Page 27 - Hoag Orthopedic Institute 2012 Outcomes Report

HOI is committed to an active performance improvement (PI) program for maintaining a constant state of awareness of the systems and processes that affect patient care. This awareness is critical to identifying and preventing defects, and pinpointing opportunities for improvement. PI projects incorporate LEAN techniques, pioneered by the Toyota Motor Corporation in the manufacturing sector and increasingly accepted in the healthcare industry as the gold standard for process improvement. The following grid lists HOI’s clinical PI initiatives:
DMAIC NAME
DEPARTMENTS INVOLVED
BRIEF DESCRIPTION
Astromorph Study
Blood Bank
Brace and Orthotic Control
Delirium Care
Dementia Care
Femoral Nerve Block (FNB)
Hand Hygiene
HCAHPS - Medication Communication
HCAHPS - Noise Reduction
Lower Dose of Intrathecal Bupivicaine Usage
Patients Specific Medication Schedule
PEC HOI - Coding
SCIP Beta-Blocker
SCIP - Temperature Management
Turnover Time - OR
Volume Resuscitation Project
Perioperative team
Multidisciplinary team - anesthesiologists, Perioperative Services, Blood Bank
Multi-Disciplinary team - Nursing, Central HHNB
Nursing
Nursing
Multidisciplinary team - PACU, floor nurse, Physical Therapy
Multidisciplinary team - hospital wide
HOI Medical Surgical Units
HOI Medical Surgical Units
Perioperative team
Interdisciplinary team - perioperative team, Nursing, Pharmacy
Multidisciplinary team - orthopedic surgeons, hospitalists, anesthesiologists, coders and revenue cycle staff
Interdisciplinary team - perioperative team, Anesthesia
Perioperative team
Operating Room
Perioperative team
Raw data collection from December 1 to December 29, 2011, with gradual measured decrease in the use of intrathecal Astromorph for the purpose of decreasing side effects.
Decrease frequent calls to Blood Bank for verification of blood ordered, which disrupts workflow of Blood Bank personnel.
Missed orders for braces and other orthotic devices. Prevention of missed orders targeted.
Post-op mature patients often present with delirium. Help ID condition and treat, measure by decreasing restraints.
Help ID post-op mature patients with unknown and history of dementia. Identify condition and treat, measure by decreasing restraints.
PT and floor nursing staff were not routinely informed of one-time FNB so patients had an increase risk of falls. Sticker use began in order to identify those patients.
Hand hygiene is directed to infection rates. Goal is to have 100% compliance.
Some patients on nursing units perceived that staff did not explain side effects of new medications administered. Goal is to increase scores 5% within two quarters.
Improve HCAHPS score for quietness of environment on nursing units.
Earlier ambulation of patient on nursing unit, increase in patient satisfaction and cost savings while gradually decreasing the amounts of intrathecal Bupivicaine used for decreased time in PACU.
HOI PACU, in collaboration with HOI PRE OP/PAS, Med/Surg units and Pharmacy, identified patients who need to maintain a specific medication regimen. These patients are questioned intensely regarding their medication schedule and receive their medication on their own dosing schedule to prevent complication throughout their entire stay in HOI Hospital.
Review of coding process to capture accurate patient conditions during hospitalization.
Beta-blocker administration and documentation to meet SCIP guidelines and achieve 100% compliance from random audits.
Correct inconsistencies found when active patient warming occurs and in how temperatures are measured and recorded.
HOI OR must maintain room turnovers not to exceed 25 minutes. Currently, room turnovers for joint cases have been 26 minutes while spine cases have been 22 minutes.
Review of hypovolemia and hypotension in post-op patients that resulted in new onset of renal dysfunction. New protocols implemented to ensure renal function maintenance.
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