Assessing Nursing Time Spent Tracking Equipment
University of Michigan Health System (UMHS)
Program and Operations Analysis
Final Report
Submitted to:
Hank Davis
Patient Equipment Manager, Material Service
Frank Krupanksy
Director, Materiel Services
Jackie Lapinski
Project Manager, Children’s and Women’s Project
Submitted by:
Team Number 9, IOE 481:
Kevin Brown
Norman Chao
Benjamin Killmer
Limor Yoeli
Date Submitted:
December 1, 2008
Table of Contents
Executive Summary .......................................................................................................... 4
Introduction ....................................................................................................................... 6
Goals and Objectives .............................................................................................................. 6
Background ............................................................................................................................. 6
Project Scope .......................................................................................................................... 7
Overview of Project .......................................................................................................... 7
Support Required from Operating Entities ............................................................................. 7
Expected Impact ..................................................................................................................... 8
Approach................................................................................................................................. 8
Findings.............................................................................................................................. 9
Nursing Time Spent Tracking Equipment ............................................................................ 10
Nursing Observations ........................................................................................................... 11
Frequency of Equipment Requests ....................................................................................... 11
Tracking Times by Equipment Type .................................................................................... 12
Conclusions ...................................................................................................................... 13
Recommendations ........................................................................................................... 14
Investigate Materiel Services ................................................................................................ 14
Investigate Redistribution of Unit-Owned Equipment Allocation ....................................... 14
Investigate Patient Mobility .................................................................................................. 14
Appendix A: Data Entry Form ...................................................................................... 15
Appendix B: Patient-Owned Equipment ...................................................................... 16
Appendix C: Unit-Owned Equipment .......................................................................... 17
Appendix D: Nursing Personnel Equipment Tracking Flowchart............................. 18
Appendix E: Interview Questions for Nursing Personnel ........................................... 19
Appendix F: Count of Observed Equipment Requiring Active Tracking Time ....... 20
Appendix G: Count of Observed Equipment Requiring Waiting Time .................... 21
Appendix H: Bibliography of Investigated Works from Literature Search ............. 22
2
List of Tables and Figures
Table 1: Observation Times by Nursing Type ............................................................... 9
Table 2: Observation Times by Location........................................................................ 9
Table 3: Summary of Nursing Tracking Times per 8 Hour Shift (Hour:Min:Sec) .. 10
Table 4: Summary of Active Nursing Tracking Time (Hour:Min:Sec)..................... 12
Table 5: Summary of Nursing Waiting Time (Hour:Min:Sec) .................................. 13
Figure 1: Tracking Time Breakdown ........................................................................... 10
Figure 2: Equipment Requests by Nursing Unit .......................................................... 11
Figure 3: Equipment Requests by Equipment Type ................................................... 12
3
Executive Summary
In preparation for the new C.S. Mott Children’s Hospital and Women’s Hospital (C&W),
the University of Michigan Hospital System (UMHS) requested that a team of engineers
investigate the time nursing personnel spend tracking equipment. This report is a detailed
account of our analysis of the current equipment tracking procedure across five nursing
units (PCTU, NICU, 5 East, 5 West and Birthing Center), our evaluation of the procedure
and recommendations for future investigation. Hank Davis, Patient Equipment Manager
of Materiel Services; Frank Krupanksy, Director of Materiel Services and Jackie
Lapinski, Project Manager for Children’s and Women’s Project, asked the team to
quantify the time nursing personnel spend tracking equipment and gain staff level insight
about the pros and cons of the current tracking system.
To develop an initial project approach, a literature search was conducted. The search
focused on the data collection techniques such as Westinghouse Multifactor Pace Rating
System and its rating factors – skill, effort, conditions, and consistency. The literature
search also included research on how nurses spend time working in hospitals and how to
conduct effective time studies.
During the next phase of the project, 12 employees were interviewed for 20 minutes each
to gain staff level insight about the current tracking system. The nursing personnel
unanimously felt that the implementation of the Periodic Automatic Replenishment
(PAR) was a pro because the system greatly reduced the time spent tracking equipment.
The staff felt that a long delivery time was the main con for the current system.
Specifically, 50% of the interviewed nursing personnel perceived a significant amount of
wait time associated with patient mobility and pumps ordered from the Patient Equipment
Department. A lack of unit-owned equipment was expressed by nursing personnel as
well as observed in PCTU. In contrast, NICU never experienced a shortage of unitowned equipment and appears to have an excess inventory of unit-owned equipment.
This equipment disparity was confirmed by PCTU staff who also stated that sometimes
they find it necessary to borrow equipment from NICU or hoard certain types of
equipment to have an extra readily available (specifically pacemakers).
After conducting staff interviews, the current equipment tracking process was defined by
observing the nursing personnel at the hospital. Depending on the nursing unit, 1 to 3
staff members were shadowed and any equipment that the staff member tracked was
recorded. A total of 40 visits to Mott hospital, lasting 2 to 4 hours each, were made to
document the current tracking processes and volume of equipment being tracked. Data
samples were collected across six different shifts – morning, evening, and nighttime, for
both the week and weekend. The team visited all five available nursing units. In total, 73
individual pieces of equipment were observed.
Nursing personnel aggregated across the five units spend approximately 29 minutes per
shift actively tracking equipment. Total equipment tracking time including wait time
ranged from 18 minutes in the NICU to 1.5 hours per shift in the PCTU and Birthing
Center. Of the pieces of equipment that required waiting time, 79% were pumps and
4
patient mobility. Typically, patient mobility equipment required the most waiting time.
After examining the current situation and other references, the team developed several
statistics to illustrate and quantify the differences in equipment tracking across nursing
units and indentified several avenues for further investigation.
Based on the project findings, Materiel Services should investigate the possibility of
expanding the PARs to include other types of equipment. As patient mobility equipment
is typically large, it would be impossible to implement a PAR system due to a lack of
storage space. Also, the demand does not appear large enough to warrant a PAR system
for patient mobility equipment. Instead, UMHS should investigate the routing and order
response process for patient mobility equipment to reduce the delivery lag time. Also,
UMHS should work to develop a method to express the urgency of an equipment request.
Based on observations, Materiel Services should also explore the re-distribution of unitowned equipment across PCTU and NICU.
5
Introduction
UMHS is building the new C&W hospital and is searching for ways to improve current
nursing tasks such as equipment tracking. The Materiel Services department of the
UMHS requested that a team of engineers study the time nursing personnel spend
tracking equipment in C.S. Mott Children’s and Women’s Hospital (Mott).
The purpose of the project is to identify any problematic areas in the equipment tracking
process. This information will be used to influence the design and organization of
equipment in the new C&W hospital. The manager of Patient Equipment is primarily
concerned with the ordering, managing, cleaning, transporting and inventorying of
equipment. The results of the project quantify how much time nursing personnel spend
tracking equipment. This report presents an overview of the project, the findings, the
conclusions and the recommendations.
Goals and Objectives
The goals of the project were to:
•
•
•
Determine how much time nursing personnel spent tracking equipment
Understand which types of equipment were the most problematic to track
Identify which nursing units were having the most difficulty tracking equipment
UMHS will use the project’s findings and recommendations while designing the material
services department at the new C&W hospital to increase the efficiency of the system.
Background
UMHS is building a new C&W hospital and would like to study the current hospital to
identify areas of potential improvement for the new hospital. Previously, UMHS was
interested in the implications of implementing an automated radio-frequency
identification (RFID) tracking system for patient equipment in the new C&W hospital. In
2007, a team of Mechanical and Biomedical Engineers completed a partnership project in
which they analyzed the potential for an RFID system. UMHS did not implement the
RFID tracking system, but requested another study to quantify the amount of time
nursing personnel spend tracking equipment to see if a new system should be
implemented
Prior to this project, a PAR system was implemented to relieve equipment needs in Mott
hospital. The PAR system involves periodic replenishment of frequently used pieces of
equipment by Materiel Services personnel. Each nursing unit typically has a storage
space where frequently used pieces of equipment are stored. Stock levels are checked and
replenished accordingly several times a day by Materiel Services staff. Although no
historical data were collected before the PAR system, UMHS is interested in staff
opinions on the effectiveness of the PAR system.
6
UMHS will use the project’s quantitative data to distinguish problematic areas in the
equipment tracking process. Specifically, UMHS would like a breakdown of the time
spent tracking the following groups of equipment: Beds, Cribs, or Isolettes; Pumps;
Patient Mobility; Unit-Owned Equipment; Accessories and Other. In order isolate and
understand the effectiveness of the PAR system, any equipment that was tracked using
the PAR system was included in the unit-owned equipment category. The tracking
process included ordering, managing, cleaning, transporting and inventorying equipment.
The following nursing units were observed in Mott hospital: 5 East, 5 West, Birthing
Center, Newborn Intensive Care Unit (NICU) and Pediatric Cardio-Thoracic Unit
(PCTU).
Although the project evaluated processes in Mott hospital, the study will be used to
determine if a different tracking system should be implemented in the new C&W
hospital.
As proposed, the following key issues are driving the need for the project:
•
•
•
•
There is a nursing shortage in Mott and in hospitals across the country
There is a lack of equipment storage space in Mott
The new C&W hospital is considering alternate equipment tracking methods
No historical data were collected before the PAR system, but UMHS would like
qualitative data on the effectiveness of the PAR system
Project Scope
This project only focused on the equipment tracking process. Any task not directly
related to the tracking process was not included in the scope of this project. Specifically,
tasks or activities associated with other hospitals or with using the medical equipment
were not studied.
As defined in the project, the equipment tracking process began when a nurse requested
equipment and ended when the nurse received the equipment and completed any
additional cleaning or equipment management needed prior to patient use. The project
included observations concerning which groups of equipment require extra time or
resources and identified any specific problems with particular pieces of equipment.
Plans for the new C&W hospital were not evaluated. The project did not include a return
on investment analysis, although the project findings may be used for such an analysis.
Overview of Project
The project progressed according to the original schedule and proposal definition. The
project tasks were completed on schedule and no significant problems or setbacks
occurred.
Support Required from Operating Entities
The primary parties involved in this project are the Patient Equipment Manager, the
Director of Materiel Services, the Associate Hospital Director, charge nurses, registered
7
nurses, nursing assistant personnel and the Project Manager of the Children’s and
Women’s Project.
Hank Davis, Patient Equipment Manager, provided details of the problem at hand,
requirements, expectations and contact information. He provided background
information on patient equipment including itemized lists and descriptions. He also acted
as a liaison between the team and Materiel Services to ensure full cooperation. Finally,
Hank Davis provided the team with a report that described the number of orders that the
Patient Equipment Department received over a specific week according to shift.
Jackie Lapinski, the Project Coordinator, mentored and guided the team. She helped
maintain analytical quality and a positive client relationship. The project coordinator
provided the team with data collection tools such as stopwatches and clipboards. In
addition, she walked the team through a tour of Mott hospital system and additional
relevant areas. Finally, the project coordinator provided feedback regarding project
progress and assisted the team’s professional development.
Expected Impact
Conclusions derived from the project assessed the current tracking system and included
staff-level insight into the benefits and shortcomings of the current system. This
knowledge will be used to aid the design of the tracking system for the new C&W
hospital. Also, the conclusions from this project will be used to evaluate the impact of
Materiel Services taking over the delivery of patient mobility equipment on tracking
times within the new C&W hospital.
Approach
To determine how much time nursing personnel spend tracking equipment in Mott
hospital, several steps were taken. The team conducted a literature search, interviewed
nursing personnel, observed the nursing units, conducted time studies and analyzed the
collected data.
Literature Search
The team conducted a literature search to understand different time study techniques and
hospital equipment tracking methods. The bulk of the research was on the Westinghouse
Multifactor Pace Rating System and its rating factors – skill, effort, conditions, and
consistency. The team also reviewed research papers outlining how nurses spend time
working in hospitals and how to conduct effective time studies. The knowledge gained
from the literature search aided in the design of our data collection methods and gave the
team a general understanding of the nursing profession. A bibliography of investigated
works can be found in Appendix H.
Personnel Interviews
The project team gathered feedback directly from 12 employees as they tracked
equipment. These employees included nine nurses, two clerks, and one tech. The
nursing interviews lasted approximately 20 minutes each. Working directly with the
nursing personnel ensured that the gathered data is relevant to the tracking process. The
8
questions that the team asked the nursing staff can be found in Appendix F. The
preliminary interviews helped the team gain a basic understanding of the problem areas
in the equipment tracking process.
Workplace Observations and Time Studies
The current equipment tracking process was defined by observing the nursing personnel
work at the hospital. Team members followed 1 to 3 nursing personnel each and
recorded any equipment that the nursing personnel tracked. A total of 40 visits to Mott
hospital, lasting 2 to 4 hours each, were made to document the current tracking processes
and volume of equipment being tracked. The on-site observations were scheduled and
confirmed at least a week in advance to ensure nursing personnel availability.
The team conducted a preliminary time study to define and categorize relevant nursing
tasks. Additionally, the team used a formal time study to quantify the amount of time
nursing personnel spend tracking equipment. Stopwatches were used to measure time
required to track equipment. Data samples were collected across six different shifts –
morning, evening, and nighttime, for both the week and weekend. The team visited all
five available nursing units. In total, 73 individual pieces of equipment were observed.
The team dedicated 118.25 man-hours to observing the equipment tracking process
across the five available units. See Tables 1 and 2 for a breakdown of observation times
by nursing type and location.
Table 1: Observation Times by Nursing Type
Nurses
Clerks
Techs
98.5 hours
16.75 hours
3 hours
Table 2: Observation Times by Location
5 East
5 West
Birthing Center
NICU
PCTU
24.25 hours
16.5 hours
22 hours
18 hours
25 hours
Analysis
The data gathered through observations, interviews, time studies and physical
measurements was combined using Microsoft Excel. The data were organized by type of
equipment, key tasks, shift time, and location using pivot tables. Analysis was conducted
using Microsoft Excel and MiniTab statistical software.
Findings
After the data were analyzed using Microsoft Excel and MiniTab software, several key
findings were made clear. These findings represent sample sizes of only three or more
pieces of equipment to ensure significance. Also, no beds, cribs or isolettes were
observed during any of the data collection sessions.
9
Nursing Time Spent Tracking Equipment
Total tracking time was divided into two categories – active tracking time and waiting
time (see Figure 1).
Total Tracking
Time
Active Tracking
Time
Waiting Time
Figure 1: Tracking Time Breakdown
Table 3 below summarizes nursing tracking times per shift. In terms of total tracking
time, nursing personnel spend 1.25 hours per shift actively tracking and waiting for
equipment. However, there is a wide range of total tracking times among units. PCTU
and Birthing Center nursing personnel spend the most amount of time with an average of
1.5 hours per shift spent actively tracking and waiting for equipment.
The average time per shift that nursing spends only actively tracking equipment is 29
minutes. PCTU and Birthing Center spend the most amount of time actively tracking
equipment with nearly 34 minutes and 33 minutes, respectively, per shift. NICU spends
the least amount of time with 18 minutes per shift.
Table 3: Summary of Nursing Tracking Times per 8 Hour Shift (Hour:Min:Sec)
Overall per Shift
5 East
5 West
Birthing Center
NICU
PCTU
Only Active and Active Waiting
0:29:16
0:23:16
0:28:32
0:33:09
0:18:26
Only Waiting
0:45:35
0:17:03
0:35:36
0:51:55
--
Total
1:14:51
0:40:19
1:04:07
1:25:04
0:18:26
0:33:37
0:53:33
1:27:11
The amount of time that nurses spend only waiting for equipment to arrive was also
investigated. The team observed 14 pieces of equipment that required nursing to wait for
arrival. Four of the 14 observed pieces never arrived during the team’s data collection
session. For the pieces of equipment that did not arrive, the team recorded how long the
pieces were being waited for before the team left. 50% of the observed equipment pieces
that required waiting were observed in the PCTU. PCTU and Birthing Center both
require an average of around 1.5 hours per shift for pieces that required waiting. NICU
did not have any observed pieces of equipment that required waiting times.
10
Nursing Observations
Direct feedback was gathered from 12 employees through interviews. The interview
questions can be found in Appendix F. All 12 employees mentioned the positive effect
that the PAR system had on decreasing tracking times. Since the PAR system includes
the unit-owned equipment, the most frequently ordered equipment type, it significantly
reduces the number of orders and corresponding wait time. Patient Equipment
Department can now respond more rapidly to the remaining orders, reducing overall wait
time.
However, 50% of the interviewed nursing personnel perceived a significant amount of
wait time associated with patient mobility and pumps ordered from the Patient Equipment
Department.
Frequency of Equipment Requests
Equipment was steadily observed over each of the units, signifying that equipment is
requested at a consistent rate across units (see Figure 2).
Pareto Chart of Equipment Requests by Location
80
100
70
60
Count
50
60
40
30
40
20
20
10
0
Location
Count
Percent
Cum %
Percent
80
Birthing Center
18
24.7
24.7
PCTU
18
24.7
49.3
5 West
14
19.2
68.5
NICU
12
16.4
84.9
5 East
11
15.1
100.0
0
Figure 2: Equipment Requests by Nursing Unit
The most frequently observed equipment type was the unit-owned equipment, which
accounted for 42% of the observed equipment (see Figure 3).
11
Pareto Chart of Overall Equipment Requests
80
100
70
60
Count
50
60
40
30
40
20
20
10
0
Equipment Type
Count
Percent
Cum %
Percent
80
s
r ie
y
lit
bi
o
w
o
s
O
s
M
itce
nt
Un
Ac
it e
Pa
31
13
12
42.5
17.8
16.4
42.5
60.3
76.7
d
ne
m
Pu
ps
9
12.3
89.0
er
th
O
0
8
11.0
100.0
Figure 3: Equipment Requests by Equipment Type
Although nursing units were observed over all times of day, 74% of the observed
equipment occurred between 10 a.m. and 10 p.m.
Tracking Times by Equipment Type
Of the 73 observed pieces of equipment, 81% did not require any waiting. The average
active tracking time associated with equipment that does not require waiting is 3.3
minutes, with a standard deviation of 2.6 minutes (see Table 4).
Table 4: Summary of Average Active Nursing Tracking Time (Hour:Min:Sec)
Accessories
Other
Patient Mobility
Pumps
Unit-Owned
Unit Average
5 East
0:03:48
0:02:33
0:02:40
0:10:55
0:02:55
0:03:44
5 West
0:01:46
0:02:38
0:03:53
--
0:01:27
0:02:16
Birthing Center
0:02:13
--
0:02:15
0:01:20
0:03:33
0:02:40
NICU
--
--
--
--
0:04:10
0:04:10
PCTU
0:02:15
0:03:15
0:01:30
--
0:04:28
0:03:53
Equipment Ave.
0:02:22
0:02:42
0:02:40
0:06:07
0:03:47
0:03:19
Around one of every five pieces, or 19%, of equipment required both waiting and active
tracking. The two most common pieces of equipment that required waiting were pumps
and patient mobility, which combined accounted for 11 of the 14 pieces of equipment.
Pumps require an average tracking time of 42 minutes and patient mobility requires 1.25
hours (see Table 5).
12
Table 5: Summary of Average Nursing Waiting Time (Hour:Min:Sec)
5 East
5 West
Birthing Center
NICU
PCTU
Equipment Ave.
Accessories
--2:00:00
--2:00:00
Other
-0:02:00
---0:02:00
Patient Mobility
-3:00:00
--1:26:50
1:50:07
Pumps
0:23:00
0:08:00
0:20:00
-1:01:15
0:42:17
Unit-Owned
-------
Unit Average
0:23:00
0:48:00
1:10:00
-1:12:13
1:01:28
The average combined waiting and active tracking time associated with the pieces of
equipment that required waiting is a little longer than 1 hour. The average pure waiting
time for these pieces of equipment is 54 minutes. However, the standard deviation for
pure waiting time is 52 minutes.
Conclusions
Pure waiting time is a significant contributor to total tracking time for each nursing unit,
except NICU. Waiting times also vary greatly within the units, suggesting that it is
difficult for nursing to predict when ordered equipment will arrive.
Unit-owned equipment is the most frequently tracked type of equipment and is also rarely
ordered since it is replenished through the PAR system. In interviews, nursing often
expressed dissatisfaction about the waiting time to receive patient mobility equipment
and beds. Although beds were never observed, patient mobility was one of the slowest
types of equipment to be tracked. Items such as wheelchairs often had to be ordered
during busy periods and the waiting process frequently required several hours. Based on
the qualitative findings, the PAR system reduces the time necessary to retrieve frequently
needed equipment.
One of the shortcomings of the current hospital has been a lack of standardization in
nursing tasks, as well as facility layouts. Equipment storage systems were not consistent
throughout different units, which increased the time nursing personnel spend tracking
equipment. In most units, unused equipment was placed in the hallways or other empty
spaces because there is a lack of storage space. Several of the designated storage rooms
appeared over-packed and unorganized. The lack of storage space also increased
equipment tracking times.
Management perceptions of the material service delivery times are different from nursing
perspectives. For example, management expected PARs to be checked and replenished
once per hour for each unit. Through interviews, nursing personnel expressed suspicions
that the PARs were being checked less frequently than once per hour. Management also
believed that 90% of all equipment requests were filled within one hour of ordering.
However, nursing personnel felt that requests require more time and this sentiment has
13
been supported by the project’s findings. Delivery times also vary significantly across
nursing units.
Recommendations
Based on the quantitative and qualitative findings of this project and the analysis that was
conducted, the project resulted in several key recommendations. These recommendations
include the investigation of current systems and processes including PAR system,
equipment allocation, and delivery routes.
Investigate Materiel Services
During staff interviews, the success of the PAR system was expressed across the units.
Nursing personnel felt that not having to order equipment for each new patient saved a
large amount of time. Nursing personnel also confirmed that the PAR re-stocking rate is
appropriate for the needs of the units. From the project’s study, PAR-tracked equipment
required an average tracking time, including waiting, of less than 4 minutes per piece of
equipment, compared with an average of more than 1 hour for other types of equipment.
Therefore, the team recommends that Materiel Services investigate the possibility of
expanding the PARs to include other types of equipment. The team also recommends
investigating how to express the urgency of an equipment request so the system is
properly used by nursing personnel.
Investigate Redistribution of Unit-Owned Equipment Allocation
Unit-owned equipment comprised over 70% of tracked equipment for NICU and PTCU.
This high percentage of equipment verifies that unit-owned equipment is critical to both
NICU and PTCU. A lack of unit-owned equipment was expressed by nursing personnel
as well as observed in PCTU. In contrast, NICU never experienced a shortage of unitowned equipment and appears to have an excess inventory of unit-owned equipment.
This equipment disparity was confirmed by PCTU staff who also stated that sometimes
they find it necessary to borrow equipment from NICU or hoard certain types of
equipment to have an extra readily available, specifically pacemakers. The team
recommends that Materiel Services investigate the re-distribution of unit-owned
equipment across PCTU and NICU.
Investigate Patient Mobility
Patient mobility and pumps were the only categories that had a significant number of
equipment pieces require waiting. Patient mobility required an average of 1 hour and 50
minutes of wait time, compared with 40 minutes for pumps. The long wait times
associated with patient mobility were confirmed during staff interviews. As patient
mobility equipment is typically large, it would be impossible to implement a PAR system
due to a lack of storage space. Also, the demand does not appear large enough to warrant
a PAR system for patient mobility equipment. Instead, the team recommends
investigating the routing and order response process for patient mobility equipment as a
means of reducing the lag time associated with delivery.
14
Appendix A: Data Entry Form
15
Appendix B: Patient-Owned Equipment
Patient-Owned Equipment List
Name
Category
Wall Suction*
Accessory
Iv Poles
DME
Wheelchairs
Mobility
Stretchers
Mobility
Alaris Single Pump
DME
Medfusion Syringe Pump*
DME
Flowtron Compression Device
DME
Syringe Pump (Baxter)
DME
Alaris Pump
DME
Kangaroo Feeding Pump
DME
PCA Pump
DME
Warmflo Blood/Solution Warmer
DME
Pacemaker
DME
Omni Flow
DME
Gaymar T-Pad
DME
Bair Hugger
DME
Epidural Pump
DME
Portable Suction
DME
General Care Beds
Mobility
Birthing Beds
Mobility
Cribs
Mobility
Isolettes
Mobility
Marquette Monitor
DME
Blanketroll II
Other
Wound Vac (Rental) ²
DME
HEPA Filter ²
Other
ICP Monitor
DME
Crash Carts
Mobility
Peritoneal Dialysis Cycler
DME
Moblvac
DME
Triology Pump
DME
Wedge Frame
Other
Foot Compression
DME
Flolan Pump
DME
16
Appendix C: Unit-Owned Equipment
17
Appendix D: Nursing Personnel Equipment Tracking Flowchart
Identify equipment
needed
Walk to Clerk
Is equipment
unit owned?
No
Walk to Clean
Room
Request Order
Yes
Search for
equipment
Walk to Storage
Room
No
Walk to Soiled
Room
Equipment
Found?
Wait
Yes
No
Yes
Equipment
Arrive?
Equipment
Clean?
No
Yes
Clean Equipment
Take Equipment to
Room
18
Appendix E: Interview Questions for Nursing Personnel
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Currently, what is the procedure you follow for tracking equipment?
Which equipments do you use most often?
o Can you estimate roughly how many times per day?
Which equipments do you use least often?
o Can you estimate roughly how many times per day?
What is your procedure if tracking a piece of equipment requires two nursing
personnel?
Which equipments do you spend the most of your time tracking?
Which equipments do you spend the least of your time tracking?
Do nursing assistive personnel track equipment?
o How does their level of participation / procedure differ from yours?
Do you have any suggestions for improvements that will decrease the time you
spend tracking patient equipment?
Has equipment tracking has changed for you since the PAR system was added?
o Better or worse?
o What was it like prior to the PAR system?
o How big was the impact of introducing the PAR system?
o Do all nursing personnel use the PAR system?
How do you know where the specific equipment that you are located for is
located?
o Are you ever unable to find the equipment?
o If so, who do you contact?
How would you categorize the equipments that you track daily?
Have you developed any helpful improvisations to locate equipment more easily
(such as post-it notes or handwritten lists)?
Which shifts do you work the most?
What other shifts do you take?
What are the differences that you notice in the time it takes you to track
equipment across the different shifts?
o Across weekend/ week day
o Across different time within one shift
Does the time you spend tracking equipment ever interfere with a task that needs
immediate attention?
19
Appendix F: Count of Observed Equipment Requiring Active Tracking Time
Count of Observed Pieces of Equipment Only Requiring Active Tracking
Accessories Other
Patient Mobility Pumps Unit-Owned
Grand Total
2
3
2
1
2
10
5 East
3
2
2
-3
10
5 West
6
-3
1
6
16
Birthing Center
----12
12
NICU
1
1
1
-8
11
PCTU
12
6
8
2
31
59
Grand Total
20
Appendix G: Count of Observed Equipment Requiring Waiting Time
5 East
5 West
Birthing Center
NICU
PCTU
Grand Total
Count of Observed Pieces of Equipment Requiring Waiting Time
Patient
Accessories Other
Mobility
Pumps Unit-Owned
---1
--
Grand Total
1
-1
2
--
1
--
1
1
---
4
2
---
---
-3
-4
---
-7
1
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Appendix H: Bibliography of Investigated Works from Literature
Search
Buck, James R., and Mark R. Lehto. Introduction to Human Factors and Ergonomics for
Engineers. Danbury: Lawrence Erlbaum Associates, Incorporated, 2007.
Fry, Emory A., and Leslie A. Lenert. "MASCAL: RFID Tracking of Patients, Staff and
Equipment to Enhance Hospital Response to Mass Casualty Events." University
of California San Diego School of Medecine and the San Diego Veterans Affairs
Healthcare System, AMIA 2005 Symposium Proceedings, 2005, San Diego, CA.
PubMed Central. National Institute of Health.
<http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1560691>.
Hendrich, Ann, Marilyn Chow, Boguslaw A. Skierczynski, and Zhenqiang Lu. "A 36Hospital Time and Motion Study: How Do Medical-Surgical Nurses Spend Their
Time?" The Permanente Journal 12 (2008): 25-34.
Lee, Ting-Ting, Mary E. Mills, and Ming-Huei Lu. "Impact of a Nursing Information
System on Practice Patterns in Taiwan." CIN: Computers, Informatics, Nursing
26 (2008): 207-14.
Mayer, Raymond R. Production and Operations Management. Madison, WI: McGrawHill, 1975.
Sangwan, Raghvinder S., Robin G. Qui, and Daniel Jessen. "Using RFID tags for
tracking patients, charts and medical equipment within an integrated health
delivery network." Networking, Sensing and Control, 2005. Proceedings. 2005
IEEE. (2005): 1070-074.
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