol 12 (7) ◽

pp. e784-e791 ◽

Cited By ~ 1

Author(s):

Bayabel Mengistu ◽

Dina Ray ◽

Passion Lockett ◽

Vivian Dorsey ◽

Ron A. Phipps ◽

...

Keyword(s):

Clinical Trials ◽

Early Phase ◽

Patient Flow ◽

Care Facility ◽

Cost Savings ◽

Primary Source ◽

Wait Time ◽

Turnover Time ◽

Wait Times ◽

Blood Collection

Purpose: Long wait times are a primary source of dissatisfaction among patients enrolled in early-phase clinical trials. We hypothesized that an automated patient check-in system with readily available display for increasing awareness of waiting intervals would improve patient flow and use of our rooms, with decreased turnover time and increased throughput. Methods: We recorded in-room wait times for patients seen in our clinic and observed the logistics involved in the blood collection process to delineate causes for delays. We then implemented a three-step strategy to alleviate the causes of these delays: (1) changing the collection of materials and the review of faxed orders, (2) improving our LabTracker automated database system that included wait time calculators and real-time information regarding patient status, and (3) streamlining lower complexity appointments. Results: After our intervention, we observed a 19% decrease in mean wait times and a 30% decrease in wait times among patients waiting the longest (95th percentile). We also observed an increase in staff productivity during this process. Modifications in LabTracker provided the biggest reduction in mean wait times (17%). Conclusion: We observed a significant decrease in mean wait times after implementing our intervention. This decrease led to increased staff productivity and cost savings. Once wait times became a measurable metric, we were able to identify causes for delays and improve our operations, which can be performed in any patient care facility.

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Case Study of Particle-Related UV Shielding of Microorganisms When Disinfecting Unfiltered Surface Water

Water Quality Research Journal ◽

10.2166/wqrj.2010.030 ◽

2010 ◽

Vol 45 (3) ◽

pp. 343-351 ◽

Cited By ~ 1

Author(s):

Raymond E. Cantwell ◽

Ron Hofmann ◽

Jennie L. Rand ◽

Patrick M. Devine ◽

Monique VanderMarck

Keyword(s):

Surface Water ◽

Uv Light ◽

Pilot Scale ◽

Uv Disinfection ◽

Particle Count ◽

Uv Reactor ◽

Before And After ◽

Log Linear ◽

Uv Lamps

Abstract The goal of this case study was to provide pilot-scale information about the ability of ultraviolet (UV) light to disinfect unfiltered surface water. A pilot-scale (0.25 L/s) UV reactor with low-pressure UV lamps was installed on raw water entering an aqueduct from the Pardee Reservoir at the East Bay Municipal District, California. A pilot monitoring system also collected hourly particle count (2 to 100 m), turbidity, and ultraviolet transmittance (UVT) measurements for 14 months. Grab microbial samples were collected and analyzed for indigenous total coliforms and total aerobic spores (TAS) both before and after UV disinfection, to correlate survival of the organisms across the UV reactor to water quality characteristics. Concentrations of indigenous coliforms and TAS ranged up to 163 and 1,383 per 100 mL respectively, before UV exposure. The data showed that the ability of UV to disinfect coliforms was essentially unaffected by the presence of particles (up to 703>10 m per mL and 1.3 nephelometric turbidity unit [NTU]) in the unfiltered surface water. In 13 of 14 samples, no coliforms were detected in the UV treated water. Log-linear inactivation of TAS up to 2.5-log suggests that at least 99.6% of the TAS were not protected from UV disinfection by particles.

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Sorbitol enhances the physicochemical stability of B12 vitamers

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000578 ◽

2020 ◽

Vol 90 (5-6) ◽

pp. 439-447 ◽

Cited By ~ 1

Author(s):

Andrew Hadinata Lie ◽

Maria V Chandra-Hioe ◽

Jayashree Arcot

Keyword(s):

Ascorbic Acid ◽

Uv Light ◽

Heat Exposure ◽

Water Soluble ◽

Uv Exposure ◽

Physicochemical Stability ◽

Before And After ◽

The Stability

Abstract. The stability of B12 vitamers is affected by interaction with other water-soluble vitamins, UV light, heat, and pH. This study compared the degradation losses in cyanocobalamin, hydroxocobalamin and methylcobalamin due to the physicochemical exposure before and after the addition of sorbitol. The degradation losses of cyanocobalamin in the presence of increasing concentrations of thiamin and niacin ranged between 6%-13% and added sorbitol significantly prevented the loss of cyanocobalamin (p<0.05). Hydroxocobalamin and methylcobalamin exhibited degradation losses ranging from 24%–26% and 48%–76%, respectively; added sorbitol significantly minimised the loss to 10% and 20%, respectively (p < 0.05). Methylcobalamin was the most susceptible to degradation when co-existing with ascorbic acid, followed by hydroxocobalamin and cyanocobalamin. The presence of ascorbic acid caused the greatest degradation loss in methylcobalamin (70%-76%), which was minimised to 16% with added sorbitol (p < 0.05). Heat exposure (100 °C, 60 minutes) caused a greater loss of cyanocobalamin (38%) than UV exposure (4%). However, degradation losses in hydroxocobalamin and methylcobalamin due to UV and heat exposures were comparable (>30%). At pH 3, methylcobalamin was the most unstable showing 79% degradation loss, which was down to 12% after sorbitol was added (p < 0.05). The losses of cyanocobalamin at pH 3 and pH 9 (~15%) were prevented by adding sorbitol. Addition of sorbitol to hydroxocobalamin at pH 3 and pH 9 reduced the loss by only 6%. The results showed that cyanocobalamin was the most stable, followed by hydroxocobalamin and methylcobalamin. Added sorbitol was sufficient to significantly enhance the stability of cobalamins against degradative agents and conditions.

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Study of the Ultraviolet Effect and Thermal Analysis on Polypropylene Nonwoven Geotextile

Materials ◽

10.3390/ma14051080 ◽

2021 ◽

Vol 14 (5) ◽

pp. 1080

Author(s):

Clever Aparecido Valentin ◽

Marcelo Kobelnik ◽

Yara Barbosa Franco ◽

Fernando Luiz Lavoie ◽

Jefferson Lins da Silva ◽

...

Keyword(s):

Uv Light ◽

Polymeric Materials ◽

Tensile Tests ◽

Thermomechanical Analysis ◽

Material Stiffness ◽

Before And After ◽

Electron Microscopy Analysis ◽

Physical Tests ◽

Nonwoven Geotextile

The use of polymeric materials such as geosynthetics in infrastructure works has been increasing over the last decades, as they bring down costs and provide long-term benefits. However, the aging of polymers raises the question of its long-term durability and for this reason researchers have been studying a sort of techniques to search for the required renewal time. This paper examined a commercial polypropylene (PP) nonwoven geotextile before and after 500 h and 1000 h exposure to ultraviolet (UV) light by performing laboratory accelerated ultraviolet-aging tests. The state of the polymeric material after UV exposure was studied through a wide set of tests, including mechanical and physical tests and thermoanalytical tests and scanning electron microscopy analysis. The calorimetric evaluations (DSC) showed distinct behaviors in sample melting points, attributed to the UV radiation effect on the aged samples. Furthermore, after exposure, the samples presented low thermal stability in the thermomechanical analysis (TMA), with a continuing decrease in their thicknesses. The tensile tests showed an increase in material stiffness after exposition. This study demonstrates that UV aging has effects on the properties of the polypropylene polymer.

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Improving patient flow and timeliness in the diagnosis and management of breast abnormalities: the impact of a rapid diagnostic unit

Current Oncology ◽

10.3747/co.23.3017 ◽

2016 ◽

Vol 23 (3) ◽

pp. 260 ◽

Cited By ~ 8

Author(s):

J.M. Racz ◽

C.M.B. Holloway ◽

W. Huang ◽

N.J. Look Hong

Keyword(s):

Care Delivery ◽

Patient Flow ◽

Wait Time ◽

Definitive Treatment ◽

Wait Times ◽

Fisher Exact Test ◽

Patient Anxiety ◽

Diagnostic Unit ◽

Clinical Investigations ◽

The Impact

Background Efforts to streamline the diagnosis and treatment of breast abnormalities are necessary to limit patient anxiety and expedite care. In the present study, we examined the effect of a rapid diagnostic unit (RDU) on wait times to clinical investigations and definitive treatment.Methods A retrospective before–after series, each considering a 1-year period, examined consecutive patients with suspicious breast lesions before and after initiation of the RDU. Patient consultations, clinical investigations, and lesion characteristics were captured from time of patient referral to initiation of definitive treatment. Outcomes included time (days) to clinical investigations, to delivery of diagnosis, and to management. Groups were compared using the Fisher exact test or Student t-test.Results The non-RDU group included 287 patients with 164 invasive breast carcinomas. The RDU group included 260 patients with 154 invasive carcinomas. The RDU patients had more single visits for biopsy (92% RDU vs. 78% non-RDU, p < 0.0001). The RDU group also had a significantly shorter wait time from initial consultation to delivery of diagnosis (mean: 2.1 days vs. 16.7 days, p = 0.0001) and a greater chance of receiving neoadjuvant chemotherapy (37% vs. 24%, p = 0.0106). Overall time from referral to management remained statistically unchanged (mean: 53 days with the RDU vs. 50 days without the RDU, p = 0.3806).Conclusions Introduction of a RDU appears to reduce wait times to definitive diagnosis, but not to treatment initiation, suggesting that obstacles to care delivery can occur at several points along the diagnostic trajectory. Multipronged efforts to reduce system-related delays to definitive treatment are needed.

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COMPREHENSIVE MEDICATION MANAGEMENT SERVICES IN A BRAZILIAN SPECIALITY PHARMACY: A QUALITATIVE ASSESSMENT

International Journal of Pharmacy and Pharmaceutical Sciences ◽

10.22159/ijpps.2017v9i3.16398 ◽

2017 ◽

Vol 9 (3) ◽

pp. 227 ◽

Cited By ~ 1

Author(s):

Kirla Barbosa Detoni ◽

Mariana Martins Gonzaga Do Nascimento ◽

Isabela Viana Oliveira ◽

Mateus Rodrigues Alves ◽

Manoel Machuca GonzÁles ◽

...

Keyword(s):

Participant Observation ◽

Patient Flow ◽

Medication Management ◽

Implementation Process ◽

Ethnographic Study ◽

Qualitative Assessment ◽

Healthcare Team ◽

Structured Interviews ◽

Eligibility Criteria ◽

Manager Support

Objective: To understand and describe the implementation process of a comprehensive medication management (CMM) service in a public speciality pharmacy in Brazil.Methods: Ethnographic study conducted over 17 mo (September 2014 to February 2016) in a public speciality pharmacy. Semi-structured interviews were conducted with twelve participants. Notes on field journals, resulting from participant observation conducted by the two pharmacists directly responsible for the service implementation, were also used as a source of data.Results: Ten important conditions to improve the success of CMM service implementation were identified: manager support; evaluation of physical and material resources; evaluation of human resources practitioners’ characteristics and knowledge about the theoretical framework of CMM services; time dedicated to CMM services; redefining the work process; defining patient eligibility criteria to CMM service; defining patient flow to CMM service; communication with healthcare team; integration with the staff; and marketing the service internally.Conclusion: The results unveiled by this article can be used by pharmacists and managers as a tool to optimize the implementation of CMM services in different healthcare settings. These conditions do not consist the only aspects necessary to ensure the success of the service; however, they can contribute to optimize the implementation process of the practice

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TiO2 BEADS FOR PHOTOCATALYTIC DEGRADATION OF HUMIC ACID IN PEAT WATER

Indonesian Journal of Chemistry ◽

10.22146/ijc.21389 ◽

2011 ◽

Vol 11 (3) ◽

pp. 253-257 ◽

Cited By ~ 1

Author(s):

Winarti Andayani ◽

Agustin N M Bagyo

Keyword(s):

Aqueous Solution ◽

Humic Acid ◽

Oxalic Acid ◽

Chemical Oxygen Demand ◽

Photocatalytic Degradation ◽

Uv Light ◽

Batch Reactor ◽

Oxygen Demand ◽

Color Intensity ◽

Before And After

Degradation of humic acid in aqueous solution containing TiO2 coated on ceramics beads under irradiation of 254 nm UV light has been conducted in batch reactor. The aim of this experiment was to study photocatalytic degradation of humic acid in peat water. The irradiation of the humic acid in aqueous solution was conducted in various conditions i.e solely uv, in the presence of TiO2-slurry and TiO2 beads. The color intensity, humic acid residue, conductivity and COD (chemical oxygen demand) of the solution were analyzed before and after irradiation. The compounds produced during photodegradation were identified using HPLC. The results showed that after photocatalytic degradation, the color intensity and the COD value of the solution decreased, while the conductivity of water increased indicating mineralization of the peat water occurred. In addition, oxalic acid as the product of degradation was observed.

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Confirmatory Method for N-Nitrosodimethylamine and N-Nitrosopyrrolidine in Food by Multiple Ion Analysis with Gas Chromatography-Low Resolution Mass Spectrometry Before and After Ultraviolet Photolysis

Journal of AOAC INTERNATIONAL ◽

10.1093/jaoac/65.5.1162 ◽

1982 ◽

Vol 65 (5) ◽

pp. 1162-1167

Author(s):

W I Kimoto ◽

Walter Fiddler

Keyword(s):

Mass Spectrometry ◽

Gas Chromatography ◽

Uv Light ◽

Capillary Gc ◽

Low Resolution ◽

Total Extract ◽

Before And After ◽

Ultraviolet Photolysis ◽

Peak Areas ◽

Volatile Nitrosamines

Abstract A confirmatory procedure is described for determining N-nitrosodimethylamine (NDMA) and N-nitrosopyrrolidine (NPYR) in bacon, beer, and malt by gas chromatography-low resolution quadrupole mass spectrometry (GC-MS). The presence of 3 monitored ions, m/z 30, 42, and 74 for NDMA, and m/z 30,42, and 100 for NPYR, before and disappearance after photolysis under UV light at 365 nm without quantitation of peak areas was considered confirmatory evidence for their presence. The extracts, obtained by mineral oil distillation methods' for bacon and malt, and dry column methods for bacon and beer, underwent cleanup procedures before capillary GC-MS analysis. Less than 100 ng nitrosamine in the total extract, or approximately 2 ng NDMA or 3 ng NPYR injected into the GC-MS instrument, can be confirmed by this method. This technique should also be applicable for other volatile nitrosamines.

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Dietitian first gastroenterology clinic: an initiative to reduce wait lists and wait times for gastroenterology outpatients in a tertiary hospital service

Frontline Gastroenterology ◽

10.1136/flgastro-2018-101063 ◽

2018 ◽

Vol 10 (3) ◽

pp. 229-235 ◽

Cited By ~ 3

Author(s):

Rumbidzai N Mutsekwa ◽

Russell Canavan ◽

Anthony Whitfield ◽

Alan Spencer ◽

Rebecca L Angus

Keyword(s):

Patient Flow ◽

Wait Time ◽

Tertiary Hospital ◽

University Hospital ◽

Wait Times ◽

Activity Data ◽

Patient Journey ◽

Service Activity ◽

High Level ◽

The Impact

ObjectiveThe demand for outpatient gastroenterology medical specialist consultations is above what can be met within budgetary and staffing constraints. This study describes the establishment of a dietitian first gastroenterology clinic to address this issue, the patient journey and its impact on wait lists and wait times in a tertiary gastroenterology service.DesignA dietitian first gastroenterology clinic model was developed and a mixed-methods approach used to evaluate the impact of the service over a 21-month period.SettingGold Coast University Hospital, Queensland, Australia (a public tertiary hospital).Patients658 patients were triaged to the clinic between June 2016 and March 2018.InterventionA dietitian first gastroenterology clinic for low-risk gastroenterology patients.Main outcome measuresWe examined demographic, referral, wait list, wait time and service activity data, patient satisfaction and patient journey.ResultsAt the time of audit, 399 new (67.9% female) and 307 review patients had been seen. Wait times for eligible patients reduced from 280 to 66 days and the percentage of those in breach of their recommended wait times reduced from 95% to zero. The average time from referral to discharge was 117.8 days with an average of 2.4 occasions of service. 277 patients (69.4%) had been discharged to the care of their general practitioner and 43 patients (10.7%) had an expedited specialist medical review. Patient surveys indicated a high level of satisfaction.ConclusionA dietitian first gastroenterology model of care helps improve patient flow, reduces wait times and may be useful elsewhere to address outpatient gastroenterology service pressures.

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