SWAT Process Improvement Final Presentation Team 11 Julian Covos Tasha Gillum Allie Mukavitz Thomas White April 18, 2017 Tom

Introduction SWAT - Specialized Workforce for Acute Transport June 2016 policy change doubled the number of transport requests SWAT desires improved coordination between SWAT team, bedside nurses, and procedural units  Tom

Goals & Objectives Goal: Analyze the current process flow of transporting patients and identify key areas for improvement concerning awareness, communication, readiness, and efficiency Objectives: Identify coordination issues in the current patient transport process  Formulate solutions to improve patient handoffs Make recommendations on how these solutions should be implemented  Tom Coordination includes: communication, awareness, readiness, and efficiency

Engineering Methodologies Tom

Methods for Collected Data Task Sample Size On-site Observations​ 8 weeks​ Shadowing Transport Runs 25 runs​ SWAT Team Interviews 16 nurses Team 11 Time Studies 23 runs Previous IOE 481 Team Time Studies 180 runs SWAT Database 6683 entries SWAT Clipboard Data 910 entries Bedside Nurse Interviews 12 nurses Tom

Lean Methods of Analysis Went to the Gemba to observe operations first hand Developed a process map Searched for 8 wastes in SWAT transport Tom

Statistical Methods of Analysis Performed a paired t-tests to validate observations Studied time distributions to understand tendency and spread Stratified data to compare performance metrics Tom

Findings & Conclusions Tasha

Transport Process Has High Variation Tasha 9% of runs encounter procedural delays

15 Minute Policy Involves Built-In Waste Tasha 29%of runs are +/- five minutes late

SWAT Database Highlights 7 Frequented Units Tom

Patient Readiness in 7 Frequented Units Tom

Bedside Nurse Interview Matrix Julian Source: Nurse Interviews       Sample Size: 12 Nurses      Interview Period: March 2017

Nurses Desire Reliability and Communication SWAT does not inform nurses of late arrivals, procedure delays, or return times Bedside nurses can confidently predict SWAT arrivals and returns unless SWAT or the procedure is delayed 5/12 nurses interviewed nurses were interested in notifications when SWAT encounters a delay Julian Most nurses are comfortable predicting the return of a patient based on known procedure times  Team 11's time studies show that this notification would only be necessary on approximately 9% of transports   Interviewed nurses were supportive of additional communication 

Recommendations Allie

Weekly Huddles with Bedside Nurses Allie Issues between SWAT and bedside nurses are not resolved  Variation in readiness percentages suggest room for improvement  More communication is desired by interviewed bedside nurses

Meet with Bedside Nurses Regularly At meetings (aka "huddles") SWAT and bedside nurses would: Track metrics and assess overall impressions​ Communicate issues  Identify problem solvers Brainstorm solutions Ensure follow ups and create accountability Reduce inconsistency 

Proposed Huddle Template

Proposed Huddle Template

Huddles Will Foster Communication Improved communication Improved trust and relations between Bedside Nurses and SWAT Opportunity for feedback on piloted changes and problem solving Allie

Page Bedside Nurses Julian

Recall Relevant Findings Procedural delays of 10+ min occur in 9% of runs Interviewed bedside nurses desired more communication with SWAT Shares SWAT definition of Patient Readiness 12/12 Expects SWAT 15 min before procedure 7/12 Before SWAT arrival transfers patient to transport monitors 3/12 Would like pager warning before SWAT returns 5/12 Julian

Page Bedside Nurses to Improve Coordination Team 11 recommends three additional points of contact to improve coordination: When SWAT is running late When procedure is delayed Before returning to inpatient units Julian

Late SWAT Arrival On the rare occasion when SWAT is late for a transport, Team 11 recommends they send a page to inform the nurse Expected Impact: Prevent patients for waiting unnecessarily on stretchers Save bedside nurses time spend monitoring patients Improve trust in SWAT team Julian

Procedural Delay X-Ray is delayed 15 mins Team 11 recommends SWAT send out a page notifying nurses of any procedural delay Expected Impact: Pages will reduce waste Nurses could be more productive and better prepared for patient hand-offs Improving coordination on the 9% of transports that experience >10 min delays X-Ray is delayed 15 mins Julian Waste include waiting and underutilized time

SWAT's Return Team 11 recommends SWAT send pages to notify nurses when they are returning from the procedure with the patient Expected Impact: Will serve as an early "call light" so nurses can prepare for patient hand-off Will improve coordination between SWAT and the nurses Without burdening nurses – according to nurse interviews Julian

Pages Will Improve Hand-Off Coordination Improved communication Improved coordination for efficient patient hand-offs Reduced waiting time Julian

Flexible Bedside Preparation Times Tasha

Change 15 Minute Policy to Plan for Variation

When the Bedside Nurse Prepares Patient

When SWAT and Bedside Nurse Prep Patient

Flexible Bedside Prep Will Add Value Plan for variation in patient mobility Reduced risk of waiting waste and lost table time Increased nurse utilization (Save 11 hours each week)

Steps Toward Process Improvement Tasha

Thank You! Tasha

SWAT Clipboard Sheet

Accountability and Performance IOE professor's dissertation discussed an experiment that studied accountability and its positive influence on performance Improved performance can be incentivized by increasing the accountability of the individuals involved in handoffs

Process Map (90th percentile observations)

Discrepancy in Collected Data Research suggests that default in data entry may explain discrepancy If SWAT fails to provide an assessment of readiness, the field remains unchecked The database may grossly underestimate patient readiness Johnson and Goldstein We will continue with the SWAT team member responsible for data entry and analysis to understand the data entry procedures and improve the accuracy

Observation Data Validation Paired t-test suggests average times in January 2017 tend to be 45 sec shorter than November 2016 data