1. Final Report: Analysis of Room Turnover Processes for EP and Cath Labs
December 13, 2016
IOE 481 Team 1:
Scott Agnew, Kim Cusmano,
Brandon Duba, and Holly Johnston

2. UMHS’s Cardiac Procedures Unit (CPU)
Electrophysiology Labs (EP) & Catheterization Labs (Cath)
CPU experiencing long turnover times
Turnover = Patient wheeled out to next patient wheeled in
Out-of-Scope: Heart Failure Lab, EP lab 6 and patient pre-op
In-Scope: EP and Cath labs turnovers
Change slide design

3. Key Issues Patient, physician, and staff dissatisfaction
Different definitions of turnover across staff
No turnover measurement system
No standard work

4. Goals Objectives Evaluated current turnover processes
Identified waste/
coordination problem
Established means to evaluate future turnovers
Objectives
Conducted time studies and interviews
Developed process maps of current state
Developed a means to evaluate performance
Provide
turnover recommendations

5. Historical Data Analysis
Methods
Historical Data Analysis
Literature Search
Process Maps
Staff Interviews
Time Study

6. Literature Search Method
Search past student reports for:
Background info
Past work in CPU
Search GoogleScholar for:
Lean Tools of Standard Work
Statistical Analysis

7. Historical Data Analysis Method
Coordinators provided historical MiChart data
Cath and EP lab operations Jan-Aug 2016
Analyzed data using R programming language
Primary metrics:
Turnover start time
Turnover time
Room ready minus room start

8. Time Study Method Turnovers observed: 20 Cath & 10 EP
Full turnovers observed: 12 Cath & 5 EP
To gain a better understanding of the tasks and staff coordination involved in the turnover process, the team observed the turnover processes for approximately 53 hours in the EP and Cath labs, witnessing 31 turnovers collectively. The team used stopwatches to map the start and end times of each step in the process and recorded it on a data collection sheet. The data collection sheet is attached in Appendix X. The major steps are outlined below:
Steps Inside Lab:
Patient wheeled out of room
Room is cleaned and trash is disposed of
New equipment for next lab is laid out
Patient and inventory information is entered into computer
Patient wheeled into room
Steps Outside of Lab:
RN wheels patient out of room and transports to recovery
Hook up equipment for patient
Relay post-lab data to other RN
Dispose medical waste
Find next patient
Return with next patient
The team then analyzed this data to find a baseline for the current state. To find the full turnover time the team averaged all of the full turnover times (12 for cath, 5 for EP). To find the length of each step, the team averaged the time for each step (with varying sample sizes).These numbers have been utilized to create the swim lane diagrams.

9. Process Maps Method District Cath & EP maps
Swim lane set-up shows each staff member role
Used to visualize delays & identify wastes

10. Current State Cath Process Map

11. Current State EP Process Map

12. Staff Interviews Methods Sets of questions based on different roles
Interviewed 2 Cath Nurses, 2 Cath Techs, 4 EP Nurses, 2 EP techs & 1 EP CRNA
ed questions to 3 Cath Physicians & 3 EP Physicians

13. Conclusions

14. Tasks inside lab not the cause of long turnovers
87% of time study observations show room was ready before next patient wheeled in
47% of Cath & 39% of EP labs idle
Nurses & CRNAs:
Communication issues during Pre-op activities

15. 3. Average time between room-ready & wheels in: 47%
Tasks inside lab not the cause of long turnovers
3. Average time between room-ready & wheels in: 47%

16. 7. Average time between room-ready & wheels in: 39%
Tasks inside lab not the cause of long turnovers
7. Average time between room-ready & wheels in: 39%

17. Current turnover times longer than goal
Median Turnover Times (minutes):
Goal
Historical Data
(N = 2320)
Time Study
(N = 17)
Cath 15 28 16 EP 30 40 48

18. Variation in EP & Cath turnover processes
Standardize definition of turnover reduces misconceptions [4]
Order of tasks in process vary for each tech
Physicians:
Have unique procedure preferences

19. Lack of parallel workflow
Parallel workflow is valuable during turnover [3]
Balanced workloads led to 45% decrease in time [6]
Workload is not balanced between techs

20. Lack of parallel workflow
Cath
No parallel work between techs EP
No parallel work between techs

21. Task completed before wheels out
176% increase in frequency of short turnovers by streamlining cleaning to before wheels out [5]
Tasks completed before wheels out
Short turnover defined as 30 minutes

22. Tasks completed before patient is wheeled out
Tasks completed before wheels out
Cath
Tasks completed before patient is wheeled out EP
Wheels Out

23. Valuable MiChart fields not consistently entered
Standardize definition and collect time data for baseline management [4]
48% of MiChart data within project scope
Only 8% of data contained Room Ready field
Physicians:
Have unique procedure preferences
Delete physician preference?

24. Leave lab to retrieve equipment
EP Techs leave lab to retrieve equipment
80% of observations staff leaves lab during turnover to retrieve equipment
Leave lab to retrieve equipment

25. Recommendations

26. Recommended Further Investigation
Root Cause Analysis for Techs leaving lab
Lack of equipment stocked
Physician prefer different equipment
Potential Causes for Out of Lab Delay
Waiting for Pre-Op
CRNA and RN Communication

27. Recommended Cath Turnover Process
Red Circles are like callouts - represent changes

28. Recommended EP Turnover Process
Red Circles are like callouts - represent changes

29. Recommended Future Turnover Tracking Use MiChart Metrics
Room Ready:
Techs Write Room Ready on Whiteboard
Nurses Record Timestamps
Management Posts Quarterly Reports

30. Next Steps Investigate Implement Utilize Distribute
Project findings & recommendations
Pre-op delays and EP equipment retrieval
Whiteboard space for techs to record room ready
Future state maps in training staff

31. Expected Impact Understanding of the current turnover processes
Reduction of wasted actions and time
Means for future evaluation & measurement
Standardization of turnover processes
Implementation plans for the recommendations

32. Thank you clients, coordinators, & professors!
Janice Norville, MSN, MSBA, RN, Director of Clinical Operations
Sheryl Wagner, Nursing Supervisor
Jim Bloom, Allied Health Senior Supervisor
Colleen Lucier, Allied Health Senior Supervisor
Katie Schwalm, Industrial Engineer
Andrei Duma, Industrial Engineer
Mary Duck, UMHS IOE 481 Liaison
Mark Van Oyen, IOE 481 Faculty Instructor
Jai Sura, IOE 481 Graduate Student Instructor

33. Thank you, any questions?

34. Appendix A: Historical Data Analysis Plots

35. Appendix B: Historical Data Analysis Plots

36. Appendix C: Historical Data Analysis Plots

37. Appendix D: Historical Data Analysis Plots

38. Appendix E: Historical Data Analysis Plots

39. Appendix F: Historical Data Analysis Plots

40. Appendix G: Current State Cath Process Map
1. Tasks completed before patient is wheeled out
3. Average time between room-ready & wheels in: 47%
2. No parallel work between techs

41. Appendix H: Current State EP Process Map
5. Leave lab to retrieve equipment
4. Tasks completed before patient is wheeled out
6. No parallel work between techs
7. Average time between room-ready & wheels in: 39%

42. Appendix I: List of all Conclusions
Tasks inside lab not the cause of long turnovers
Current turnover times longer than goal
Variation in EP & Cath turnover processes
Lack of parallel workflow
Task completed before wheels out
Valuable MiChart fields not consistently entered
EP Techs leave lab to retrieve equipment 1. 2. 3.
4. Lit search – streamlining tasks before turnover starts