Kaizen Quick Hits is a new monthly feature on BetterHealthCare.ca. In it, you’ll find short summaries of recently completed Rapid Process Improvement Workshops (RPIWs) from around the province. These paragraphs provide a snapshot of what improvement teams were able to accomplish in one week. True success over the longer term depends on the effort that follows an RPIW, as staff in that area work to hold and build on the gains achieved. If you have questions about these improvements, we encourage you to contact the host organization’s Kaizen Promotion Office.
Sustaining Reduced Wait Time from Emergency Department Triage to Care (RPIW #4, PAPHR)
Patients in Prince Albert Parkland who require an initial assessment in the Emergency Department continue to have shorter waits thanks to an RPIW held three months ago. Prior to the improvement workshop, patients were waiting on average 3:30 hours from the time they were triaged to the time they received care; now they’re waiting less than half an hour. By creating standard work processes, re-organizing the ER entrance area, involving hospital volunteers, and posting new signage, triage nurses are now able to perform their work without interruptions and patients are better prepared to proceed to admission. As part of this Rapid Process Improvement Workshop, the team also developed new educational pamphlets for patients explaining how urgency of care needs are assessed in the ED (CTAS scoring) and community resources.
Continue to Eliminate Defect in Registration Process of the Pediatric Outpatient Department at Royal University Hospital (RPIW #37, SHR)
Patients visiting Outpatient Pediatrics at Saskatoon’s Royal University Hospital are still being registered quickly and efficiently, thanks to changes introduced as part of an RPIW held six months ago. Visitors now register directly at the department; the new one-stop process has streamlined registration and reduced the distance parents must walk with their children. As part of the improvement workshop, staff balanced workloads of registration clerks and eliminated waste in the old process; these changes increased productivity so that a registration clerk can now assist 5 patients per hour, as compared to 1 patient per hour. As well, the introduction of a standard appointment letter that includes important details (i.e., directions, what to bring, parking information) ensures families arrive at the department better prepared.
Continue to improve the flow of the clients experience at the Pediatric Therapies at Lloydminster Co-op Plaza (RPIW #7, PNHRA)
Three months after an RPIW to improve patient flow, Prairie North’s Pediatric Therapies is still seeing more patients every month as a result of the changes. By creating new standard work for clerical and pediatric therapy staff, and reorganizing the therapy room to make better use of the space and time with patients, the clinic’s productivity has increased from 38 to 80 appointments/month. As well, changes in how the receptionist handles incoming calls ensures patients are acknowledged immediately patients and directed to the correct department.
Reducing Wait Time and Re-route Outpatients to the Primary Health Care Clinic when Appropriate (RPIW #1, KTHR)
Patients visiting the outpatient emergency clinic in Kelsey Trail are waiting less than 15 minutes to be seen thanks to changes introduced as part of an RPIW three months ago. Staff created new standard processes and better signage to redirect patients with less-urgent care needs to the region’s primary care clinic, thus ensuring patients are seeing the right provider in the right time at the right place. As part of this improvement effort, staff also converted a file room into space practitioners can use for testing patients.
Faster Transcription Process at the Saskatchewan Cancer Agency (RPIW #3, SCA)
The Saskatchewan Cancer Agency is continuing to transcribe patient information into medical records on the same day it is collected three months after improving the process through an RPIW. Thanks to process changes, staff has reduced the backlog of records from 1124 to 11 jobs. Creation of standard work for transcribing, better communication between departments, and coaching physicians on how to improve the quality of their dictation have all helped improve staff satisfaction; they like being able to finish today’s work today.
Implementing team-based care in the Heart Function Clinic (RPIW #28, RQHR)
Patients attending the Heart Function Clinic in Regina Qu’Appelle are now waiting and walking less thanks to the introduction of a team approach to care delivery, better communication and documentation. New patients now complete their clinic visit in 1.5 hours instead of 2, while returning patients spend about 45 minutes in the clinic (down from 1.5 hours). New patients have to walk 68% less, because providers and services now come to the patient, rather than having the patient walk to each area. As well, new patients now see all providers (nurse, physician, pharmacist, and dietitian) at the same time, so they share their information story once rather than multiple times, saving time and frustration.
Decreased time for Clinical Teaching Unit consult in the Emergency Department (RPIW #63, SHR)
Thanks to new standard work and better set-up, consultants working in Saskatoon Health Region’s Clinical Teaching Unit are now creating patient care plans in half the time they used to spend (from 4 hours and 10 minutes to 2 hours / 52% reduction).The improvement means the Unit can potentially increase the number of patient consults in a 12-hour shift from 4.4 to 14.3. Changes in this process means patients are getting to the CTU unit more quickly, and are not being moved until admission orders have been prepared, thus ensuring they receive the care they require.
Less time spent waiting in Emergency Room in Yorkton (RPIW #4, Sunrise Health Region)
Patients who come to the Emergency Department in Yorkton are spending less time waiting, thanks to improvements in how supplies are stocked, better communication and patient flow, and creation of a consultant work space. People with less urgent and non-urgent care needs (CTAS 4 and 5 patients) now wait 43 minutes from the time they are triaged by ED staff until they are discharged (down from 1 hour and 37 minutes / a 56% reduction). This improvement workshop also focused on infection control; the team saw improvements in compliance with hand washing protocols and room turnover practices.
Improve timely access to therapies in FHHR (RPIW #22, FHHR)
Patients in Five Hills Health Region can now access outpatient therapy services more quickly, as a result of a new “quick assessment” process to determine the most appropriate treatment plan for them. With the new intake process, the time from when the most urgent patients are referred for therapy until they have been assessed by a physiotherapist is now 68% shorter (from 12 to 4 days).Staff also reduced the number of forms in the filing cabinet from 4355 to 2561 (41% reduction), making it quicker and easier for them to find the most appropriate information for patients. A standard was developed for intake, assessments, and charting to ensure consistency and a A plan has been put into place to eliminate the current waitlist.
Improved patient information flow at the Allan Blair Cancer Centre (RPIW #6, SCA)
Patient information is being recorded in their charts more quickly now, thanks to changes in how staff at Allan Blair Cancer Centre handle mail. The Patient Information Services (PIS) Mail Clerk is now walking 46% less to retrieve the mail. As well, this project reduced by 35% the time it takes for staff to enter patient information into patient charts (from 2 hours and 22 minutes to 1 hour and 35 minutes). A process to ensure consistent and timely documentation of patient calls in the electronic chart was also developed, which has improved communication and reduced the need for PIS staff to file paper slips.