Using RTLS, Business Intelligence and
Integrations to Improve Pump Management
The use of organized team efforts to facilitate change in
culture backed by data.
Chris Gutmann, Director of Clinical Engineering
In conjunction with Darcy Hennessey and Brooke Spadaccino (not presenting at HIMSS)
Project Goals
Ensure EVERY patient will have a pump when needed
Multi Disciplinary Team:
•
•
•
Materials Management
Pharmacy
Information Services
•
•
•
Nursing
Clinical Engineering
Operations Support
How will we achieve this?
•
•
•
•
•
Staff will readily release pumps when not in use
Pumps will be available when they call/request
Patients will arrive on units from procedure areas/OR’s /ED with
pumps in place, ( receiving unit staff will give back a pump)
Each area will have the appropriate “safety stock” for unexpected
situations
Identify the “safety stock" needed at entry points in the care
continuum
2
Yale – New Haven Health System
2013 Yale New Haven Health System Profile
k
Yale-New Haven Bridgeport
Hospital
Hospital
Greenwich
Hospital
NEMG
YNHHS
(Total)
Total Licensed Beds*
1,541
383
206
--
2,130
Average Daily Census
1,173.4
267.0
142.4
--
--
Inpatient Discharges
80,503
18,454
12,439
--
11,396
Outpatient Encounters 1,085,738
242,784
296,673
--
1,625,195
Total Assets
$2.8 billion
$443 million
$566 million
$26 million
$3.8 billion
Total Revenue**
$2.4 billion
$445 million
$343 million
$164 million
$3.3 billion
Medical Staff***
Employees****
4,138
11,436
825
2,512
545
1,754
552
1,091
6,060
18529*
3
Y-NHH: A Tradition of Excellence
Nursing continually looks to for opportunities of
systems redesign which solidify our team approach.
4
Yale – New Haven Hospital
The history of Yale-New Haven Hospital extends back to 1826 when the
General Hospital Society of Connecticut was chartered as the first hospital
in Connecticut and the fourth voluntary hospital in the nation. The
hospital rented temporary quarters and raised US$5,000 toward purchase
of land and construction. A new 13-bed hospital opened in 1833
on seven and a half acres of land bordered by Cedar Street and Howard,
Davenport and Congress avenues.
2013:
• 5 Million Square Feet owned and operated by YNHH
•
•
•
•
•
4 main pavilions = 2,000,000 ft2
— 60 Operating Rooms, 25+ procedure rooms
— 1,120 Patient Beds
— Level 1 Trauma in Pediatrics and Adult Emergency Medicine
Park St. - Lab and Pharmacy = 130K ft2
Physicians Building and Psych. Hospital = 100K ft2
Yale School of Medicine adjacent/attached to hospital
Former Hospital of St. Raphael’s = 1,000,000 ft2
5
SOS Alert
Continual crisis episodes sent routine alerts
to the entire organization calling for pumps!
Continual issues add to the alarm fatigue…
Please call the
SRC for pick-up
now.
688-9000
6
Project Charter: Sigma Pump
Participant/Process Representatives
Project Sponsor:
• Sue Fitzsimons – Chief Nursing
Officer
Process Owner:
• Carol Just - Director, Surgical
Services
•Chris Gutmann – Director, Clinical
Engineering
Multi Disciplinary Team
Members:
• Clinical Engineering
• Information Services
• Materials Management
• Nursing
• Operations Support
• Pharmacy
Project Description / Problem Statement
Cycle of distrust: Only broken when everyone cooperates
Sigma pump equipment management including:
• System to Locate Pumps does not identify “pump in
use”
• Procurement
• Inability to get a pump when needed induces lack of
trust in process and hiding of pumps
• Hiding pumps lead to a shortage of pumps
Project Goals
Ensure EVERY patient will have a pump when needed.
How will we achieve this?
• Staff will readily release pumps when not in use
• Pumps will be available when they call/request
• Patients will arrive on units from procedure areas/OR’s
/ED with pumps in place, ( receiving unit staff will give
back a pump)
• Preventative maintenance
• Allocation for each clinical area
Process Scope: In/Out
In Scope:
• York Street Campus, Saint Raphael
Campus
Out of Scope:
• Bridgeport and Greenwich hospitals
Project Y / Key Metrics
• Sigma pump monthly call volume
• Identify the “safety stock" needed at entry points in
the care continuum
• Sigma pump call volume by unit per month
Call Service Response Center and/ or Off Shift
Executive and/or Off Shift Nursing Leader to
deliver pumps and/or go floor by floor in the
hospital to collect unused pumps
Store the pumps in a safe
location in case they are need
for the next patient
• Movement throughout the hospital
• Each area will have the appropriate “safety stock” for
unexpected situations
SIPOC / High Level Process Map for Unit
Sigma pump
needed but none
available
Process Scope: Start/end
Remove the pump(s) from
patient departing the unit
• Average monthly Materials sigma pump job
completion time
Pump(s) received
Place pump(s) on patient
Customer CTQ’s
Pump available
when needed
7
Defining the Available Supply
YNHH Average Monthly Census (by Calendar Year)
Average Midnight Census
2008-09
2010
2011
2012
2013
1
900
UCL=904.5
_
X=878.3
850
LCL=852.0
800
1
750
700
8
t-0
Oc
9
r -0
Ap
tOc
09
0
r- 1
Ap
0
t- 1
Oc
1
r -1
Ap
1
t-1
Oc
2
r- 1
Ap
2
t- 1
Oc
3
r- 1
Ap
1400 pumps purchased in 2009
no additions to date!
8
Sigma Pump Process Map
9
Do We Have Enough Pumps?
All Stakeholders need to buy-in to the process…
Vicious Cycle of Distrust:
Snapshot of audit on 1/26/2012
(5am contact census 923)
No
equipment
churn
Staff Hoard
equipment
An episode
of delay
1500
Crisis Calls
per Month
Equipment
not
available
Patient
criticality
not driving
need
• Total in fleet – 1375
• Entry Points buffer - 359
– IR, HVC Labs, OR, PACU,
– L&D & EDs
– Oncology infusions
1375 (total)
- 452 (noncirculating)
= 923 Available
• Remote Locations - 31
– Ambulatory, Psych
– Dialysis, Pedi Clinic, Urgent care
• Maintenance Process - 17
• Pumps in Waiting - 45
– Material’s pool for distribution
10
Defining the Demand
Data Collection through the call center for materials and Baxter pump
data on infusions started at entry points over the course of a day.
11
Streamlining the Movement Process
12
Streamlining the Movement Process
Process for units:
Process for SOS alert:
• Unit leadership or
• Rounding 3x daily
assigned staff person to
• Safety stock set as a profile
round as soon as alert
for each unit
issued and check with all
• 5S storage areas to define
staff for unused sigma
storage location of “safety
pumps
stock”
• Place unused sigma
• Unused clean equipment
pumps in green bin and
placed in green bins
call SRC 688-9000 for
• Units looks in green bin or
pickup
safety stock before calling
materials for delivery
Process for materials staff:
• Check with charge RN that
Process for EVS staff:
safety stock (red tape with
• Clean equipment is placed
par number) is filled
in green bin for pick up
before removing sigma
pumps from units
• (no clean pumps to be left
in rooms)
• Collect equipment from
green bin
13
Driving Results through Culture Change
• In face of rising census the need to call
the Service Response Center for pumps
has decreased.
• A plateau in reducing the number of calls
for sigma pumps and are look to
reinforce rounding and pilot technology
to continue the downward trend.
14
14
State Monitoring -> Utilization
At Material’s storage
location in WP
basement ready for
shipment to unit
Undergoing service at
clinical engineering
In transit for use
In use at patient bedside
Not in use, at patient bedside
Not in use, in green bin
or safety stock. Ready
for usage by next
patient
15
Score Card:
Unit
EP 7-7
SP 6-1
SP 6-4
Greens
12
23
16
Data Validation Pilot
Asset ID
Delivered
Asset ID
H50203G
EPH50203G
7-7
EP 7-7
99%
1.50%
99%
1.50%
0%
0%
0%
EPH51356G
7-7
EP 7-7
0%
100%
0%
100%
0%
0%
0%
EPH53176G
7-7
EP 7-7
0%
0%
0%
0%0%
100%
0%
H50273G
EPH50273G
7-7
EP 7-7
0%
100%
0%
100%
0%
0%
0%
• Running: time between the “start H51378G
infusion” button is pressed and the H51475G
H51035G
pump completes drug delivery or is H50899G
H50202G
stopped
H50183G
H51179G
• Not Running: amount of time the pump
H50549G
is not infusing
H50537G
H50393G
• Available: amount of time the pump is
H50551G
physically in green bin or safety stock H51390G
H50821G
• Delivered: amount of time the pump H50548G
H50703G
travels from materials storage to a unit
H50469G
H50904G
before used for an infusion
EPH50360G
7-7
EP 7-7 57.97%
57.97%
42.03%
42.03%
0%
0%
0%
EPH51378G
7-7
EP 7-7 3.90%
96.10%
3.90%
96.10%
0%
0%
0%
EPH51475G
7-7
EP 7-7 45.77%
45.77%
54.23%
54.23%
0%
0%
0%
EPH51035G
7-7
EP 7-7 84.35%
84.35%
15.65%
15.65%
0%
0%
0%
EPH50899G
7-7
EP 7-7 63.68%
63.68%
36.32%
36.32%
0%
0%
0%
EPH50202G
7-7
EP 7-7 9.69%
90.31%
9.69%
90.31%
0%
0%
0%
EPH50183G
7-7
EP 7-7 100%
100%
0%
0%0%
0%
0%
EPH51179G
7-7
EP 7-7 78.82%
78.82%
21.18%
21.18%
0%
0%
0%
EPH50549G
7-7
EP 7-7
0%
100%
0%
100%
0%
0%
0%
EPH50537G
7-7
EP 7-7 40.10%
40.10%
59.90%
59.90%
0%
0%
0%
EPH50393G
7-7
EP 7-7
0%
100%
0%
100%
0%
0%
0%
EPH50551G
7-7
EP 7-7 40.38%
40.38%
59.62%
59.62%
0%
0%
0%
EPH51390G
7-7
EP 7-7 41.17%
41.17%
58.83%
58.83%
0%
0%
0%
EPH50821G
7-7
EP 7-7
0%
0%
0%
0%0%
100%
0%
EPH50548G
7-7
EP 7-7
0%
100%
0%
100%
0%
0%
0%
EPH50703G
7-7
EP 7-7
0%
100%
0%
100%
0%
0%
0%
EPH50469G
7-7
EP 7-7
0%
100%
0%
100%
0%
0%
0%
EPH50904G
7-7
EP 7-7 18.34%
18.34%
81.66%
81.66%
0%
0%
0%
H50862G
EPH50862G
7-7
EP 7-7
0%
100%
0%
100%
0%
0%
0%
H50534G
EPH50534G
7-7
EP 7-7 72.83%
72.83%
27.17%
27.17%
0%
0%
0%
Green
Yellow
Red
Running
> 2.4 hrs
Reds
12
4
2
Not Running
Available
>12 hrs
>18 hrs
> 21.6 hrs
>8hrsH51356G
<18hrs
H53176G
>18 hrs
H50360G
Pilot participants: SP 6-1, SP 6-4 and EP 7-7
Running
NotRunning
Running
Not
Available
Running Delivered
Available
Delivere
1
1
16
Dashboard Concept – Info @ Front Lines
Actionable Data
Pilot Studies on clinical units for
profile setting of departments.
Management Report
Managers can view multiple
floors to see a snapshot of the
past 24 hours.
17
Demand is a function of Patient Acuity
Worked with units individually to understand flow and
patient acuity mix to set the proper PAR levels.
SICU
Not all units created equal…
Step Down
ORTHO
18
Improved Utilization
Trust of the front line patient care groups feed a process
which allows for less “stagnant” assets
Step Down 71.5%
SICU 69.6%
ORTHO 68%
SICU 50.6%
Step Down 47.2%
ORTHO 41.2%
19
Questions?
Chris Gutmann, Director of Clinical Engineering
In conjunction with Darcy Hennessey and Brooke Spadaccino (not presenting at HIMSS)