Perinatal Patient Flow San Francisco Medical Center

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(No Transcript)
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Perinatal Patient Flow San
Francisco Medical Center
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Perinatal Patient Flow In San Francisco
What Are We Trying To Accomplish?
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How Will We Know A Change
is an Improvement?
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What Changes Can We Make That Will
Result In An Improvement?
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KPSF Perinatal Patient Flow High Level
Triage
Admission/Delivery or OP
Postpartum
Recovery
Check-in
Pt sent home (35 of pts)
Pt admitted to Antepartum for observation
Pt checks in at Security
Pt waits in Waiting Room for eval
Pt evaluated in Triage, Antepartum or LD
Pt admitted to OR for C-section, returns to LD
Pt recovers in PPT/APT (overflow) d/c
Pt delivers wait to transfer to Postpartum or
Antepartum
Pt admitted to LD for delivery
Birth to Discharge ALOS 2.2
Triage to Decision
Check-in to Triage
Admit to Birth
ALOS/ Wait Times
Birth to Transfer
Transfer to D/c
ALOS 0.76
ALOS 1.82
(Incl. 2 hr recovery)
ALOS 4.1 hrs
Key Issues Impacting Flow

• Timely triage/ availability of staff to triage
  patients
• Outpatient issues addressed in inpatient setting

• Timely decision-making/availability of staff
• Availability of LD room

• Decision to incision time for scheduled C/S
• Possible clinical practice issues, admitting pts
  early
• Others TBD

• Availability of Postpartum/Antepartum bed,
  boarding in LD
• Possible nursing practice issues

• Completion of testing, lactation consult, orders,
  birth certificate, etc.
• Weekend d/c processes

All LOS information based on 10/09 data capture.
Triage to Decision times include IP/OP times
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Current Trend
Wow !
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Lessons Learned
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How Flow Works

• Flow Requires that the Whole Process Be
  Considered Simultaneously
• It begins with the order and ends with the
  customer receiving it
• Avoid Batch and Queue
• Littles Law If capacity is constant, cycle
  time increases as work in process (WIP) increases
• PCT WIP / Exit Rate PCT
  Process Cycle Time (Total Lead Time)
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  WIP Work in Process
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  Exit Rate (also called
  completion rate)
• Congestion often occurs due to variation in
  demand
• You can limit how much work you allow into the
  process at any given time by..
• Triaging, not all demand is created equal
• Creating Pull system, when one item goes out it
  automatically triggers the next item to come
  into the process

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Roles - Where Do You Fit

• An Improvement effort often spans across
  multiple functions/departments
• system wide collaboration and communication is
  required
• A project is led by two co-leads, one of them is
  a union co-lead
• IA and faculty mentors (deep experts of
  improvement methodology and data analysis) coach
  the project team, while the co-leads drive it.
  Oversight committee is made up of executive
  sponsors/champions
• Stakeholders are part of the process (owners and
  operators of the A-Is or To-Be process). They
  are key elements of change management and are
  involved from the very beginning
• Customers are those who use the process output
• Team members provide the subject matter
  expertise

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Exercise

• Weight loss

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Activity (15 minutes)

• Purpose Describe an inpatient flow process
  (high level)
• Describe the As-Is Process flow (in text or a
  flow diagram)
• Identify some key measures (outcome measures,
  process measures, balancing measures)
• Gather at your table, come up with two for each
  measure.
• This exercise has two parts
• Part 1 At your table, discuss your key measures
  and
• How could the flow be improved? What would be a
  more effective/efficient flow (shorten the cycle
  time, decrease rework/errors or improve outputs)?
• Are there any disconnects in the process flow?
• Are any parts of the process being
  sub-optimized?
• Part 2 Prepare a 2-minute report to the whole
  group on your measures and flow improvements.
  Other tables are not to comment during the
  report.
• Caution There is no such thing as perfect
  process. Every process can be improved none
  can be made perfect. Instead, focus on major
  improvement on what exists, rather than seeking
  to make it perfect.
• Make sure you keep an open mind. We all have our
  pet solutions. However, an improvement that
  solves one problem may cause more problems
  somewhere else.

Templates are available for the above activities
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Q A