At all times and that the patient drank the contrast

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at all times and that the patient drank the contrast fluid in a sequence synchronized with the availability of radiology staff to conduct the scan. This ensured that the scan did not have to be repeated, which would lengthen the patient’s stay in the ED. The nurse workstation organization project created a neater area by moving desks and office equipment and by relocating the medication station, which had been in the workstation, to the former triage room that was nearby. This saved space and provided a more controlled environment for medication administration. The reorganization allowed for the establishment of a new process to organize patient charts so physicians could clearly see which patient was next. The project team reorganized cycle time, equipment, and supplies in the code area. To improve business processes, project teams created a brief preregistration process to improve the collection and documentation of demographic information recorded in patient records and to relocate medical records coding staff into available space in the ED. The intent was to improve communication between physicians and coding staff and to decrease billing delays. Monitoring, Control, and Sustainment Only one monitoring activity was mentioned by Exhibit 5.12. Project Team Composition ED Value Stream Project staffing: varied from 5 12 staff Physician(s) Nursing staff Administrative staff as they related to the project (i.e., medical records staff) Staff/specialists from other areas related to the project (i.e., radiologists) Team leader from an outside department
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186 participants in the ED Value Stream projects. The team monitored the patient’s cycle time in the ED using daily improvement management techniques. For example, whenever a patient was in the ED for more than 5 hours, a provider registered that fact and the cause of the delay on a tracking sheet posted on a bulletin board in the hall. Within the week, the project team and ED staff not on the team discussed what had happened and how to improve the process in the future. Sustainment Monitoring Heights Hospital shared sustainment information on some of the ED value stream projects: ESI Triage: The ESI triage process was sustained from implementation. Diagnosis and Discharge: Teams created to accelerate diagnoses and discharges were also sustained, as were the whiteboards used by these teams to track the status of their patients. Abdominal Pain: Staff continued to monitor patient cycle time and posted it on the department’s bulletin board on a daily basis. Nursing Workstation Organization: Structural changes to reorganize the seating and set up of the nurse workstation remain in place, although executives and senior managers stated that the conversion of the triage room into a medication room might be revisited. One frontline staff member noted that after the nurse workstation event, pictures from the RIE event were
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