1. Department of Respiratory Care University Hospital
Time Study and Workflow Evaluation for EKG Support
IOE F7- 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.

2. 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

3. Team Introduction
Angjela Keci
Erin Moore
Lennox Ramsey

4. 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.

5. 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

6. 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

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

8. 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

9. 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

10. 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

11. 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.

12. 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.

13. 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.

14. EKG Service Plus Travel (minutes)
Findings
EKG Service Plus Travel (minutes)
Sample Size: 1546; Source: IOE 481 Team; Collection Period: Oct 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)

15. EKG Service Time Plus Travel (minutes)
Findings (cont.)
EKG Service Time Plus Travel (minutes)
Sample Size: 1546; Source: IOE 481 Team; Collection Period: Oct 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

16. Findings (cont.) Time Lost per Year
Sample Size: 1546; Source: IOE 481 Team; Collection Period: Oct 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

17. EKG Service Time Plus Travel (minutes)
Findings (cont.)
EKG Service Time Plus Travel (minutes)
Sample Size: 1546; Source: IOE 481 Team; Collection Period: Oct 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

18. EKG Service Time Plus Travel (minutes)
Findings (cont.)
EKG Service Time Plus Travel (minutes)
Sample Size: 1546; Source: IOE 481 Team; Collection Period:
Oct 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

19. Technician Survey Results
Findings (cont.)
Technician Survey Results
Sample Size: 12; Source: IOE 481 Team; Collection Period:
Nov 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

20. 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 minutes faster than predicted

21. 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

22. 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

23. 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

24. 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