1. ICU Patient Transfers to Floors

2. Wholeness Stewardship Excellence Respect Response to Need 2 Michelle Blakely Team Leader Cheryl Stensrud Director Brittany Quinn Supervisor Lorri Deplazes Sensei Team Members

3. Wholeness Stewardship Excellence Respect Response to Need 3 Business Case ICU patients are transferred to the floor, per orders written, timely and safely.

4. Wholeness Stewardship Excellence Respect Response to Need 4 Problem Statement The average time from order written to actual transfer of an ICU patient is 191.5 minutes June and July 2011 (total 88 records reviewed) –This results in delays of ICU staff reduction: floating to floor, place on call, TFR. –Also affects receiving floors staff: under staffed until nurse arrives, mandatory on call person remains on shift until staff arrives to cover.

5. Wholeness Stewardship Excellence Respect Response to Need 5 Scope Process Start: Order for Patient to Transfer to Floor Process End: Patient Transferred to Floor Exceptions: OB

6. Wholeness Stewardship Excellence Respect Response to Need 6 Aim/Goal Statement Decrease the ICU patient transfer time to floor from average of 191.5 minutes to an average of 120 minutes by December 31, 2011.

7. Wholeness Stewardship Excellence Respect Response to Need 7 Key Measures or Metrics ICU Transfers post MD order to floor minutes Nurses averages MD order times Number of patient admits and dc’s in ICU on days of floor transfers

8. Wholeness Stewardship Excellence Respect Response to Need 8 DEFINE PHASE

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10. 10 SIPOC

11. Wholeness Stewardship Excellence Respect Response to Need 11 Voice of the Customer (VOC) (Floor Staff)

12. Wholeness Stewardship Excellence Respect Response to Need 12 Voice of the Customer (VOC) (ICU Staff)

13. Wholeness Stewardship Excellence Respect Response to Need 13 VOC- Results of Survey

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17. Wholeness Stewardship Excellence Respect Response to Need 17 Measure Phase

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20. Wholeness Stewardship Excellence Respect Response to Need 20 Operational Definition Transfer order must be written by the primary MD Transfer time documented in the patient record All records had orders and nurses notes reviewed for possible reasons of delayed transfers. These transfers were removed from data as outliers. –After lunch –After PO tolerated –In the evening –Weaning medications

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23. Wholeness Stewardship Excellence Respect Response to Need 23 Average time MD writes order to Transfer is 0945.

24. Wholeness Stewardship Excellence Respect Response to Need 24 Approximate Average time Nurses Transfer Patient to the floor is 1245

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27. Wholeness Stewardship Excellence Respect Response to Need 27 Analyze Phase

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31. Wholeness Stewardship Excellence Respect Response to Need 31 Improve Phase This is where we are in the DMAIC phase.

32. Wholeness Stewardship Excellence Respect Response to Need Things Left to Do Finish VOC Meet with staff (floor and ICU) Develop future state Plan how to control Financial Benefits Monitor progress and revise where necessary 32

33. Wholeness Stewardship Excellence Respect Response to Need 33 Lessons Learned So Far What worked and what would you have done differently. Need more VOCs Been able to track when floor not able to take pts. Lorri has helped greatly. Without her this project would not be this far (more time to work on project).