Evaluation of a children's hospital's direct admission process to improve outcomes and efficiency of care.

Process improvement;Admissions;Work flows;Patient safety;Prospective;Process mapping

Scott R. Hoover

University:University of Louisville

Department:Industrial Engineering

关键词: Process improvement;    Admissions;    Work flows;    Patient safety;    Prospective;    Process mapping;   

Others  :  https://ir.library.louisville.edu/cgi/viewcontent.cgi?article=1631&context=etd

美国|英语

来源: The Universite of Louisville's Institutional Repository

【 摘 要 】

Delays in healthcare process pose problems in hospitals today (Lane, Monefeldt, & Rosenhead, 2000; Horwitz & Bradley, 2009; Stone, Boehme, Mundorff, Maloney, & Sriastava, 2010). These delays create risk for patient by preventing timely delivery of care. The purpose of this research was to evaluate the Admission Express Unit (AEU) of Kosair Children's Hospital (KCH) for potential areas for improvement to aide in decreasing the amount of time required for patients to be processed through the unit. This research was a prospective study using direct observations from both the patient's point of view and the nurse's point of view. Also, one-on-one interviews were performed with doctors, nurses, nurse managers, and administrators who work in or with the AEU to gain a complete understanding of the process. From this research, several observations were made about the AEU that identified some of the issues related to increased amount of time for patients to travel through the system. First, it was discovered that 37% of the deviated events or failures, which resulted in delays, were found in the Nurse Assessment step. Secondly, it was discovered that the Intake Process had the highest average time to recover from delays, averaging 32 minutes. Thirdly, it was discovered that, according to the staff and personnel of the AEU, there are five problematic process steps, out of approximately thirty, in the AEU process: 1) Patient Pre-Arrival Work, 2) Patient Roomed AEU, 3) Physician Arrives, 4) Make/View/Receive Orders, and 5) Call Report to Floor. Next, it was discovered that of the five problems identified by the staff and personnel, three of the problem areas are dependent on one another; Patient Pre-Arrival Work, Physicians Arrives, and Make/View/Receive Orders. Finally, it was discovered that the Call-in/Patient Pre-Arrival Process is the most important process of the AEU relative to the amount of time patients spend in the unit because it is the first step the patient incurs. If it does not go smoothly the remaining processes are affected. Also, the remaining process steps cannot be executed until the Call-in/Patient Pre-Arrival Process is successfully completed. From these findings, a list of recommendations was created to provide to Kosair Children's Hospital that could potentially assist in improving the AEU process. First, the AEU needs to identify one point of contact for the primary care physicians to call to admit patients. Also, whoever the contact person is, they need to develop an intake form