scholarly journals 365 Arrival to Decision: Improving Waiting Times in Surgical Ambulatory Care

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
F Mahmood ◽  
P Patel ◽  
O Islam
Keyword(s):  
Quality Improvement ◽  
Data Collection ◽  
Ambulatory Care ◽  
Patient Flow ◽  
Waiting Times ◽  
Improvement Project ◽  
Team Members ◽  
Referral Form ◽  
Flow Through ◽  
Clear Communication

Abstract Introduction An audit of the newly established Surgical Emergency Ambulatory Care Unit (SEAC) at Furness General Hospital found perceived patient waiting times were high. This Quality Improvement Project assessed the patient flow through the SEAC unit and aimed to improve the average time from arrival in the department to senior review by 10%. Method The Plan Do Study Act (PDSA) methodology for quality improvement was used, the time from arrival in the unit to senior decision was recorded for each patient seen over one-week data collection periods. Analysis of the data allowed for a patient process map to be created to visualise bottlenecks in patient flow. The findings were discussed with all team members and an agreed intervention was implemented and tested. Results Over three PDSA cycles, a significant improvement in the overall time from arrival to decision was achieved, from an average time of 193 minutes to 150 minutes. This was achieved by introducing a referral form, which altered how and when members of the multidisciplinary team communicated with each other. Conclusions Clear communication at the appropriate time between all members of the SEAC team significantly improved the average time from arrival to decision.

scholarly journals How does clinical space utilisation impact patient flow?

2019 ◽  
Vol 8 (3) ◽  
pp. e000542 ◽  
Author(s):  
Alexandra von Guionneau ◽  
Charlotte M Burford
Keyword(s):  
Quality Improvement ◽  
Waiting Time ◽  
Primary Outcome ◽  
Patient Flow ◽  
Waiting Times ◽  
Wait Time ◽  
Limiting Factor ◽  
Electronic Systems ◽  
Improvement Project ◽  
Medical Wards

BackgroundLong waiting times in accident and emergency (A&E) departments remain one of the largest barriers to the timely assessment of critically unwell patients. In order to reduce the burden on A&Es, some trusts have introduced ambulatory care areas (ACAs) which provide acute assessment for general practitioner referrals. However, ACAs are often based on already busy acute medical wards and the availability of clinical space for clerking patients means that these patients often face long waiting times too. A cheap and sustainable method to reducing waiting times is to evaluate current space utilisation with the view to making use of underutilised workspace. The aim of this quality improvement project was to improve accessibility to pre-existing clinical spaces, and in doing so, reduce waiting times in acute admissions.MethodsData were collected retrospectively from electronic systems and used to establish a baseline wait time from arrival to having blood taken (primary outcome). Quality improvement methods were used to identify potential implementations to reduce waiting time, by increasing access to clinical space, with serial measurements of the primary outcome being used to monitor change.ResultsData were collected over 54 consecutive days. The median wait time increased by 55 min during the project period. However, this difference in waiting time was not deemed significant between the three PDSA cycles (p=0.419, p=0.270 and p=0.350, Mann-Whitney U). Run chart analysis confirmed no significant changes occurred.ConclusionIn acute services, one limiting factor to seeing patients quickly is room availability. Quality improvement projects, such as this, should consider facilitating better use of available space and creating new clinical workspaces. This offers the possibility of reducing waiting times for both staff and patients alike. We recommend future projects focus efforts on integration of their interventions to generate significant improvements.

scholarly journals Introducing an electronic tracking tool into daily multidisciplinary discharge rounds on a medicine service: a quality improvement project to reduce length of stay

2018 ◽  
Vol 7 (3) ◽  
pp. e000174 ◽  
Author(s):  
Nicholas Meo ◽  
Evan Paul ◽  
Christopher Wilson ◽  
Janice Powers ◽  
Marinette Magbual ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Length Of Stay ◽  
Average Length ◽  
Multidisciplinary Care ◽  
Coordinated Care ◽  
Improvement Project ◽  
Team Members ◽  
Electronic Tool ◽  
Medicine Service ◽  
Daily Discharge

BackgroundInefficient coordination of care around discharge can increase length of stay, lead to ineffective transitions and contribute an unnecessary cost burden to patients and hospital systems. Multidisciplinary discharge rounds can improve situational awareness among team members leading to more efficient and better coordinated care. This project aimed to standardise the daily discharge rounds occurring on a medicine service to reduce length of stay. Participants included physicians, nurses and social workers.MethodsA key driver diagram was developed to understand drivers of length of stay. Improving multidisciplinary care coordination was targeted as an initial area of focus. Stakeholder interviews were held to understand current participants challenges with the daily discharge rounds process. Baseline assessment included a review of discharges for 6 weeks before the initial intervention. A Plan Do Study Act quality improvement framework was used to implement change.InterventionAn electronic tool was developed which highlighted critical information to be captured during discharge rounds on each current inpatient in a standardised fashion. Information was reviewed and solicited from care teams by a facilitator, then edited and displayed in real time to all team members by a scribe.ResultsThe average length of stay decreased by 1.4 days (p<0.05), an improvement of 21.1%. There was no measured increase on readmission rate during the intervention period.ConclusionAn electronic tool to standardise information gathered among team members in daily discharge rounds led to improvements in length of stay. Multidisciplinary discharge rounds are an important venue for discharge planning across inpatient care teams and efforts to optimise communication between team members can improve care.

scholarly journals P.017 Results of a Pilot feasibility study to develop reduce wait times strategy in the evaluation of children with new onset epilepsy

2018 ◽  
Vol 45 (s2) ◽  
pp. S20-S20
Author(s):  
JA Mailo ◽  
M Diebold ◽  
E Mazza ◽  
P Guertjens ◽  
H Gangam ◽  
...  
Keyword(s):  
Patient Flow ◽  
Waiting Times ◽  
Wait Time ◽  
Febrile Seizures ◽  
Limiting Factors ◽  
Wait Times ◽  
Timely Access ◽  
Flow Through ◽  
Pilot Feasibility Study ◽  
New Onset

Background: The goal was to understand factors leading to prolonged wait times for neurological assessment of children with new onset seizures. A second objective was to develop an innovative approach to patient flow through and achieve a reduction in waiting times utilizing limited resources.Methods:Audit of the referrals, flow through, wait timesIdentification of bottlenecksDevelopment of triaging strategy:Suspected Febrile seizures and non-epileptic events;Suspected benign and absence epilepsies;Suspected other Focal epilepsies, generalized epilepsies, epilepsy under 2 yearsInitiation of early telephone contact and supportDevelopment of a ketogenic dietResults: Using a triaging strategy and focusing on timely access to investigations, wait times for clinic evaluations were shortened despite larger numbers of referrals (mean wait time reductions from 179 to 91 days). Limiting factors such increase in referral numbers, attrition in support staff, interfered with sustainability of reduced wait times achieved in the initial phase of the program. Conclusions: This pilot study highlights the effectiveness of an innovative triaging strategy and improvements in patient flow through in achieving the goals of reduction in wait times for clinical evaluation and timely investigations to improve care for children with new onset seizures. Insights into limitations of such strategies and factors determining sustainability are discussed.

110 Neurosurgery Morning Huddle Reduces Costs and Increases Patient Satisfaction

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 222-223
Author(s):  
Alvin Chan ◽  
Sumeet Vadera
Keyword(s):  
Patient Satisfaction ◽  
Patient Care ◽  
Direct Cost ◽  
Inpatient Care ◽  
Patient Flow ◽  
Hospital Costs ◽  
Team Members ◽  
Before And After ◽  
Flow Through ◽  
Strongly Agree

Abstract INTRODUCTION Morning discharge huddles, consisting of inpatient care team members, improve communication and patient care, facilitating patient flow through the hospital. However, how huddles affect hospital costs and patient satisfaction is unclear. The aim was to investigate how a neurosurgery-led interdisciplinary daily morning huddle affected different costs of patient care and patient satisfaction. METHODS Data was collected retrospectively for average ICU days, average stepdown days, average direct cost, average laboratory costs, average pharmacy costs, hospital ratings, hospital recommendations. Then the data before and after implantation of the huddle were compared. RESULTS >There was a significant decrease in the number of ICU days, average laboratory costs, and average pharmacy costs per patient after the huddle was implemented (all P < 0.05), resulting in an estimated $1408,047.66 in savings. The percentage of patients who rated our hospital as a “9 or 10” significantly increased (P < 0.05). The percentage who answered “strongly agree” when asked whether they would recommend the hospital also significantly increased (P < 0.05). There was no difference for average direct cost. CONCLUSION Implementation of a morning huddle may result in significant hospital savings while simultaneously increasing patient satisfaction.

scholarly journals Minimizing ED Waiting Times and Improving Patient Flow and Experience of Care

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Assaad Sayah ◽  
Loni Rogers ◽  
Karthik Devarajan ◽  
Lisa Kingsley-Rocker ◽  
Luis F. Lobon
Keyword(s):  
Positive Impact ◽  
Patient Flow ◽  
Waiting Times ◽  
Improvement Project ◽  
Ambulance Diversion ◽  
Experience Of Care ◽  
Left Without Being Seen ◽  
Patient Satisfaction Scores ◽  
Core Measures ◽  
The Impact

We conducted a pre- and postintervention analysis to assess the impact of a process improvement project at the Cambridge Hospital ED. Through a comprehensive and collaborative process, we reengineered the emergency patient experience from arrival to departure. The ED operational changes have had a significant positive impact on all measured metrics. Ambulance diversion decreased from a mean of 148 hours per quarter before changes in July 2006 to 0 hours since April 2007. ED total length of stay decreased from a mean of 204 minutes before the changes to 132 minutes. Press Ganey patient satisfaction scores rose from the 12th percentile to the 59th percentile. ED patient volume grew by 11%, from a mean of 7,221 patients per quarter to 8,044 patients per quarter. Compliance with ED specific quality core measures improved from a mean of 71% to 97%. The mean rate of ED patients that left without being seen (LWBS) dropped from 4.1% to 0.9%. Improving ED operational efficiency allowed us to accommodate increasing volume while improving the quality of care and satisfaction of the ED patients with minimal additional resources, space, or staffing.

The Journey of the Purple Butterfly: A Quality Improvement Initiative

2021 ◽  
pp. 104990912110141
Author(s):  
Jessica O’Brien Gufarotti ◽  
Anna Krakowski
Keyword(s):  
Quality Improvement ◽  
Interdisciplinary Team ◽  
Urban Setting ◽  
Quality Improvement Initiative ◽  
Communication Tool ◽  
Patient Centered ◽  
Improvement Project ◽  
Comfort Care ◽  
Team Members ◽  
Job Duties

Introduction: Dying in the hospital is not always a good experience for patients and their families. To be more in line with evidence-based practices for healthcare workers to effectively support high quality end of life care, the project team implemented a standardized communication tool to alert interdisciplinary team members of patients on comfort care measures. Methods: Purple Butterfly was a quality improvement project that was implemented at a diverse community hospital in the urban setting. Clinical and non-clinical interdisciplinary team members participated in a pre- and post- implementation survey to assess the need for a standardized communication tool that would alert them of patients who transitioned to comfort care. Results: Pre-implementation, 37% of survey respondents (n = 60) reported they were always aware of the presence of a patient on comfort care measures prior to entering the room. After implementation of a standardized communication tool, 100% (n = 43) of respondents at 9 months, reported that they were always aware of the presence of a patient on comfort care measures prior to entering the room. Additionally, 9 months post-intervention 100% of respondents reported that knowing this contextual information supported them in performing their job duties in a compassionate, patient-centered fashion. Conclusion: Implementation of a standardized communication tool increased awareness for team members, about the presence of patients on comfort care measures prior to entering the room and supported team members to perform their job duties in a compassionate, patient-centered fashion supportive of this patient population.

485 Optimisation of The Evening Surgical Handover Process in A Large Tertiary Surgical Department - A Quality Improvement Project

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
P Brennan ◽  
D Holroyd
Keyword(s):  
Quality Improvement ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Team Members ◽  
Surgical Department ◽  
Significant Variability ◽  
Standard Operating ◽  
Handover Process ◽  
Audit Standards ◽  
Standard Operating Protocol

Abstract Introduction The aim of the project was to improve the quality and effectiveness of the evening surgical handover in a large tertiary surgical department, incorporating up to 150 patients. Method Audit standards were derived from GMC and RCSEng guidelines. An initial audit of the evening handover was conducted over a period of two weeks. Following this, a standard operating protocol (SOP) was introduced, with re-audit 4-weeks following implementation. Results The initial audit identified an inconsistent format and significant variability. Few handovers commenced with all team members present (11%) and were uninterrupted (33%). A laminated handover SOP checklist was produced and a new proforma was introduced to document tasks or reviews required overnight. A mandatory evening surgical HDU round was invoked and a “watchers” system was introduced to identify patients at highest risk of deterioration. Re-audit demonstrated significant improvements in all domains to &gt; 85%. ICU referrals overnight decreased from 6% to 2%. Further improvements measures were implemented in the form of a dynamic virtual handover document. Conclusions A structured SOP improved the consistency of the handover process. A night review of all HDU patients reduced the rate of ICU referrals. Implementation of virtual handover processes may be required in the COVID-era.

scholarly journals https://staging.acutemedjournal.co.uk/investigating-for-pulmonary-embolism-in-pregnancy-five-year-retrospective-review-of-referrals-to-the-acute-medical-unit-of-a-large-teaching-hospital/

2016 ◽  
Vol 15 (2) ◽  
pp. 51-57
Author(s):  
T Brougham ◽  
C Gillett ◽  
L Powter ◽  
Keyword(s):  
Data Collection ◽  
Quality Indicators ◽  
Patient Flow ◽  
Waiting Times ◽  
Electronic System ◽  
Acute Medicine ◽  
Bed Management ◽  
Acute Medical Unit ◽  
Large Teaching Hospital ◽  
Medicine Quality

Aims: To create a system to co-ordinate the medical take, bed management and track patient flow. To use the system to continuously audit against Society for Acute Medicine Quality Indicators. To use the data to model patient flow and optimize working patterns to improve waiting times. Method: An online whiteboard and underlying database system were designed, tested and implemented. Data from this system were used to audit against SAM Quality Indicators and then analysed to optimise both trainee and consultant working patterns. Results: The online whiteboard proved effective and popular as a working tool. Data collection improved using the electronic system. Optimising junior doctor working patterns to match demand led to a reduction of average waiting time to see a doctor from 190 minutes to 71 minutes (p < 0.0001), and a reduction in the proportion of patients waiting over 4 hours from 40% to 10% (p < 0.0001). Optimising consultant working patterns did not produced significant changes in waiting times. Conclusions: The online whiteboard improved day-to-day working and data collection, when compared to the previous paper-based system. Better data facilitated analysis of working patterns leading to a significant improvement in patient waiting times.

scholarly journals 1473 Urology Consent Forms at a District General Hospital – a Quality Improvement Project

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
D Bernstein ◽  
A West ◽  
E Preston ◽  
P Premakumaran ◽  
N Suleyman ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Data Collection ◽  
General Hospital ◽  
District General Hospital ◽  
Quality Improvement Project ◽  
Consent Form ◽  
National Guidelines ◽  
Improvement Project ◽  
Consent Forms ◽  
Carbon Copy

Abstract Aim Consent is a core component of interaction between patients and healthcare professionals. Prior to surgery, forms are completed to record patient consent. As well as containing risks and benefits of the procedure, the consent form, as per guidelines1,2, must be legible and suitable to a patient’s capacity. To evaluate compliance with local and national guidelines, a quality improvement project was undertaken at a district general hospital. Method Over a three-week period 30 urology consent forms were selected to assess adherence to local and national guidelines. The appropriateness of consent form, patient signature, legibility, acronym use and whether the patient was offered a carbon copy were assessed. After initial data collection, all urology staff consenting patients were notified of the findings and how best to improve guideline adherence. A further three-week data collection was undertaken, though the sample set was small due to Coronavirus and Christmas. Results The results confirmed that patients had appropriate consent forms filled out and were signed appropriately. After intervention, there was clear improvement in legibility, with no low legibility consent forms, and 100% vs 83% high or moderate legibility between data sets. Intervention also resulted in significant reduction of acronym use; 33% vs 60%. More patients were also offered to retain a carbon copy; 89% vs 40%. Conclusions Through this intervention of highlighting local and national guidance as compared to current practice, compliance drastically improved. As the pandemic subsides, we hope regular emails to surgical teams will improve consent form completion to better patient care.

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