Surgical Patient Throughput work continues

Here’s the latest from Incident Command

Incident Command remains diligently focused on Surgical Patient Throughput. The last 2.5 weeks have generated significant visibility, learning and progress.

Discovery thus far confirms that some patients receive their care in the appropriate classification window, and some do not. This focused effort dedicates resources to ensure that every surgical patient who receives care at Salem Health receives their surgery within their case classification window 100% of the time.

This week, key stakeholders partnered together to make the following visible: 

Progress to date:

• Procedural Patient Throughput Dashboard.
• Earlier in this process, we defined the case classification window. As a reminder, that includes elective/scheduled cases needing surgery within 45 days all the way through to emergency cases within 1 hour.
• The surgical progression huddle occurs 2x/day during the week and 1x/day on weekends.  They now have validated SW in place and are continuing to check and adjust. Yesterday, for the first time since starting this work, 100% of add-on cases performed were within the appropriate case classification.
• Added retrospective review of in-patient add-on cases that miss their case classification.  Every surgical patient who misses their case classification window is problem-solved.
• OR turnover time (wheels out of previous case to wheels in of next case) has improved by 5 minutes. Continued problem-solving to further reduce turnover moves to next week.
• Medical Group Clinics at Salem Health have initiated several TOCs:
  • In one surgical clinic, the backlog of patients waiting to be scheduled in-clinic has reduced from 178 to 100, and the number of patients ready to schedule increased from 32 to 40, indicating progress in our work to move surgical patients from waiting to ready.
  • In another clinic, patient scripting guides have resulted in 75% of patients selecting the next available surgery appointment, up from 62%.
• Work started with a backlog of 302 case packs to be processed in sterile processing. We reached our target of 100 or less for the first time, and problem-solving continues to reach sustainment at or below target.
• While other health systems have cancelled elective surgical procedures due to the IV solution shortage, the great work done by our pharmacy, clinical and supply chain teams has ensured we remain at Level 1 by sourcing additional fluids and in-house manufacturing, allowing us to not only provide the same volume of care, but to increase surgical procedures. 

Next week’s work is focused on defining the surgery traffic control (STC) structure referenced in the yellow bar of the Value Stream map. Incident command will continue until we can hand off visibility and ownership to the to-be developed STC team. This teams’ focus is to sustain, operate and continuously improve this important work to ensure that 100% of surgical patients receive their surgery within their case classification window.

We deeply appreciate the hard work our teams have been engaged in, moving this significant problem forward with the patient focus in mind.