GRASS-ROOTS QI
April 1, 1999 2 minutes read
GRASS-ROOTS QI
Our Lady of Lourdes Medical Center in Camden, NJ, accepted General Motors’ invitation to apply GM’s PICOS (achieving peaks of excellence in quality, service, and price) process in the discharge-to-clean-bed cycle. "It was not a glaring problem," notes Eileen Craig, RN, MSN, CPHQ, director of Nursing Performance Improvement. Rather, the 12-month project is an opportunity to integrate functions controlling patient flow through this 377-bed facility.
IMPROVEMENT OPPORTUNITY
Adapting hotel checkout and auto manufacturing standardization techniques, Craig’s team segmented the process:
• paperwork;
• discharge order to departure from bed;
• time to clean bed.
SOLUTIONS
Paperwork:
Eliminate and consolidate forms.Discharge order to patient departure: During admission, discuss estimated discharge time and transportation, and note clothing needs like coats and boots. (An extra overnight stay, due to family schedule conflicts, in one randomly selected case, accounted for order-to-departure time of 1,151 minutes at Project Month 1. A strong argument for advance planning!) Identify discharge wheelchairs with bicycle flags inscribed "discharge express." Use one easy-to-navigate exit for departures.
Time to clean bed: Standardize and teach uniform cleaning procedures to environmental services associates.
Technological support: Identify products to further reduce paperwork and expedite discharge orders (long-term goal).
RESULTS
• Number of discharge forms were down 33%: 18 forms to 14 at Month 3, and 12 at Month 9. Month 12 target is 9 forms.
• Paperwork completion time is down 19%: 108 minutes to 88 minutes at Month 6.
• Order-to-departure cycle is down 79%: 1,151 minutes to 132 minutes at Month 6.
• Time to clean bed is down 63%: 75 minutes to 28 minutes at Month 6.
KEYS TO SUCCESS
"PICOS looks at what’s most important to the patient," Craig explains. "In the discharge, it’s when the doctor says they can go home, writes the prescriptions, and the patient leaves the hospital. Those were the points we concentrated on." They grouped ideas in functional "buckets," such as patient education and environmental services. Each bucket had a departmental champion.
CONTACT
Eileen Craig, Our Lady of Lourdes Hospital, Camden, NJ. Telephone: (609) 757-3759. Fax: (609) 757-3393.
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