G7 Driving Waste Out of the System - C. Kennedy

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<ul><li> 1. Identifying Waste At The Front-LineInstitute for Healthcare ImprovementHospital Inpatient WasteIdentification Tool </li> <li> 2. IHI Hospital Waste Identification Tool How Interior What is It? Try it Out! Health Has Used It Background, Experience, Application </li> <li> 3. IHI Hospital Inpatient Waste Identification ToolWhat Is It? </li> <li> 4. connecting front-line staff with system levelImprovement </li> <li> 5. Procedure Adverse Drug Complications Events Flow Delays Unnecessary HospitalizationsClinical Care Delays Healthcare Associated Infections </li> <li> 6. ..hospital resources that are used, consumed, spent orexpended where, from the perspective of the patient, thehospital, or the community, patient care is not enhanced as aresults of such expenditures (IHI, May 2010) Waste </li> <li> 7. Five DiagnosisModules Module Intended to becustomized for the area of use Patient Patient Module Care ModuleWard Module Treatment Module </li> <li> 8. Identify and categorize actual or potential waste from the perspective of front-line staff Assess if waste is present Move from qualitative to quantitative dataWaste Reduction </li> <li> 9. Qualitative to QuantitativeUse to prioritize action, furtherreview, and develop a businesscase for improvement . </li> <li> 10. Front-Line LeadershipQualitative QuantitativeEvaluation EvaluationModules ImplementSelectedWards Selected StrategiesTool Instruction Decision to ResourceReview FinancialConducted ImplicationsPotential Waste Enriched ReviewID Engagement </li> <li> 11. IHI Hospital Inpatient Waste Identification ToolTry It Out! </li> <li> 12. Try it Out!Ward Module Review Module Instructions Watch Video Complete Ward Module Discuss Results Discuss Next Steps </li> <li> 13. Review Ward ModuleReview Ward Module andInstructions </li> <li> 14. Review Ward ModuleCount Down </li> <li> 15. Review Ward ModuleCount Down </li> <li> 16. Review Ward ModuleCount Down </li> <li> 17. ExperiencePlay Trailer and Video Simulation </li> <li> 18. Waste Tool Trailer </li> <li> 19. Waste Tool Sample Patients What wastes do you identify? What percentage waste is there (of the 3 patients)? What might be some next steps? </li> <li> 20. Waste Tool Sample Patients </li> <li> 21. Discuss Waste Identified, Percentage Waste and Next StepsCount Down </li> <li> 22. Discuss Waste Identified, Percentage Waste and Next StepsCount Down </li> <li> 23. Discuss Waste Identified, Percentage Waste and Next StepsCount Down </li> <li> 24. Discuss Waste Identified, Percentage Waste and Next StepsCount Down </li> <li> 25. Discuss Waste Identified, Percentage Waste and Next StepsCount Down </li> <li> 26. What wastes did your table identify? What percentage waste did you see? What might be some next steps? Debrief </li> <li> 27. IHI Hospital Inpatient Waste Identification ToolHow Interior Health Has Used It </li> <li> 28. Still Early. On the Journey </li> <li> 29. Our ExperienceIdentified a site and an inpatient wardIdentified reviewer (s)Selected module (s)PDSA cycles Trialed and customizedFront-line staff used the tool Indicated yes/no if waste was present At moment of module useTotal # of beds (percentage waste) </li> <li> 30. In PracticeWard Module (Medical &amp; Surgical Wards)Combined Treatment/Ward Module(ICU/SDU)Patient Care Module in Planning Phase(Medical Ward) </li> <li> 31. IHI Waste Tool in 6 NorthSurgical WardModified Ward Module </li> <li> 32. In Practice 6 N Results 6 North Total Waste per audit100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% </li> <li> 33. In Practice 6 N Results Clinical Care Delay70.0%60.0%50.0%40.0% Clinical Care Delay30.0%20.0%10.0% 0.0% Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 </li> <li> 34. In Practice 6 N ResultsClinical Care Delay Diagnostic Imaging Commitment from Leadership to Address Almost Immediate ResultsCreeping up Again Order Delays an Issue </li> <li> 35. In Practice 6 N Results Procedure Complication25.0%20.0%15.0% Procedure Complication10.0% 5.0% 0.0% Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 </li> <li> 36. In Practice 6 N ResultsVenous Thromboembolism Waste Chart Review Project with Surgical Network VTE Prophylaxis CCMPressure Ulcer Waste Focused Project 11 of 33 PatientsSurgical Site InfectionsUrinary Tract Infections </li> <li> 37. Moving Forward 6 NorthClinical Care Delays Procedure Delays VTE Prophylaxis Surgical Network Actions NSQIP (Surgical Site and Urinary Tract Infections)Flow Delays Alternative Level of Care Discharge Orders Progress Notes Targeted Physician Lead Project </li> <li> 38. Reinforces what I knew was a problemHelps to direct changeDeb Chaplain, Director Patient Care Services, RIH 6N Feedback </li> <li> 39. IHI Waste Tool in ICU/SDUIntensive Care/Step Down UnitTreatment/Ward Module </li> <li> 40. In Practice SDU/ICU ICU Total Waste per audit100.0% 90.0% 80.0% 70.0% 60.0% Total 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% </li> <li> 41. In Practice SDU/ICU Invasive Tools 30.0% 25.0% 20.0% 15.0% Invasive Tools 10.0% 5.0% 0.0% </li> <li> 42. In Practice SDU/ICUTargeted Staff Practice Foley Catheters Art Lines Central Lines Versus Peripherally Inserted Central Catheters Richmond Agitation Sedation Scale ScoresTeachable Moments </li> <li> 43. Moving Forward SDU/ICUInterventionsRichmond Agitation Sedation Scale ScoresClinical Care Delays Consult Delays Procedure DelaysFlow Delays End of Life </li> <li> 44. Ive got people disengaging because the system is sooverburdened right now. It [the IHI waste tool] brings theirattention back to providing good, safe, quality care.to getthem [the patient] home.Sandy Semograd, Manager ICU/SDUICU/SDU Feedback </li> <li> 45. A wonderful opportunity to connect with staffand for them to connect in a learning way.Sandy Semograd, Manager ICU/SDUICU/SDU Feedback </li> <li> 46. Moving InformingForward Further Quantitative Data Collection Directing Expanding Additional To Additional Change Sites/Areas Expanding PartneringTo Additional With Modules Finance </li> <li> 47. Sandy Semograd, Manager ICU/SDU ICU/SDU Team Layla Mault, PCC 6 North 6 North Team IH West Quality Team Naomi Erickson (Pressure Ulcers) Julie Wootton (NSQIP) Jennifer Stieda (Patient Module) Jen Treger (Admin Support Extraordinaire) Thank You </li> <li> 48. ?IHI Hospital Inpatient Waste Identification ToolQuestions? </li> <li> 49. Identifying Waste At The Front-LineInstitute for Healthcare ImprovementHospital Inpatient WasteIdentification Tool </li> </ul>