IMPROVING THE PROCESS OF TRANSFERRING … · 2019. 9. 19. · Ismail, Wong Pui Kuan, Hsu Taryar,...
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IMPROVING THE PROCESS OF TRANSFERRING CARDIOTHORACIC SURGERY PATIENTS TO STEPDOWN WARDS Frequent delays in the patient stepdown process had led to long waiting time in accepting post-surgery patients to CTICU. The project aimed to develop an efficient and safe methods of transferring patients to stepdown care and freeing up beds for post-operative patients. Prior to the new implementation, the transfer process requires two staff and there are numerous delays in many touch points. The narrow hallways and small lifts added to the challenges and risks during the transfer. The risks include chest drainage tubing getting caught in-between bed’s rail and bed knocking against walls of narrow hallways and lift doors. Our project had met our goal for Zero Clinical Incidences. We eliminated the waiting time wasted for porter and Transfer Time was Reduced by 59% due to the streamlined process. The manpower required to transfer patient was also reduced from 2 to 1 staff. Clinical Incidences Clinical Incidences Transfer Time Time saved for stepdown transfer in Ward 56 and CTICU were estimated to be 2141 and 2409hours per annum respectively. Total time saved was 4550hours per annum. Reduce Patient Step-Down Transfer Time by 50% Zero Clinical Incidences During Patient Step-Down Transfers SOLUTION The solution used wheelchairs as an alterative to replace beds during patients’ stepdown transfer. The implementation processes went through three Plan- Do-Check-Action (PDCA) cycles: In PDCA 1- Patients or staff had to hold the chest drainage system that is attached to the patient during stepdown transfer. The wheelchair had no place to hold the chest drainage. In PDCA 2- A metal bar was installed at the back of the wheelchair to hang the chest drain. The solution worked well for patients’ transfer to general ward but was not feasible for CTICU post-surgery patients who have two chest drainage systems upon stepdown transfer. In PDCA3- The team re-modified the wheelchair with a double metal casing installed behind the wheelchair to hold up to two chest drainage systems securely. The casing is removable and compatible with the standard wheelchairs used in the hospital. CONCLUSION The re-designed work process leads to better collaboration and coordination of care for patients. Nurses are able to spend more quality time for patient care. Streamline process in patients’ transfer has shortened turnover time for bed to be ready for new admission. This has facilitated the potential bed crunch at emergency department and post operation patients. The team has demonstrated their commitment in constantly seeking improvement for smoother inter- institutional processes to achieve better patient service and patient-centric motto: “ Target Zero Harm”. Sustainability: The team perform regular data collection in the clinical areas and tracks our data through weekly run chart. The same modified patients’ wheelchair transfer mode is used to ensure that the solutions are implemented uniformly. Total Time Saved = 4550 hours/ annum Total Time Saved = 4550 hours/ annum Ward 56 ICA Total time taken (patient transfer) No. of Manpower (patient transfer) Total time per patient transfer Number of patients/ annum Total man hours/ annum Time Saved Pre implementation 46 minutes 2 92 minutes 2007 3077.4 2141 hours Post implementation 28 minutes 1 28 minutes 2007 936.6 CTICU Total time taken (patient transfer) No. of Manpower (patient transfer) Total time per patient transfer Number of patients/ annum Total man hours/ annum Time Saved Pre implementation 83 minutes 2 166 minutes 1095 3029.5 2409 hours Post implementation 34 minutes 1 34 minutes 1095 620.5 Lew Chee Kwong, Yeoh Lee Shien, Wu Wing Yin, Yang Yang, Abegail M Donalanta ,Rosnita Binte Ismail, Wong Pui Kuan, Hsu Taryar, Jacqueline Huo
Transcript of IMPROVING THE PROCESS OF TRANSFERRING … · 2019. 9. 19. · Ismail, Wong Pui Kuan, Hsu Taryar,...
IMPROVING THE PROCESS OF TRANSFERRING CARDIOTHORACIC SURGERY PATIENTS TO STEPDOWN WARDS
Frequent delays in the patient stepdown process had led to long waiting time in accepting post-surgery patients to CTICU. The project aimed to develop anefficient and safe methods of transferring patients to stepdown care and freeing up beds for post-operative patients. Prior to the new implementation, thetransfer process requires two staff and there are numerous delays in many touch points. The narrow hallways and small lifts added to the challenges and risksduring the transfer. The risks include chest drainage tubing getting caught in-between bed’s rail and bed knocking against walls of narrow hallways and liftdoors.
Our project had met our goal for Zero Clinical Incidences. We eliminated the
waiting time wasted for porter and Transfer Time was Reduced by 59%due to the streamlined process. The manpower required to transfer patient
was also reduced from 2 to 1 staff.
Clinical IncidencesClinical Incidences
Transfer Time
Time saved for stepdown transfer in Ward 56 and CTICU were estimated tobe 2141 and 2409hours per annum respectively. Total time saved was4550hours per annum.
Reduce Patient Step-Down Transfer Time by 50%
Zero Clinical Incidences During Patient Step-Down Transfers
SOLUTIONThe solution used wheelchairs as an alterative to replace beds during patients’stepdown transfer. The implementation processes went through three Plan-Do-Check-Action (PDCA) cycles:
In PDCA 1- Patients or staff had to holdthe chest drainage system that isattached to the patient during stepdowntransfer. The wheelchair had no place tohold the chest drainage.
In PDCA 2- A metal bar was installed at theback of the wheelchair to hang the chest drain.The solution worked well for patients’ transferto general ward but was not feasible for CTICUpost-surgery patients who have two chestdrainage systems upon stepdown transfer.
In PDCA3- The team re-modified thewheelchair with a double metal casinginstalled behind the wheelchair to holdup to two chest drainage systemssecurely. The casing is removable andcompatible with the standardwheelchairs used in the hospital.
CONCLUSIONThe re-designed work process leads to better collaboration and coordination of care for patients. Nurses are able to spend more quality time for patient care.Streamline process in patients’ transfer has shortened turnover time for bed to be ready for new admission. This has facilitated the potential bed crunch atemergency department and post operation patients. The team has demonstrated their commitment in constantly seeking improvement for smoother inter-institutional processes to achieve better patient service and patient-centric motto: “ Target Zero Harm”.
Sustainability: The team perform regular data collection in the
clinical areas and tracks our data through weekly run chart. The samemodified patients’ wheelchair transfer mode is used to ensure that thesolutions are implemented uniformly.
Total Time Saved = 4550 hours/ annumTotal Time Saved = 4550 hours/ annum
Ward 56 ICA
Total timetaken (patienttransfer)
No. ofManpower(patienttransfer)
Total time perpatient transfer
Number ofpatients/annum
Total manhours/ annum
Time Saved
Pre implementation46 minutes 2 92 minutes 2007 3077.4
2141hoursPost implementation
28 minutes 1 28 minutes 2007 936.6
CTICU
Total timetaken (patienttransfer)
No. ofManpower(patienttransfer)
Total time perpatient transfer
Number ofpatients/annum
Total manhours/ annum
Time Saved
Preimplementation
83 minutes 2 166 minutes 1095 3029.52409hoursPost
implementation34 minutes 1 34 minutes 1095 620.5
Lew Chee Kwong, Yeoh Lee Shien, Wu Wing Yin,Yang Yang, Abegail M Donalanta ,Rosnita BinteIsmail, Wong Pui Kuan, Hsu Taryar, Jacqueline Huo
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