presented by: maria annissia angeles, michele aguilar, jhoenalyn mendoza, sandra mendoza, stacey...
TRANSCRIPT
Quality Improvement in LAC-USC Medical Center’s ER Wait Time
Presented by: Maria Annissia Angeles, Michele Aguilar, Jhoenalyn Mendoza, Sandra Mendoza,
Stacey Kim, & Kristine Sayavong
Los Angeles County – USC Medical Center (LAC-USC)
600-bed public teaching hospital located in the Boyle Heights neighborhood of Los Angeles County of California
Jointly operated by Los Angeles County and the University of Southern California
Problem in LAC-USCLos Angeles Times
reports that the hospital has an average Emergency Wait time of 12 hoursAmbulances are being
divertedPatients are being
transferred to different hospitals for better care
Problem with Long Patient Wait-TimesBad Patient Outcomes
patients leave due to long patient wait-time without even receiving care
Health complicationsambulatory diversion results in
delayed care and progressive pain and suffering
late diagnosis and treatmentDeath
2007: 200 emergency physicians said they’ve knew of patients who died due to long patient wait-time
Why the Need for Improvement?
Faster and efficient care in case of an emergencyBetter and profitable healthcare services providedPatients receives the care that they need when they need
it
Project Aim/GoalTo Reduce patient wait time in the LAC-USC Emergency Room to an average of four-hours
or less to avoid:•Ambulatory diversion•Bad patient outcomes•Health complications•Death
Time-frame: 1-fiscal year
Fishbone Diagram
Pareto Chartu
nd
ers
taffe
d
ign
ora
nce
ab
ou
...
sho
rta
ge
of s
u...
ag
ree
me
nt w
ith...
sho
rta
ge
of
ph
...
lasc
k o
f gro
un
...
no
su
pe
rvis
ion
incr
ea
sed
in m
...
0
10
20
30
40
50
60
70
80
90
100
Possible solutionsMake sure that there is always enough staff on the schedule
especially during peak times as well as always have specialist on call so that they can come in case they are needed.
Better staff training for proper identification of patient condition, so that they can diagnose non-emergencies quickly without taking up one of the emergency beds and redirect non-emergency patients to different providers.
Make sure that the emergency room is equipped with the latest technology, enough medicine and supplies so that the ER could work faster and more efficiently.
Other hospital policies, such as how the X-ray and lab departments prioritize patients, must be reviewed and whenever possible, aligned to meet the needs of the ER.
Plan
Cycle 1: Reschedule shifts to make sure the number and type of staff line up with the numbers and timing of when patients present to the ER
Cycle 4: Work with the X-Ray and lab departments and ask them to give ER patients priority to meet the needs of our department
Cycle 3: Invest in technology, more supplies, and medicine, and be able to allocate them efficiently to have enough available
Cycle 2: Better staff training to identify non-emergency patients and redirect them to other providers without taking up emergency beds
DoEach cycle was implemented individually one after the
other for a period of three months. We recorded the waiting time for each patient in the ER to get an average for each cycle.
Cycle Average
1 3.5 hours
2 5.0 hours
3 4.0 hours
4 4.5 hours
StudyAccording to the findings, we conclude that every cycle
helped reduce the waiting time in the ER significantly.However, the only cycle that was effective in achieving
our goal was the first one by reducing the waiting time less than 4 hours.
ActSince all the cycles were effective in reducing the waiting
time in the ER, we are going to implement them together to have better results.
We will keep track of the wait time average in the ER so we maintain our objective constant.
How are we going to implement Change?
Team Development StagesForming – schedule a time
and day to meet up with our group and prepare a discussion
Storming – collaboration of ideas; picking and choosing the most appropriate topic
Norming – delegating tasks for each member
Performing – executing tasks and meeting deadlines
Team Management Skills
Delegation – Matching team members with tasks and explaining roles and goals
Motivation Theory X and Theory Y
Communication - You need to let your team know what's happening and keep them informed as much as possible
Implementing CQI Programs: Communication - lessens surprise Sponsorship - If there is not strong
leadership behind the change, resistance will keep it from happening.
Coaching - Provides hands-on help to move from A to B. Senior leadership coach management, who coaches their staff members to facilitate behavior change.
Education - Builds knowledge and ability
Understanding the resistance - helps deflect the defensiveness around change, which facilitates moving ahead. When people know ahead of time, there will be less resistance than if it is forced into place in a hurry.
References Billimoria, R. (2013, February 27). Plan Do Study Act [Powerpoint
slides]. Retrieved April 9, 2013, from Beachboard website: https://bbcsulb.desire2learn.com/d2l/lms/content/viewer/main_frame.d2l?ou=182948&tId=1715355.
Gorman, A. (2013, March 5). Officials consider adding more beds to County/USC Medical Center. Los Angeles Times. Retrieved from:http://articles.latimes.com/2013/mar/05/local/la-me-county-usc-20130305.
Los Angeles County & USC Medical Center. (March 2013). Retrieved May 1, 2013 from Wikipedia: http://en.wikipedia.org/wiki/Los_Angeles_County%2BUSC_Medical_Center.
Strategy to reduce emergency department wait times. (2012). Retrieved April 9, 2013, from Newfoundland Labrador website: http://www.health.gov.nl.ca/health/wait_times/emergency_department_strategy.pdf.