Saturday, November 3, 2012

Improving care transitions: CCRMC RIE/Kaizen Report Out

Last week’s Kaizen report-out focused on improving our patients’ experience as they leave CCRMC and return home. In order to accomplish that goal, a dedicated Kaizen team – comprised of medical, administrative and EVS staff, a social worker and a patient representative – got together to come up with ways to reduce the lead time from when a physician issues a discharge order to when the bed is ready for the next patient in our 4B Med/Surg Unit.

Sometimes the discharge process is unnecessarily long, and that can be frustrating for our patients and our staff. And it doesn’t just affect the patient who is leaving. It means arriving patients must wait longer in the Emergency Department for their rooms to be ready.

One great improvement the team made (with the help of our patient representative) was creating a user-friendly discharge-checklist board in the patient rooms. This board provides a simple visual aid that lets patients know where they are on their journey home. It also helps staff see what patients still need before they leave – everything from whether they have medical supplies to take with them to whether they’ve received a financial consultation to whether they have a ride home. 

One focus of this Rapid Improvement Event was on improving communication between the multiple disciplines involved in discharging a patient. The team worked to create a digital version of the census board on 4B that would make it more clear to the nurses and EVS staff when a doctor has issued the discharge order and a room can be made ready for the next patient. In order to expedite the cleaning of isolated rooms, the Kaizen team put together pre-assembled “precaution bags” our EVS staff can use to clean those rooms safely. This will reduce the amount of time EVS workers spend looking around for all the precaution items they need for those isolated rooms.

Some of their tests included: 

·     Improving upon the front line staff’s Discharge Rounds board to close knowledge and communication gaps and provide a clearer picture of the patient’s journey

·     Having a financial counselor input insurance information before rounds, which has helped the rounds group better identify patient needs and any financial issues before discharge (d/c)

·     Creating standard work, a script and goal discharge order times for 4B d/c rounds to help guide residents and facilitators in presenting cases in a more efficient way

·     Developing a digital census board for the unit, which will show staff when a discharge order has been made in real-time through cclink

·     Developing a communication tool for the Charge Nurse to take notes during rounds of patients ready for discharge. They will hand off to primary nurse to close the knowledge and time gap of when the nurse knows about the discharge order so they can better prepare the patient, which was one of the biggest delays

·     Developing a patient-centered board for the room that clearly shows everyone involved in their care where they are in their discharge journey, what is still needed and any patient/family concerns

·     Developing a pre-packed bundle of supplies for cleaning Precaution Rooms since it would take EVS up to 15 minutes just to search for supplies 

By the end of the week, the RIE team reduced the baseline lead time from the discharge order written to when the patient leaves CCRMC from 120 to 99 minutes resulting in a 17% improvement. More impressively, they reduced the baseline setup time from when the bed is empty to ready for next patient admission from 60 to 34 minutes, resulting in a 43% improvement. Though the goal for the event was to cut these baseline times by 50%, they are getting closer to the mark and I’m excited to see the outcomes after more tests.  

Some of these improvements may only save a few minutes, but as our Chief Medical Officer Dr. David Goldstein put it, minutes matter and they add up. Dr. Goldstein said those are minutes a patient is spending at home instead of the hospital and time staff can spend with other patients who need assistance.  

I want to thank and congratulate all of the people who worked on improving our discharge process. There were unnecessary delays in the system and this Kaizen team is helping to eliminate them. Although the 4B unit’s revamping process is still in the early stages, we’ve already seen a significant reduction in the time it takes to discharge a patient and get a room ready for the next patient. I’m proud of all those who made this Rapid Improvement Event a success. You’ve all made an important contribution to improving our patients’ journey home and our journey to being a model health system for patient-centered care.  

More very soon,

1 comment:

  1. Great Work! I would love to see this work shared with the Behavioral Healthcare Partnership and Psychiatric Units of CCRMC.

    When patients are being held involuntarily, information on discharge or transition to next placement is very important. Communication among disciplines, divisions, the patients and families is also critical. I would love to see the Discharge Check List Board(and White Boards) in patient rooms on all units.

    With the severe shortage of psychiatric beds in California and the nation, every minute really does matter. We are so fortunate to have the 23 psychiatric inpatient beds in our local public hospital. They are like gold!

    Thank you to the Kaizen Team and all involved with this rapid improvement event as this testing work on 4b is so important. I look forward to updates.