Service

Patients and specimen samples showing up without orders was a common occurrence at the East Denver Medical Office lab.

In some cases, orders weren’t in the system because there was confusion between the provider and the nurse about who ordered the test. Other times, patients were directed to the lab without verification of a lab order; and orders simply expired.

This lack of follow-through was inconvenient for the patient, who would have to go back to his or her doctor, or wait for a lab employee to contact the department. In some cases, the patient would have to make a second trip.

So, the East Denver team decided to crack down and got a little creative.

They developed an “enforcement” theme and dressed up in police uniforms to issue citations to “violators” as they tracked patients with no orders.

Departments with the most improvement were honored with coffee and donuts. Those that met the criteria for sustained success were recognized with lunch.

OB/GYN went from 42 “violations” in a seven-week period to 34 in a 10-week period. Pediatrics went from 16 occurrences to a single one in similar time frames.

“At first, we didn’t give them (other departments) the specific data,” lab clinical manager Lucy Tyler says. “Then OB asked for it so we started giving it to everyone.”

The team found by tracking the data, they discovered who needed help, and they worked with that team to solve the problem. By showing each department when they were sending patients and specimens to the lab without orders, they could see they were part of the problem.

In some cases it was a surprise.

“This work supports X-ray and pharmacy, too,” phlebotomist Alma Lahti says. “It’s improving orders in other departments.”

Getting patients where they need to go is essential to the operation of a hospital.

But the process of moving them around for tests, X-rays and other services can be a major source of delay, congestion and patient dissatisfaction.

Members of the Inpatient Transport team at the San Jose Medical Center were assigned to specific departments and different floors. Some locations were busier than others, and some transporters were tasked with more work.

And the waits for patients were at best unpredictable. Nurses and technicians often resorted to pushing occupied beds themselves, rather than waiting for a transporter. Workplace injuries rose and attendance became problematic.

San Jose transporter Dharmesh Patel lobbied for a centralized dispatch system, where calls would come into one place and transporters would wait for assignments. The unit-based team agreed to the project, and it worked.

After the change, transporters completed 68 percent more patient trips per day. Timing also improved. Transporters reached the patient’s location within five minutes of the call 90 percent of the time, as the average response time went from about four minutes to 2.46 minutes.

Savings were found in both reduced overtime and sick days.

With fewer nurses and technicians chipping in to transport patients, the team shaved an estimated $200,000 in annual costs for less overtime. In two years, workplace injuries dropped from seven to one, and sick days decreased from a rate of more than 11 days per employee to save another $15,000.

“Overtime is down, sick time is down and the patients are happy,” Patel says.

Registration reps at two medical offices in the Northwest were struggling to get their work done.

Their job aids were inadequate. And these can prove critical in busy clinics, by providing help with tasks like adding a walk-in patient to the schedule, incorporating additional insurance information or processing payments.

But disorganization, improper documentation and an unclear process meant staff members frequently had to stop and interrupt a co-worker (slowing his or her work down) to find out how to do such tasks—all while the member waited.  

So staff members started a “plan, do, study, act” improvement process.

As a first step, they held a meeting and registration representatives brought all their job aids from their desks, often just stacks of paper in no particular order. In the meeting, they tried to find specific documents and were timed.

The average time it took to locate a document was 26 seconds, and worse, the reference document often couldn’t be found.

The team decided to organize their job aid books in a consistent manner. No matter where a registration representative was sitting, every book was the same. Staff also created instruction sheets on some processes that complemented the job aids. 

Included in the new policy and procedure binders were colored job aids with cover sheets in alphabetical order, and also a step-by-step instruction sheet.

“We’ve heard nothing but good feedback from doing this improvement,” supervisor Colleen Moore says. “Staff have more confidence because they are figuring out the answers to their questions instead of asking.”

After implementing the changes, the team tested the process again and located the correct reference document each time in an average time of three seconds.