Provide one example, with supporting evidence, of nurse involvement in the design and implementation of work flow that resulted in operational improvement, waste reduction, or clinical efficiency. Supporting evidence must be submitted in the form of a graph with a data table that clearly displays the data.
OR
Provide one example, with supporting evidence, of nurse involvement in the design and implementation of work space that resulted in operational improvement, waste reduction, or clinical efficiency. Supporting evidence must be submitted in the form of a graph with a data table that clearly displays the data.
Background At FF Thompson we have patients come through our surgical center for minor procedures. These patients could technically be treated in a "clinic" or "clinical" setting as opposed to a formal operation room (OR). The only suitable available space at Thompson is within the OR. Problem "Clinic" patients are admitted to the OR and discharged from Surgical Care Center (SCC) by a completely different process than patients coming for other types of surgery. Preoperatively all other surgical patients are admitted to the Surgical Care Center (SCC) by the SCC nurses who then discharge them postoperatively from the SCC. The Clinical patients were being admitted and discharged by the OR nurses which resulted in:
These issues put the patients at an increased risk for errors in admission and discharge, and a decrease in OR efficiency. Goal
Description of the Intervention
A Do it Group (DIG) was created in November 2012. This interdisciplinary team included OR schedulers, Nurses from pre-admission testing, OR, Surgical Care nurses and an informatics nurse.
The first step was to identify the current process and a flow diagram was developed to visually describe the current steps.
Admission Process for Clinic Patients 2012
At the second meeting the interdisciplinary team developed a new "ideal state" process (see below). In addition the team created a form to track "key" issues including:
2013 New Admission Process of Clinic Patients Having mapped out the new process the team presented the ideas to the key stakeholders: leadership , MD office staff, OR schedulers and nurses working in pre-admission testing, the surgical care center and the OR. All associates involved in the operationalization of the change received information and education with respect to their role in the smooth and safe transition of clinic patients using the new process.
As depicted above, the process begins with the booking slip. On the booking slip the" clinical" patient type is checked by the physician's office and then the OR scheduler annotates "CLINICAL" in the comment section which shows up on the schedule. Also, to further alert the SCC and OR Associates of the patient's status, the patient's paper chart is placed in a "clinical" binder which is color-coded blue with a "CLINICAL" sticker affixed to the front cover.
The new process was operationalized in January 2013 and the results were tracked from January through June 2013.
Participants
DIG Chair- Catherine Habberfield RN, CNOR , Clinical Nurse Operating Room, Perioperative Services, Department of Nursing DIG member Vickii Bement, RN BSN, CNOR Charge Nurse Operating Room, Perioperative Services, Department of Nursing DIG member Kathy Cooley, RN, BSN, CNOR Informatics Nurse Operating Room, Perioperative Services, Department of Nursing DIG Member Kim Hyde, LPN OR scheduler Operating Room, Perioperative Services, Department of Nursing DIG Member Tammy Jeffrey, RN Clinical Nurse Operating Room, Perioperative Services, Department of Nursing DIG Member Kelly Hennessy, RN Clinical Nurse Pre-admission Testing Center, Perioperative Services, Department of Nursing DIG Member Louise McGuire, RN Clinical Nurse Surgical Care Center, Perioperative Services, Department of Nursing DIG Sponsor Janet Kerr Director of Performance Improvement Finance Department
Outcomes:
The graph demonstrates that the goal of reducing turnover time by at least 50% was met bringing it closer to the 20 minute average turnover time for all other surgical patients.
Exhibit NK6EO.1 OR - DIG board