Department of Respiratory Care University Hospital Time Study and Workflow Evaluation for EKG Support IOE 481 17F7- Final-Presentation Angjela Keci, Erin Moore and Lennox Ramsey December 12, 2017 Mark Konkle, MPA, RRT Administrative Director, Adult Respiratory Care, Client Jonathan Lee, Continuous Improvement Specialist Intermediate, Coordinator John Li, Management Engineer Fellow, Coordinator Dr. Mark Van Oyen, Associate Professor, Supervising Instructor Mary Duck, Industrial Engineer Expert, Liaison to UMHS Good Evening, we are team 7. This semester we worked with the Respiratory Care Department evaluating the EKG support they provide to the hospital.

Agenda Introductions Project Background Key Issues Project Scope Goals and Objectives Methods Findings Conclusions Recommendations Expected Impact Today we will be giving you all a brief project background, our goals and objectives, our design methods and fi

Team Introduction Angjela Keci Erin Moore Lennox Ramsey

Project Introduction Respiratory Care Unit Primary Task: servicing adult with severe respiratory issues Secondary Task: providing EKG coverage Project Task: Determining the opportunity cost of performing EKG services The RC department is comprised of Techs and Therapist who service adults with severe respiratory issue. Since 2015 the departemnt techs now have the added task of helping provide EKG coverage in the hospital. Our task was to determin the opportuniy cost of this added task.

Project Background EKG Increase in Demand EKG support demand has increased since leaving the Cardiology Department Technician EKG Support Hours (weekly schedule, includes Federal holidays) EKG Increase in Demand 20000 Number of EKGs 2007 2017 Year Mon Tue Wed Thu Fri Sat Sun 6am-6pm Off On 6pm-6am

Project Background (cont.) Four EKG services coverage areas - Six blood-gas labs - Six technicians work across the 6 labs Two out of the six technicians are assigned to EKG services

Project Background (cont.) RCU technicians take approximately 22-30 minutes for an EKG Cardiology technicians take 7 minutes for an EKG Shift Times between Cardiology and RCU are staggering

Key Issues • Performing an EKG is out of the job scope for RCU technicians • Transitioning shifts between RCU and Cardiology causes inconsistent g EKG coverage • Providing EKGs within the RCU is an unknown opportunity cost

Project Scope In Scope: Observing EKG services performed by RCU Documenting issues the technicians faced Out of Scope: Studying individual task load Traveling to Towsley Center, Taubman Center, Cardiology, or Mott Children's Hospital

Goal and Objectives Goal: Determine the opportunity costs of EKG testing and improve the average EKG service times of the RCU Objectives: Collecting EKG travel and service time data and service issues Conducting surveys with technicians to learn of standard of care issues

Methods (cont.) Observations October Sunday Monday Tuesday Wednesday Thursday Friday Saturday 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 The team’s observation techniques involved following one technician at time, noting their EKG practices, and asking questions about their job between October 4th through October 25th between 8pm - 11pm. However, only October 4th through October 18th were used for pure observations. During that time, the team observed 8 technicians and saw 22 EKGs performed. The rest of the time, October 19th to October 25th,was used to build and receive feedback on the data collection tool used for the time studies and the survey questions.

Methods (cont.) Time Study Time Study Dates: October 27th to November 27th Total Collected: 1,546 EKG tests To perform the time studies, the team built a self collection data tool during the observation period. The team choose to use a self data collection tool because of the technicians’ late hours (6pm to 6am) and the inability of the team to manually collect the data at the hospital during those hours. During the observation period when the preliminary tool was created, the team followed the technicians and filled out the tool themselves to see if any data fields were missing. Then the team released the preliminary tool to the technicians to see how accurately the tool could collect data. The final tool was distributed to the technicians on October 27th,and between October 27th to November 27th, 1,546 EKG tests were performed by technicians.

Methods (cont.) Survey The survey was developed while following technicians during the observation period and asking questions about their job. The survey contains 13 question. To distribute the survey efficiently, the client uploaded the survey to Qualtrics. Along with Qualtrics ability to efficiently distribution surveys, it also makes it easier to analyze the survey responses. The surveys were distributed on XX date and BLANK surveys responses have been received at this point. http://qualtrics.wp.st-andrews.ac.uk/2014/07/more-meaningful-variable-names/

EKG Service Plus Travel (minutes) Findings EKG Service Plus Travel (minutes) Sample Size: 1546; Source: IOE 481 Team; Collection Period: Oct. 27 - Nov. 27, 2017 Occurrences Average Margin of Error Lower Upper 1546 15.43 0.26 15.17 15.69 Z Score =NormsInv(0.95)* standard deviation / sqrt(occurrences)

EKG Service Time Plus Travel (minutes) Findings (cont.) EKG Service Time Plus Travel (minutes) Sample Size: 1546; Source: IOE 481 Team; Collection Period: Oct. 27 - Nov. 27, 2017 Issues Occurrences Margin of Error Average Lower Upper None 1221 0.27 14.62 14.35 14.89 O 178 0.87 18.14 17.27 19.01 P 95 1.02 17.83 16.81 18.85 M 26 1.96 18.23 16.27 20.19 O,P 18 2.93 23.11 26.04 Unknown 3 1.98 19.66 17.69 21.64 M,P 2 2.47 27.50 25.03 29.97 B 1 0.00 14.00 M,P,O 32.00 O,M 30.00 Key: B - Barcode, M - Machine, O - Other Patient Delay, P - Precaution

Findings (cont.) Time Lost per Year Sample Size: 1546; Source: IOE 481 Team; Collection Period: Oct. 27 - Nov. 27, 2017 Occurrences Extra Service Time per EKG(minutes) Time lost over the study (hours) Expected loss over the year(hours) Machine (M) 30 3.61 1.8 21 Other Patient Delay (O) 198 3.52 11.62 135 Precautions (P) 116 3.21 6.2 72

EKG Service Time Plus Travel (minutes) Findings (cont.) EKG Service Time Plus Travel (minutes) Sample Size: 1546; Source: IOE 481 Team; Collection Period: Oct. 27 - Nov. 27, 2017 EKG Type Occurrences Margin of Error Average Lower Upper Stat 893 0.34 16.06 15.72 16.40 Routine 535 0.41 14.35 13.94 14.76 Timed 74 1.33 14.82 13.50 16.15 Urgent 31 2.03 16.74 14.71 18.77 Code 11 3.62 19.18 15.56 22.80 Unknown 2 4.11 5.5 1.39 9.61

EKG Service Time Plus Travel (minutes) Findings (cont.) EKG Service Time Plus Travel (minutes) Sample Size: 1546; Source: IOE 481 Team; Collection Period: Oct. 27 - Nov. 27, 2017 Technician Number Issues EKGs Margin of Error Average Lower Upper Tech 1 43 74 1.29 21.76 20.47 23.04 Tech 20 1 5 2.04 10.8 8.76 12.84

Technician Survey Results Findings (cont.) Technician Survey Results Sample Size: 12; Source: IOE 481 Team; Collection Period: Nov. 22 - Dec. 5, 2017 Average (minutes) Completed Survey 15.21 Retrieve Machine from Another Location 13.65 Take Machine when Leaving Lab 16.33 EKG service is on average 3.08 minutes faster for technicians that leave the machine at location than take the machine with them

Recommendations Standard of Care RCU should determine if standard of care practices are not being met or if technicians are running more efficient Technicians averaged 10.57 minutes faster than predicted

Recommendations (Cont.) Issue Frequency and Duration Investigate Other patient delay, Precautions, Machine, and Barcode Implement possible solutions Schedule around concurrent patient care Prepare precautions enroute or streamline process Improve machine software or replace leads/machines Investigate practice or ignore issue

Recommendations (Cont.) EKG Machine Retrieval Technicians should leave the machine at a location such as CVC or Burn units rather than take it from the lab

Expected Impact UMH can analyze the opportunity cost for EKG service given the 95% confidence interval for service times EKG service should be improved with investigation into the recommended focus areas and EKG machine carry practices

Special Thanks to: Mark Konkle Dr. Mark Van Oyen Heather Saxton Jonathan Lee John Li Dr. Mark Van Oyen Mary Lind Joy Chang All the technicians