Neurosurgery and ENT Pod 5 Team
Starting surgeries on time and turning around operating rooms quickly is important for high-volume operating room suites, like those at Barnes-Jewish Hospital. Concentrating on these objectives also improves patient and staff satisfaction. To improve performance, the team cross-trained staff to support both ENT and neurosurgeries, purchased equipment that was previously borrowed from other areas and standardized work processes. As a result, on-time starts for first cases have increased from about 35 percent, to 88 percent, room turnaround times were cut in half, and communication and staff morale has improved.
Star Billing Team
Accounting for every supply item used during a surgery is important for proper inventory control, data analysis, as well as accurate billing. With about 4,500 items per day utilized and documented in the ORs every day, this becomes a sizeable challenge. Any item that does not carry a BJC item ID number requires manual entry and increases the chance for error. In a little over a year of implementing new work processes, the team exceeded its initial goal and reduced the number of manual entries from more than 1,000 items per month, to less than 200 items per month.
Interventional Neuroradiology Team
Interventional radiology currently treats more than 100 patients per year for ischemic stroke, which is caused by loss of blood flow to the brain. Looking for ways to speed time to treatment, this team identified an outdated, time-consuming pre-procedure set-up process involving 17 individually packaged sterile items. The team replaced these items with a single, custom-made supply kit, which improved treatment times in these critical, time-sensitive cases, with the long-term goal of improving patient outcomes
Improvement of Triple Lumen Catheter Clamp Team
The pheresis department was experiencing an unusually high number of broken central venous catheter clamps when providing apheresis therapy to patients. This team took action by partnering with the manufacturer over a 5-year period to design a new clamp. Since the new clamps have entered the supply stream, no broken clamps have been reported.
Patient Experience for South General Diagnostic Radiology Team
The South General Diagnostic Patient Experience Focus Group improved several processes that enhanced the patient experience. In less than a year, they increased their PRC percentile of excellence by 106 percent and increased their current percent of excellent by 24 percent. The team set a goal of eliminating all outpatient wait times, and as a result, no outpatients needed to use the waiting room. The team also streamlined the handoff between registration and diagnostic radiology and kept awareness high by distributing a newsletter that identified team goals, current scores and improvement initiatives.
Goldfarb Compliance Project Team
Goldfarb School of Nursing at Barnes-Jewish College identified that required documentation of mandatory student, faculty and staff compliance training was not centralized, so therefore was hard to verify. The same was true of licensure and certification tracking requirements for nursing students and faculty. By working with the hospital’s performance improvement department, the team identified key stakeholders and developed standardized processes that were previously being completed by seven different departments using six different systems. As a result of the team’s work, the college can now track and validate students, faculty and staff completion of training required by the Department of Education and other agencies.
ICU Mobility Team
For ICU patients, early mobility is beneficial and is endorsed by multiple national critical care organizations. However, early mobility was not being emphasized in all of the Barnes-Jewish ICUs. So this team implemented mobility protocols in the six hospital ICUs over a period of eight months. Data collection demonstrated decreased ICU and hospital length-of-stay, a decrease in pressure injuries and a decrease in delirium-positive days. Early mobility protocols also have been shown to be safe with a low rate of complications.
Familiar Faces Team
Familiar Faces is a new program at Barnes-Jewish focused on reducing avoidable emergency room visits by high utilizers. By working with patients to establish goals and connect them with community resources, Familiar Faces has significantly reduced ED visits for many patients and improved their quality of life. The care team now serves as “catalysts” to enable housing placement, substance abuse treatment, and many other interventions to coordinate care while patients are in the hospital and after discharge. After experiencing remarkable results in the first year of the program, the team is hopeful this program will continue to positively impact the lives of our patients while preparing the hospital for potential changes in reimbursement for low-acuity and non-emergent ED visits.
Inpatient Obstructive Sleep Apnea Screening Implementation Team
For some time, our hospital has screened patients scheduled for surgery for obstructive sleep apnea. This team recognized the need to expand this screening to all inpatients. By collaborating across teams, they developed a way for the screening to integrate with our electronic medical records system so that it’s clear to everyone on the care team that the screening was performed, and the patient’s result. They also evaluated the screening and reporting process to assure that patients were not “over-identified” with OSA, which would diminish the value of the screening tool. As a result, our patients are now in a safer, more aware environment and sometimes they learn that they indeed have an undiagnosed case of obstructive sleep apnea.
Endovascular Acute Stroke Committee
For stroke patients, time is brain. For patients whose stroke is caused by a blocked brain artery, their long-term outcome is dependent on the timeliness of procedures like a mechanical thrombectomy. The multidisciplinary endovascular acute stroke committee and the interventional neuroradiology team worked together to re-engineer complex clinical workflows that could delay administration of a thrombectomy. Through their efforts, the time between patient arrival and procedure start has fallen from an average 147 minutes to 39 minutes. This best-in-class performance far exceeds the 120-minute benchmark recommended by the American Heart Association.