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Perinatal Patient Flow San Francisco Medical Center

Perinatal Patient Flow San Francisco Medical Center. Perinatal Patient Flow In San Francisco “ What Are We Trying To Accomplish?”. “How Will We Know A Change is an Improvement?”.

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Perinatal Patient Flow San Francisco Medical Center

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  1. Perinatal Patient Flow San Francisco Medical Center

  2. Perinatal Patient Flow In San Francisco “What Are We Trying To Accomplish?”

  3. “How Will We Know A Change is an Improvement?”

  4. “What Changes Can We Make That Will Result In An Improvement?”

  5. Min: 0 minutes Min: 0 min/29 min Max: 7.5 hours Max: 9:57hrs/8hrs Avg: 37 minutes Avg: 1:36hrs/2:29hrs KPSF Perinatal Patient Flow – High Level Check-in Triage Admission/Delivery or OP Recovery Postpartum 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 L&D Pt admitted to OR for C-section, returns to L&D Pt recovers in PPT/APT (overflow); d/c Pt delivers; wait to transfer to Postpartum or Antepartum Pt admitted to L&D for delivery Check-in to Triage Triage to Decision Admit to Birth Birth to Discharge ALOS: 2.2 ALOS/ Wait Times ALOS: 0.76 Birth to Transfer Transfer to D/c 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 L&D 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 L&D • 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

  6. Current Trend Wow !

  7. Lessons Learned

  8. 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) • WIP = Work in Process • 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

  9. 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

  10. Exercise • Weight loss

  11. 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

  12. Q & A

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