Door To Doc Case Study

DOOR TO DOC IN ED

INTRODUCTION
An overview of the project demonstrates how the Six Sigma DMAIC methodology provided tools to decrease Door-to-Doc times and meet the ED target.
Overcrowding in the ED has the potential to leave without being seen, creates a perception to inefficiency. Which to loss in revenue and could ultimately become a life issue.
DEFINE PHASE
Door to Doc throughput was selected as a project by a Hospital for several reasons, including the opportunity to improve:
Lapses in patient safety and quality of care Patient/family dissatisfaction Patients leaving before medical screening (PLBM) Loss Revenue Privacy Issues Life Safety issues Community perception of inefficiency
Project scope:
The objective of this project
is to decrease the time it takes patients to go from Door to Doc
Problem statement:
The average throughput time of the Door to Doc does not consistently meet the ED target.
Goal:
Reduce the average time
PO BOX 560728 Miami, Fl 33256-0728 Phone: [phone] Fax: [phone] Email: [e-mail]
The following chart shows average time spent on some cases before the changes.
The team consisted of the four Green Belts, managers and staff from the emergency department and registration staff. Serving as the project Champions were the vice president of nursing and the director of the emergency department. An emergency department physician served as physician Champions; their active support were key elements in the success of the project.
The project charter established a focus and direction for the team, and also established parameters for the process beginning and completion. The team developed a process map of the current process. Employees working in the process assisted in verifying the map details.
MEASUREMENT AND A NALYSIS OF THE DATA
The team created a value stream map of the five sub-processes:
1. Patient arrival
2. Patient seen by ERT
3. Patient seen by Nurse
4.
Registration
5. After registration
While analyzing the data by sub-process, the team found that 40 percent of the variation in the process in time was occurring when the patients arrive the ED and explain his/her
Avg. Monthly ED Admitted LOS 5.96.46.96.86.75.25.45.65.866.26.46.66.877.2YTD 2003YTD 2004YTD 2005YTD 2006YTD 2007Hours
PO BOX 560728 Miami, Fl 33256-0728 Phone: [phone] Fax: [phone] Email: [e-mail] symptoms to triage nurse and wait until a doctor is available to examine the patients, in some cases patients did not have the patience to wait for the doctor and left.
This situation created two Critical Total Quality issues.
Decrease Door to Doc time and Decrease LWBS
Data and voice of the staff revealed that opportunity areas were: Registration process Triage Process Lack off in staffing Inappropriate design of the facility
RECOMMENDATION FOR IMPROVEMENT
The team made a recommendation and gained approval from their Champion and Sponsors to immediately eliminate some action that caused delays. In order to develop a standardized process for handling the ED, the team conducted a Work-Out with frontline staff. It resulted in the following improvements: Discontinued ordering of contrast CT 30 minute requirement to be transported to floor once bed available Changed process for Minor Care patients going to X-ray Bypassing triage when ED beds available Implementation of bedside registration Implementation of “Quick Registration” Added 3 ED bed (previous storage area)
PO BOX 560728 Miami, Fl 33256-0728 Phone: [phone] Fax: [phone] Email: [e-mail]
CONTROL
Results after few months showed a significant improvement in door-to-doc and LWBS
times:
A v e r a g e L O S ( H o u r s ) f o r P t s No t A d m it t e d
I n d iv id u a ls U C L = 7 . 4 9 6 , M e a n = 6 . 3 0 7 , L C L = 5 . 1 1 8 ( m R = 2 ) ( t e m p )
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T a r g e t
U C L
M e a n
L C L
ED left without being seen (LWBS)
Recommendation to Control the improve changes
1. Control charges should be analyzed quarterly in order to identify any undesirable pattern or trend.
The following indicators should be part of this quarterly analysis to establish a better control and appropriate monitoring:
Door to Doc time
Door to Registration time
Door to Nurse time
LOS for admitted patients
LOS for Discharge patients
LWBS