This article is part of a new series called RPIW Spotlight. In it, we highlight recent Rapid Process Improvement Workshops (RPIW) that appear to be “bright spots.” RPIWs provide a great opportunity to focus on a specific issue and test small changes intended to make care better and safer for patients. It’s incredible what can be achieved over the course of a 5-day workshop. However, the end of an RPIW is only the beginning for the staff in that area, as they then work to sustain the gains made and continue to build upon those improvements.
What was the problem?
Patients being transferred from the Emergency Department to the Medicine unit of Moose Jaw Union Hospital often experienced long waits. Staff had trouble finding clean rooms because there was no way to alert housekeeping staff when rooms needed to be cleaned. Because there was no standard way to set up rooms after they had been cleaned, they were not consistently stocked with all of the supplies required to care for patients. As well, information about the patient’s condition, medications, and special needs (for example, whether the patient needs to be isolated, or whether they are at a higher risk of falls) was often missing or incomplete upon when the patient arrived on the unit, delaying treatment or requiring the patient to be moved to a different room. As well, the admission process was lengthy, with nurses required to fill out multiple forms – some requiring duplicate information. Staff didn’t know whether all of this information was still required for every patient.
What improvements were made?
The improvement team developed signals for housekeeping to alert them when a room needs to be cleaned. They also developed standard work for cleaning and stocking rooms, so rooms are set up properly for the arrival of new patients. Admission paperwork was reduced from 23 pieces to 10, and a standard process and check sheet were created, to ensure that all required information is collected. The team also developed a work standard and check sheet for transferring important patient information to staff on the Medicine unit.
How are things better for patients/clients?
Patients are now waiting significantly less time to be transferred from the ED to Medicine. The time from when the admission order is written to when the admission process on the unit is complete has fallen by nearly 90 minutes, from 2 hours 27 minutes to just over an hour. Eliminating the duplication in the admission process means that patients don’t have to provide the same information multiple times. When patients arrive on the unit, their room is clean and fully stocked so they are able to settle in immediately. Check sheets and standard patient transfer processes mean that important information about the patient’s condition, medications, and special needs is complete when the patient arrives on the unit, so that there are no delays in beginning treatment.
Comments from RPIW participants
“Any change that is positive and good for both workers and patients can never be a negative.” (Patient advisor)