Project selection the emergency department steering

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Project Selection The emergency department steering group selected this project because of the significant opportunity to improve care of patients who may be having a heart attack and because D2B times are reported to CMS. Project Staffing The executive sponsor and the facilitator selected the team members (Exhibit 2.10). The team leaders included an individual from patient care services and another individual from training and development. Because the D2B value stream involves the ED and the cardiology department
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79 (specifically, the cardiac catheterization lab), individuals from both departments were included in this RCI. Moreover, because D2B times are reported and monitored on a system level, members of a heart institute, another unit within the ODS, were invited to participate because physicians from this group work at both locations. The “fresh eyes” included the risk manager and the chief nursing officer (CNO). Neither of the team leaders was associated with the ED or the cardiology department. Eventually, as one team leader became busy with her other roles, team responsibilities fell to the other team leader. Moreover, the process owner also became busy with other responsibilities, leaving much of the monitoring and sustainment responsibility with the team leader from outside the value stream. This team leader was described by several staff members as “diligent.” Planning and Implementation A charter was developed in July 2009, but the RCI was scheduled for February 2010 to allow physician participation. The weeklong RCI began on February 8, 2010. The steps or activities implemented by the project team and any Lean tools used are described below. Monitoring, Control, and Sustainment After the RCI, the team leader collected data on the D2B times using manual tracking sheets. She met monthly with directors of the ED and the cardiology department and also worked with HAU Care’s heart institute to review the D2B data and reconcile the tracking sheets. In the monitoring phase, the team leader and staff believed that one of the major issues with decreasing D2B times was not the process developed by the Lean team. Rather, it was the ability to quickly determine whether someone was truly having a specific type of heart attack (an ST segment elevation myocardial infarction, or STEMI) appropriate for angioplasty (balloon insertion). Staff wanted to get more experience with identifying, but there were too few STEMIs each year (about 56 out of 55,000) to allow everyone to develop expertise in identification. Exhibit 2.10. Project Team Composition: Door- to-Balloon Project Total staff = 14: Facilitator: Process Improvement staff Team leaders: Nurse manager from patient care services and staff from training and development department Process owner: Department director Two clinical nurse specialists, one from the ED, one from the cardiology department Two physicians, one from the ED, one from the catheterization laboratory from the ED Chief Nursing Officer (CNO) One nurse One risk manager
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  • Fall '17
  • Shankar Purbey

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