slide1 l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Using Six Sigma to Improve Cardiac Medication Administration and CAT Scan Capacity PowerPoint Presentation
Download Presentation
Using Six Sigma to Improve Cardiac Medication Administration and CAT Scan Capacity

Loading in 2 Seconds...

play fullscreen
1 / 25

Using Six Sigma to Improve Cardiac Medication Administration and CAT Scan Capacity - PowerPoint PPT Presentation


  • 167 Views
  • Uploaded on

Using Six Sigma to Improve Cardiac Medication Administration and CAT Scan Capacity. Harvard Quality Colloquium August 22, 2005. Susan McGann RN, BSN Adrienne Elberfeld. Virtua Health….Today. Four hospital system in Southern New Jersey Two Long Term Care Facilities Two Home Health Agencies

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Using Six Sigma to Improve Cardiac Medication Administration and CAT Scan Capacity' - Samuel


Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

Using Six Sigma to Improve Cardiac Medication Administration and CAT Scan Capacity

Harvard Quality Colloquium

August 22, 2005

Susan McGann RN, BSN

Adrienne Elberfeld

virtua health today
Virtua Health….Today
  • Four hospital system in Southern New Jersey
  • Two Long Term Care Facilities
  • Two Home Health Agencies
  • Two Free Standing Surgical Centers
  • Ambulatory Care - Camden
  • Fitness Center
  • 8000 employees + 2000 physicians
  • 7,000 deliveries
  • $650 million in revenues
  • STAR Culture
the virtua star

ExcellentService

ResourceStewardship

Clinical

Quality

& Safety

Outstanding

Patient

Experience

CaringCulture

BestPeople

The Virtua STAR
virtua health the future
Virtua Health…. The Future
  • Change in HR Structure and Process
  • Focus on Programs of Excellence
  • Building a Greenfield site
    • Potential consolidation of multiple sites
  • Ambulatory Strategy
  • Growth in the North
  • Additional Strategic Partnerships
slide6

Define

R0 Cardiac Medication Indicators

Project Description:

Increase quality of patient care by use/non-use and appropriate documentation of aspirin, beta-blockers, and ACE inhibitors in CHF or AMI patients to achieve or exceed Virtua benchmark goals.

Project Title: Cardiac Medication:

Indicators Six Sigma Project

Sponsors: Jim Dwyer, Ann Campbell, Ellen Guarnieri, Adrienne Kirby, Mike Kotzen

Champions: Pat Orchard & Jane Slaterbeck

Master BB: Mark Van Kooy

Black Belt: Adrienne Elberfeld

Green Belt: Ted Gall

Finance Approver: Gerry Lowe

Project Start Date: July 22, 2002

Project Scope:

To have all four acute care facilities, within all medical disciplines, meet the standards of Core/JCAHO guidelines

Potential Benefits:

To achieve improved outcomes for patients with AMI/CHF diagnosis by adhering to evidence based practice through education, documentation, and compliance while meeting regulatory standards and enhancing quality of patient care at Virtua.

Team Members: Jay Brewin, Darlene Euler, Christine Gerber, Val Torres, Kathy Halstead, Kathy Plumb, Cindy D’Esterre, Lori Edell, Heather Scheckner, Angie Smolskis, Pat Quackenbush, Ronald Kieft, Michelle Weaks, Robert Singer, Vince Spagnuolo, Steve Fox

Alignment with Strategic Plan:IIA-Cardiology; Global MICP Goals for Virtua.

slide7

Measure

QRA Chart Review Gage R&R

  • During this gage, it was determined that there was variation between the QRA’s review of charts
  • A Workout was held on September 18th with the QRA’s and Case Management Directors to develop SOP’s in reviewing of all CHF and AMI patients for core indicators

Percentage of time QRA’s agreed on assessment

slide8

Analyze

Root Cause Analysis Identified through Containment

Issue

Concurrent reviews of AMI & CHF patients

Ongoing information needed for medical staff and nursing staff of the core indicators

Cardiac POE needs real time access to Clinical Care Advisor to review data

Solution

Met with CCM’s, Case Management & Quality to educate on core indicators

Identified key areas, (physician lounges, Cardiac specific units, nursing specific areas), and posted storyboards that are the same throughout the system

Cardiac POE Director, AVP, and Black Belt access to system; able to review ongoing and provide feedback to Case Management

Conclusion

Between Case Management, Quality & Nursing charts needed to coordinate efforts in reviewing charts

Have team members develop a storyboard template with pathways and indicators to be available at key areas throughout the facility

Coordinate with IS accessibility to system

Who

Team members specific to campus, J. Slaterbeck, A.Elberfeld

Team members specific to campus

C. Mullin, J. Slaterbeck, B. Rodin

slide9

Analyze

Root Cause Analysis Identified through Containment (continued)

Who

Case Mtg Directors, Quality Directors, CCM’s

Case Mgt, QRA’s, B. Singer, V. Spagnuolo, S. Fox

Case Mgt, QRA’s, C. Mullin, A. Elberfeld

Solution

Case Management to take the lead on chart reviews for patients with AMI, CHF & related diagnosis. Support from quality & nursing

If nursing and/or case mgt has direct contact with physician, they give necessary feedback. Next step is the facility QRA and physician champion

Case Management to coordinate with nursing & quality; all paperwork forwarded to Black Belt & VP Quality

Conclusion

Nursing, case management and quality are all reviewing charts; need to coordinate efforts in regard to the indicators

Need one point person to communicate directly with physicians in a timely manner

Need to appoint point people within the facility to ensure that activities are being completed and coordinated

Issue

Who is going to perform the task of daily chart reviews concurrent with care?

Communication with physicians per need for documentation

Coordination of ongoing chart reviews, documentation completion, and data information

slide10

Improve

Root Cause Analysis

slide11

Control

Realized Results of Implemented Solutions

Improvement

Y Benefit

Quality Benefit

slide12

Control

P Chart

slide13

Define

R0 CT Scan Capacity

Project Description:

Increase capacity by reducing in and out of room times for the CT Scan to adhere to GE industry benchmarks of 15 minutes without contrast and 25 minutes of with contrast.

Project Title: CT Scan Six Sigma Project

Sponsors: Ellen

Master BB: Adrienne Elberfeld

Black Belt: Kathy Eichlin

Green Belt: John Graydon, Wendy Seiler

Finance Approver: Rex Rueblinger

Project Start Date: July 28, 2004

Project Scope:

Marlton CT Scan department

Potential Benefits:

A more efficient process will lead to increased capacity thereby increasing opportunities for increased volumes.

Team Members: Beverly Crawford, Melody DeLaurentis, JoAnn Domingo, Audrey Fley, Darryl Fussell, Cynthia Koller, Jo Nast, Heather Pierce, Donna Rapp, Elizabeth Zadsielski

Alignment with Strategic Plan:Resource Stewardship

Patient Satisfaction

slide14

Measure

Descriptive Statistics

  • Y1
  • Mean = 13.6333
  • Standard Deviation = 6.6993
  • Z Score = 2.78
  • Mode = 9
  • Percent of Defects = 11.1%
  • Y2
  • Mean = 23.4688
  • Standard Deviation = 6.9884
  • Z Score = 1.90
  • Mode = 20, 21 and 24
  • Percent of Defects = 34.4%
slide15

Measure

Descriptive Statistics

  • Y3
  • Mean = 11.3671
  • Standard Deviation = 4.2972
  • Z Score = 2.58
  • Mode = 7
  • Percent of Defects = 13.98%

The problem is too much standard deviation/ variation in the process!!

slide16

Analyze

T Test for Equal Variances

Levene’s test –Test for equal variances for continuous data that is not normally distributed.

There is a statistical difference in the variance!

slide17

Analyze

Pareto Chart

A Pareto Chart shows where within the process the greatest opportunity exists for improvement. Here we see opportunities for the need for improvement with interruptions caused by the phone, door interruptions and assistance needed to move a patient resulting in 59 % of CAT Scan Delays.Use LEAN opportunities to streamline process.

slide18

Improve

2 Sample T Test & ANOVA Y1

Y1-Abdomen-Pelvis Without Contrast

One-way ANOVA: Before-Avg. Time, After-Avg. Time

Analysis of Variance

Source DF SS MS F P

Factor 1 426.2 426.2 8.04 0.005

Error 166 8794.9 53.0

Total 167 9221.1

Individual 95% CIs For Mean

Based on Pooled StDev

Level N Mean StDev ---------+---------+---------+-------

Before-A 62 14.952 9.869 (--------*--------)

After-Av 106 11.651 5.214 (------*------)

---------+---------+---------+-------

Pooled StDev = 7.279 12.0 14.0 16.0

Two-sample T for Before-Avg. Time vs After-Avg. Time

N Mean StDev SE Mean

Before-A 62 14.95 9.87 1.3

After-Av 106 11.65 5.21 0.51

Difference = mu Before-Avg. Time - mu After-Avg. Time

Estimate for difference: 3.30

95% CI for difference: (0.61, 5.99)

T-Test of difference = 0 (vs not =): T-Value = 2.44

P-Value = 0.017 DF = 81

P-value was less than .05, therefore, there is a statistical difference!

slide19

Improve

2 Sample T Test & ANOVA Y1

Y2-Abdomen-Pelvis With Contrast

One-way ANOVA: Before-Avg. Time, After-Avg. Time

Analysis of Variance

Source DF SS MS F P

Factor 1 361.4 361.4 9.15 0.004

Error 50 1974.9 39.5

Total 51 2336.3

Individual 95% CIs For Mean

Based on Pooled StDev

Level N Mean StDev ----------+---------+---------+------

Before-A 32 23.469 6.988 (------*-------)

After-Av 20 18.050 4.925 (--------*---------)

----------+---------+---------+------

Pooled StDev = 6.285 18.0 21.0 24.0

Two-sample T for Before-Avg. Time vs After-Avg. Time

N Mean StDev SE Mean

Before-A 32 23.47 6.99 1.2

After-Av 20 18.05 4.93 1.1

Difference = mu Before-Avg. Time - mu After-Avg. Time

Estimate for difference: 5.42

95% CI for difference: (2.09, 8.74)

T-Test of difference = 0 (vs not =): T-Value = 3.27

P-Value = 0.002 DF = 49

P-value was less than .05, therefore, there is a statistical difference!

slide20

Improve

Mood’s Median/Non-Normal Data

P-value was less than .05, therefore, there is a statistical difference!

slide21

Control

Can we see the improvement on the chart post SOP implementation?

I & MR Control Chart

Take away: Process is capable and in control.

slide22

Control

Can we see the improvement on the chart post SOP implementation?

I & MR Control Chart

Take away: Process is capable and in control.

slide23

Control

Can we see the improvement on the chart post SOP implementation?

I & MR Control Chart

Take away: Process is capable and in control.

the other results
The “other results”
  • Ahead of the ‘hospital’ curve
  • Data driven organization
  • The dots are connected:
    • Strategy, Operations, Quality, Finance, People
  • Financial up-spin
  • Leadership Development

The Results Go Well Beyond the Project!