CASE STUDY
Process Improvement at Thibodeaux Regional Medical Center
Background
The scope of this project was to understand and map the current state of the processes in the emergency department at Thibodeaux Regional Medical Center(TRMC), managed by Emergency Care Partner’s Louisiana group, Professional Emergency Medicine Management (PEMM). Check and Validate the data that we were receiving in the daily files from hospital by doing physical data collection and run statistical tests; identify root causes for bottlenecks and delays in patient’s stay and provide recommendations to improve throughput.
Our contract at TRMC started in November 2016 and PEMM leadership decided to conduct the evaluation similar to what we had done at St. Tammany Parish Hospital and present our findings with recommendations to the hospital management.
Executive Summary
This case study was performed in the emergency department at Thibodeaux Regional Medical Center in Thibodeaux, Louisiana from March’17 to May’17. At the time of this study, ED was seeing on average 120 pat/day and Median LOS around 160 minutes. ED had 23 beds in total but only 16 on main side were available for 24 hours and other 7 on treat side for 12 hours (10a -10p). The principles of this study were established in line with lean thinking and a proven continuous improvement six sigma methodology called PDCA. We followed the same structure for this project and started our analysis by interviewing medical staff and observe how patients are moved through ED. The we created various value stream maps to calculate value added and nonvalue added activities. At the end of our analysis, we categorized the bottlenecks with recommendations into different groups as shown below and presented it to the hospital management to take further action.
Front End
- Found bottlenecks on the front end in ED from Patient’s arrival to place in bed. Bi-modal distribution of LWBS patients suggested that there was a need for improvement in the early hours of the day (8a -10a).
- The treat side would open at 10 am and patients were waiting longer to be placed in bed during early hours of the day. Gave recommendation to open treat side at 9am as the volume of patients arriving was about the same as at 10 am.
- Rooms D, 4A, 4B, 12, T1A and T1B were under-utilized. Recommended to utilize those beds when Treat side is not used.
Radiology
- Observed order to Start time was taking about 70 minutes in the evening hours and found that the coverage was reduced from 3 to 2 at 5:30 pm. Recommended to add extra coverage or a dedicated Rad tech for ED
- Recommended to utilize PCTs to help in transporting patients to radiology after 5:30 pm and ED nurses after 10 pm
- Kanban system to store and replenish contrasts in ED
Lab
- Sample rejection rate was around 7% and recommended to educate nursing staff on methods of drawing blood samples.
- Recommended to schedule a phlebotomist in ED during peak hours.
Miscellaneous
- PCTs in Sort/Treat side to help in cleaning, transporting, rooming patients.
- Display screen to modify tracker by EMS at ambulance entrance.
Simulation Model
- A generalized simulation model was created for TRMC.
Results
With our constant involvement in ED and with help of our VPO and Providers team, we were able to achieve following results:
- Door to Provider Reduced by 58 % from January 2017 to October 2017.
- Overall LOS reduced by 19% from January 2017 to October 2017.
- LWBS reduced by 50%
Deliverables
- Presentation which included all project related findings, data analysis, observations and recommendations for each of the above-mentioned improvement areas.
- An Effort – Priority – Impact matrix was created, and all recommendations mentioned in the presentation were grouped into each bucket and submitted to the management for review.
Redefining Emergency Medicine Excellence Through Continuous Process Improvement
Our goal at Emergency Care Partners (ECP) is to improve patient experience and satisfaction by optimizing Emergency Department (ED) throughput, highlighting areas of opportunities that yield the biggest improvements, and assist in change management and implementation. If you would like to learn more about our approach with data or if you would like to discuss how we can help your emergency department, contact our team of experts.