Prinng: 2016 Healthcare Systems Process Improvement...
Transcript of Prinng: 2016 Healthcare Systems Process Improvement...
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Background Surgical Instrument Cycle • Opera&ngRooms(ORs)–Dictatesurgicalinstrumentneeds• CentralSterileProcessingDepartment(CSPD)–Reprocessesand
managesallinstrumentsflowingtoandfromtheORs
Impact/Results
Acknowledgements • IOECollaborators:MarkGrum,RamaMwenesi• UMHSCollaborators:PatBuchanan,ElvieCasper,NicoleFarquhar,Laura
Giuffrida,JuliaJackson,ReneePrince,AmyRedmond,andJaniaTorreblanca• ThisresearchisgenerouslysupportedbytheCenterforHealthcareEngineering
andPaRentSafety,theSethBonderFoundaRon,theDoctorsCompanyFoundaRon,theUMCollegeofEngineering,andtheMichiganQualitySystemGroup
A Systematic Approach to Improving the Reprocessing of Surgical Instruments Bill Zhang, Leah Raschid, Nina Scheinberg, Amy Cohn PhD, James P. Bagian MD PE, Joseph DeRosier PE CSP, Shawn Murphy MSN RN
2016HealthcareSystemsProcessImprovementConference
Problem Statement • ORStaffreportedfrequentproblemsrelatedtothereprocessing
anddeliveryofsurgicalinstruments• 51%ofproblemsreportedwereduetobioburden/debris
– 47%ofthesewerecausedbytheMinorNeuroset
• EfficiencyinsurgicalinstrumentreprocessingisacriRcalchallengeforhospitalsnaRonwide
• MeeRngreprocessingstandardsrequirescomplexcoordinaRonofmulRplehospitalfunc&ons,resources,andstakeholders
• TheUniversityofMichiganHealthSystem(UMHS)conducted51,583casesandreprocessed~15,000items/dayinFY14
• Insufficientlycleanedinstrumentscontaining“bioburden”ordebrisnegaRvelyimpactinsRtuRonaloutcomemeasures,mostnotablypa&entsafety
Pa&entSafety Quality Timeliness Financials
StaffSa&sfac&on
Goal
Tohaveallitemsrequiredforthepropercareofthepa1entavailableatthe1meofsurgery,properlycleaned,sterilized,andinworkingcondi6on–whileensuringtheefficientuseofresources.
Solution Approach • Examinedtheimpactsthati)instrumentcleanabilityandii)set
configura&onshaveonreprocessingoutcomes• Hypothesis1:Instrumentdesignfeaturesimpactcleanability• Hypothesis2:SeparaRnghigh-fromlow-riskinstruments
improvesreprocessingoutcomes• Usedprocess-flowmappingtechniquestodefinethecurrentstate• CreatedatooltoevaluatehowconfiguraRonimpactsreprocessing
outcomesandtorecommendopRmalsetconfiguraRons• CurrentlydevelopingaCleanabilityIndexingsysteminpartnershipwith
clinicians
Pilot • Separatedkerrisons(thehighest-riskinstruments)fromMinorNeuroSet• DemonstratedhowthecleanabilityandconfiguraRonofinstrumentsina
setdirectlyimpactoutcomemeasures
1)Purchased
2)Catalogued
3)Groupedintosets
4)StoredinCSPD
5)UsedinORs
6)DecontaminatedinCSPD
7)AssembledinCSPD
8)SterilizedinCSPD
Instruments Set
Scenario1:NoSepara&on
Benefitsobservedassociatedwiththisinterven&on:1. Nobioburdenincidentswiththekerrisonsets2. TheaveragenumberofmonthlybioburdenincidentsinMinor
Neurodecreasedfrom15to33. TheamountofRmesavedintheORswillresultinannualsavingsof
$23,490to$236,290(calculatedusingaveragebioburdeneventdelaysof5minutesto30minutes)
4. Anengineeringapproachtoconfiguringsets(e.g.,high-riskinstrumentseparaRon)canincreasequality
Scenario2:KerrisonSepara&on
0 5 10 15 20 25 30 35 40 45
SET,MINORNEUROUH
STRYKER
ZIMMER
SET,URQUHARTLEGHOLDERORTHOUH
POWER,MIDASREXLEGENDFOOTCONTROLNEUROUH
POWER,ANSPACHTRANSPHENOIDALDRILLNEUROUH
ORTHODRILL
SET,WRIGHTEVOLUTIONPATELLAORTHOUH
COLONOSCOPE
SENTINEL
TRIATHLON
WRIGHTMEDICAL
NumberofIncidents
SetN
ame
SetsMostCommonlyReportedtoContainBioburden/DebrisJune2014–Feb2015
Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15
MinorNeuroaccountedfor~47%ofallevents
43
4
12
7 7
1
4
12 2
10
1
2
3
4
5
6
7
8
9
January February March April May July August September October November December January
2015 2016
Num
bero
fInciden
ts
Month/Year
MinorNeuroBioburden/DebrisIncidentsJan2015-Jan2016
Pre-SeparaRon Post-SeparaRon
0 5 10 15 20 25 30 35 40 45
SET,MINORNEUROUH
SET,WRIGHTEVOLUTION…
SET,FOOTORTHOUH
POWER,MIDASREXLEGEND…
SET,THOMPSONGENERAL…
SET,LAMINECTOMYIINEUROUH
SET,ZIMMERPERSONA…
SET,TRIATHLONEXTRAS…
SET,SCOPEHOGIKYAN…
SET,IMPLANTSYNTHES…
SET,IMPLANTZIMMER…
SET,BLAHAEVOLUTION…
NumberofIncidents
SetN
ame
SetsMostCommonlyReportedtoContainBioburden/DebrisAug2015-Jan2016(Post-separa&on)
Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16
MinorNeuroaccountsfor~13%ofallEvents