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

2. 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

3. 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

4. Engineering Methodologies
Tom

5. 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

6. 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

7. 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

8. Findings & Conclusions
Tasha

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

10. 15 Minute Policy Involves Built-In Waste
Tasha
29%of runs are +/- five minutes late

11. SWAT Database Highlights 7 Frequented Units
Tom

12. Patient Readiness in 7 Frequented Units
Tom

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

14. 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 

15. Recommendations
Allie

16. 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

17. 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 

18. Proposed Huddle Template

19. Proposed Huddle Template

20. 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

21. Page Bedside Nurses
Julian

22. 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

23. 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

24. 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

25. 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

26. 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

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

28. Flexible Bedside Preparation Times
Tasha

29. Change 15 Minute Policy to Plan for Variation

30. When the Bedside Nurse Prepares Patient

31. When SWAT and Bedside Nurse Prep Patient

32. 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)

33. Steps Toward Process Improvement
Tasha

34. Thank You!
Tasha

35. SWAT Clipboard Sheet

36. 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

37. Process Map (90th percentile observations)

38. 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

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