patient throughput time tracking system user guide · your data with average and sigma lines to...

Patient Throughput Time Tracking System User Guide

Purpose To accelerate patient throughput, you have to be able to measure and improve the key steps in length of stay (LOS). The purpose of the Patient Throughput Time Tracking System is to simplify and automate the collection and analysis of LOS data. This user guide describes how to use Microsoft Excel to update and maintain the Patient Throughput Time Tracking System. This system uses native Excel capabilities and simple codes to input date/time information and to graph the results. Installation of Templates Installation is easy. Simply copy the templates from the CD to your computer’s hard drive (C drive) or to a shared Network Drive. There are two sets of templates: Control Key and Point and Click. They populate the date and time differently.

1. Point and Click - populate date and time by clicking on the cell or 2. Control Key - populate date and time by using Ctrl-d and Ctrl-t keystrokes.

The LOS templates are a single user license. If you load them on more than one PC or on a shared network drive with multiple users you will need to purchase additional licenses. You can purchase additional licenses by calling 888 468 1537 or on our website at www.qimacros.com. Setting Excel’s Security Level for Macros Since the templates contain macros, you will need to set your Excel security level to medium or low to allow the templates to work properly. To set your Excel security level:

• Open Excel • Select Tools/Macro/Security • Set your Security Level to Medium or Low. • You may need to close and reopen Excel for

the change to take effect.

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If you set your security level to Medium, you will receive the following message whenever you open one of the Patient Throughput templates. Just click on Enable Macros to open the template. If you don’t want to receive this message, set your security level to Low.

Set Workbooks to Automatically Save (Optional) You may want to set Excel to automatically save documents as you work. To do so, select Tools and then Options. Then click on the Save tab. Click in the box next to "Save AutoRecover info every" to turn the autosave function on. In the minutes box, enter how often you want Microsoft Excel to save your workbook.


Time Tracking For Patient Throughput There are several time tracking templates in the system:

• ED (Emergency Department) LOS Template • ED Whiteboard • Floor/Unit LOS Template • Meal Delivery Times Template • Bed Cleaning Times Template • Registration Wait Time Template

Template Overview The ED LOS, Floor LOS, Meal Delivery Time and Bed Cleaning Time templates are all set up in the same way:

• The first worksheet in every Excel workbook is the data entry sheet for date, time and other data.

• The Chart worksheets automatically create control charts and histograms of your data.


• The Pareto worksheets automatically create Pareto charts of your data.

• The final worksheets are for defining your pull down validation lists.

Hidden Columns and Worksheets The data entry worksheets contain hidden columns where the macros convert the date and time data into hours and minutes for graphing. The LOS templates also contain hidden worksheets with pivot tables. Unless you customize your templates, you will not need to access these areas. If you do need to access these areas, go to Format/Column/Unhide or Format/Sheet/Unhide. In the following example the columns between L and Y are hidden.


Data Entry We recommend you track data in a new set of templates each month. Following is a description of how to track and analyze data using these worksheets. The ED LOS worksheet is used as an example, however, the same instructions and basic concepts apply to all of the other templates. Date and time input areas in these templates are shaded in peach, input areas for text and other data are shaded in yellow. Inputting Dates and Times in the Templates using Built-in Short Cuts Entering dates or times into a cell in an Excel worksheet can be error prone—too many "/" and ":" and numbers: 05/14/05 07:05. Here's the good news: we have created easy ways to populate the cells with the current date and time with a single mouse click or keystroke. Just click on a cell to populate date and/or time or use the following shortcuts:

• Date - Ctrl(d) (i.e., hold down the control key and press the d) • Time - Ctrl (t) (i.e., hold down the control key and press t) • Date and Time: Ctrl(t) works for date and time as well (each worksheet is formatted to

show time or date and time as appropriate)

The time tracking data entry sheets are the primary input sheets. Just click on the cells or use the Ctrl d and Ctrl t keystrokes to input dates and times into the peach shaded cells of these worksheets.

Data Entry Errors If the date/time input is earlier than a previous step, the cell will turn reddish-orange indicating that you have a data entry error (see below.) The cells will also turn reddish-orange if you have an empty cell awaiting input. See the following example:


To correct or change a date or time simply click on the cell and edit the data using Excel's formula bar.

Customizing Data Entry Pull Down Lists In addition to inputting date and time, the templates contain other fields for inputting data for names (doctor, housekeeper, tray passer, etc.), diagnosis, bed type, room #, reason for delay, etc. These data fields are used to create Pareto charts of your data. Since Excel requires consistent data descriptions and will only summarize data if the values are EXACTLY the same, we have created pull down lists to help you input consistent data. To access a pull down list, click on the cell (e.g., Doctor). An arrow will appear to the right. Click on the arrow and the pull down list will appear. Move your cursor over the list and click on your selection.


To define the items in your pull down list, click on the appropriate list definition worksheet. Input your items into the first column. The items will then appear on the pull down list on your data entry worksheet in the order they appear on the list definition worksheet. The list can be sorted alphabetically by using Excel’s Data/Sort function. Click on the upper left square above “1” and to the left of “A” to select your whole data sheet. Then select Data/Sort and sort by the heading of column A.

Use of pre-defined pull down lists is recommended but not required. Data that is not on your pull down list can be input in any of the yellow-shaded columns. Analyzing Your Data Once you have input your data, background formulas and macros will calculate the hours and minutes and summarize your data into charts for analyses. Use Control Charts to Evaluate Patient Throughput Use the control charts and histograms to evaluate the stability and capability of your process.


Process stability can be easily determined using control charts. A control chart is a line graph of your data with average and sigma lines to determine stability. The average and sigma lines (+- 1, 2 and 3 sigma) are calculated from the data. The Upper Control Limit (UCL) is the +3 sigma line and the Lower Control Limit (LCL) is the -3 sigma line. 99.7% of all data points should fall between these two limits. How can you tell if a process is stable? Processes are never perfect. Common and special causes of variation make the process perform differently in different situations. Common Cause: Getting a lab result usually takes 20-60 minutes. These are common causes of variation; they exist every day. Special Cause: A lost, mislabeled or contaminated lab sample would be a special cause of variation. Processes that are “out of control” need to be stabilized before they can be improved. Special causes require immediate cause-effect analysis to eliminate the special cause of variation. If you have the QI Macros SPC software for Excel, you can use the stability analysis feature to quickly identify any potentially unstable conditions. If you have the QI Macros, simply click on the control chart (dark boxes will appear at the corners and edges) and then click on the QI Macros pull down menu and select “Analyze Stability.” Any unstable points or conditions will turn red.


If you do not have the QI Macros for Excel you can purchase a copy for $229 at qimacros.com/store/products.php or you can manually determine any unstable points or conditions using the following criteria. Download our free quick reference card from http://www.qimacros.com/sustainaid.pdf.

Use Histograms to Evaluate Process Capability The capability of a process is determined by the customer's (patient or doctor) requirements (i.e. specifications) and a histogram. When a customer defines an upper and a lower specification limit for a product or service all points within the two limits are considered “good.” The process capability index (Cp) indicates how well the data fits between the USL and the LSL. Cpk on the other hand indicates how centered the data is within the range. If both Cp and Cpk are greater than or equal to 1 then the process is considered capable. Cp and Cpk of: © 2005 KnowWare Int’l Inc. www.qimacros.com 9

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• 1.0 is equivalent to 3 sigma. • 1.33 is equivalent to 4 Sigma. • 1.67 is equivalent to 5 Sigma. • 2.0 is equivalent to 6 sigma.

To determine your specification limits ask yourself, or better yet ask your doctors and patients, how long does a patient expect to wait to: see a doctor, be transferred to a bed, receive a meal, etc? At what point does the patient become dissatisfied? Once you have determined the specification limits (usually less than 30 minutes), scroll to the right to reveal the specification limit input cells and input your Upper and Lower Spec limits. In the following example, the upper specification limit is set to 240 minutes and the lower specification limit is set to 0.

If you cannot see the upper/lower spec limits, these rows may be hidden by Excel’s auto filter feature. To reveal these rows, simply click on the arrow in column B1 and select “All”.

Use Pareto Charts to Focus Your Improvement Efforts The Pareto chart combines a bar graph with a cumulative line graph. The bars are placed from left to right in descending order. The cumulative line graph shows the percent contribution of all preceding bars. The Pareto chart shows where effort can be focused for maximum benefit. © 2005 KnowWare Int’l Inc. www.qimacros.com 10

In the example below, the average ED LOS for patients moving to Med/Surg beds was 164 minutes while the average ED LOS for patients moving to Tele beds was 70 minutes. If we wanted to reduce overall average LOS we would consider starting with processes related to the Med/Surg beds first since those would have the most impact on the average LOS.

When inputting data into the Doctor, Bed Type, Reason and other yellow shaded columns of the time tracking worksheets, make sure to use consistent spelling, spacing and capitalization. In the example below, there are 3 separate bars for Med/Surg beds because they were spelled 3 different ways in the input sheet (Med/Surg, Med/ Surg and Med/Surg with a space at the end.) Similarly, there are two bars for Surgery beds (Surg and surg.) Data descriptions must be 100% consistent for the Time Tracking Tool to properly summarize them for use in the Pareto charts. That is why we have created and recommend you use the pre-defined pull down lists.


ED Whiteboard The ED Whiteboard template tracks patients and their lab/radiology results. The first worksheet is the data entry worksheet. Use cells G1 to Z1 to define the lab tests and other items you want to track.

Next input your patient information. Click on the cell in column B to record the exam time by a doctor. When a doctor orders a test, click on the cell for that test to show the test has been ordered. When you click on a cell under the test names, the cell will turn orange and will be populated with an "O" for Ordered. In the example below, an EKG and X-ray were both ordered for patient Jones.

When a test is complete, click on the orange "O" to change the test status. The cell will turn green and be populated with a "C" for Completed. In the example below, the X-ray has been completed but the EKG order is still pending. Note: If you click on the same cell twice in a row, nothing will happen. You must click on another cell between indicating a test was ordered and the test was completed for the cell status to change.

It is important to click on the cell at the same time the test was ordered or completed as this will populate test start and end times in the columns to the right. If you make a mistake, you can click on a cell a third time to clear it or you can move over to the Start/End columns and edit the times.

Once all of the tests for a patient have been completed, double click on the Rm # cell to move the row of data over to the ED Stats sheet. Be careful not to move the data over until all tests are complete as there is no "undo" command for this function. To view the ED Status, click on the ED Stats worksheet.


Detailed Contents of Each Template: • Emergency Department (ED) LOS Template

o ED LOS Times – data entry sheet for ED time tracking o ED Door to Doctor Charts –graphs sign in time to exam time by doctor o ED LOS Charts - graphs sign in time to either discharge time or patient pickup time o ED Bed Charts - graphs bed request to patient pickup time o Pareto Chart by Doctor - comparison of average Door to Doctor time by Doctor o Pareto Chart by Bed Type - comparison of average ED LOS by bed type o Pareto Chart by Diagnosis - comparison of average ED LOS by Diagnosis o Pareto Chart by Delay - comparison of average ED LOS by Reason for Delay o Doctors, Bed Type, Diagnosis and Reason for Delay - pull down list definition

worksheets • ED Whiteboard Template

o ED Whiteboard- data entry sheet for tracking patients and their lab/radiology results o ED Stats -statistics worksheet for collecting data about each patient’s LOS, Lab and

Radiology turnaround times (TAT). o ED Doctors - pull down list definition worksheet

• Floor LOS Template o Floor LOS Times - data entry sheet for Floor time tracking o Floor LOS Chart - graphs date/time arrived to patient discharge or transfer time o Bed Report Chart - graphs bed assigned time to report received time o Report to Floor Chart - graphs report received time to date/time arrived o Floor to Transfer Chart - graphs transfer request time to patient transfer time o Floor to D/C - graphs discharge request time to discharge time o DC to Bed Clean chart - graphs discharge time to bed cleaned time o Pareto Chart by Delay - comparison of average Floor LOS time by reason for delay o Diagnosis, Bed Transfer Type, Reasons - pull down list definition worksheets

• Meal Delivery Times Template o Order to Delivered Times - data entry sheet for meal delivery time tracking o Total Time Charts - graphs time ordered to time delivered to patient o Order to Cook - graphs time ordered to time meal leaves cook station o Order to Leave - - graphs time ordered to time meal leaves kitchen o Leave to Delivered - graphs time meal leaves kitchen to time meal delivered o Pareto by Passer - comparison of average time left kitchen to meal delivered time by

Passer o Tray Passers, Diet - pull down list definitions worksheet

• Bed Cleaning Times Template o Bed Cleaning Times - data entry sheet for bed cleaning time tracking o Total Time Chart - graphs time discharge ordered to time bed cleaning is complete o Pareto by Housekeeper - comparison of average cleaning start to cleaning complete

time by Housekeeper o Housekeepers - pull down list definitions worksheet

• Registration Wait Time Template o Registration Data Sheet - data entry sheet for patient registration times o Regs by Hour - Histogram of Registration by hour o Date vs Minutes - Pivot table of wait times by date by minutes o Ave Wait Time Chart - graphs average registration wait time by day


System Requirements Microsoft Windows 2000-XP Microsoft Excel 2000, XP and 2003. Licensing The Patient Throughput Time Tracking System is a single user license. Therefore, you must buy one copy for every PC you load the software on or for each user if you load the templates on a shared network. Additional copies can be purchased by calling 888 468 1537 or at qimacros.com/store/products.php Customization and Enhancements The Patient Throughput Time Tracking System is written using native Excel capabilities. You can adapt these templates to meet your needs as long as you retain the original copyright and do not try to resell them. If you need help adapting the templates, creating new ones or adding new and improved functionality, we can do it for a reasonable fee. Just send your request to [email protected] and we will send you a free estimate. If you have questions, contact: KnowWare International, Inc. 2696 S. Colorado Blvd., Suite 555 Denver, CO 80222Ph: (303) 756-9144 (888-468-1537) Fax: (303)756-3107 [email protected]


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patient throughput time tracking system user guide · your data with average and sigma lines to...

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