2012 OPEN FORUM Abstracts
LEAN APPROACH TO ADDRESS WORKLOAD SURGES.
Patty C. Silver, Peggy R. Watts; Respiratory Care Services, Barnes Jewish Hospital, St Louis, MO
Background: Recent employee engagement surveys revealed dissatisfaction regarding efficiency of departmental handling of workload surges. Current surge plan: 1) Increase staffing so all ordered therapy given 2.)Extra staffing comes from support staff (e.g. educators, supervisors which are available 7am to 10pm, M-F), voluntary overtime (OT) and nightshift on-call (11pm to 7am); 3) Manual tracking of assigned acuity levels so if all ordered therapy cannot be performed, highest acuity patients are readily identified and treated first. Method: Lean Rapid Improvement Team created to develop Standard Work (SW) to address increased workloads or decreased staffing. The SW identifies when and how to implement a RCS surge plan . Also, use of visual management (VM) tools to clearly communicate to the department when surges are occurring. An additional goal to develop electronic acuity alert system and a mechanism to evaluate the impact on patients when Red condition occurred. Results: Improvements included 1. Creation of traffic light system to be displayed in department to alert staff when surges occur. Green light indicates enough staff on duty to perform ordered therapy . Yellow light indicates shortage of 1 to 2 staff per projected need with support staff, on-call and OT in use. Red light condition indicates shortage of 3 or greater staff projected based on calculated need . During Red light condition, patients are assigned a triage level (1 highest acuity, 3 lowest) and therapy given to highest acuity patients first. Additionally, automatic approval of OT for patient assessor to assure compliance with RCS protocols. Creation of a RCS electronic handoff form in the EMR was approved by management and is in process of development by IS. This form enables written communication of patient acuity level between staff but is not a part of the permanent medical record. 2. Progress back to green light condition triggers debrief process in order to analyze effectiveness of implementation of surge plan and review cases of missed therapy to assure no patients suffered adverse consequence. Conclusions: Low efficiency in handling workload surges was dissatisfying to staff. Implementation of lean SW and VM tools aid in efficiency and safety when managing our resources when workload demands exceed staffing levels. Follow up staff surveys will be conducted to evaluate the effectiveness of the interventions. Sponsored Research - None