Standardized Treatment of Patients with Alcohol Withdrawal | Oct. 2011

Overview

The Chief of the Medicine Service (Rick Albert, MD) requested that a multidisciplinary team of physicians, nurses, and pharmacists conduct a Rapid Improvement Event (RIE) to address the high rate of ICU utilization for treating patients with alcohol withdrawal.

Using LEAN

Using the systematic approach of LEAN process improvement adopted at Denver Health, the RIE team identified waste and opportunities for improvement. Standard LEAN tools such as process mapping, waste walks, communication/hand-off circle, and standardized work were utilized to develop a new future state with an improved algorithm for caring for this challenging patient population.

Tactics

• Developed new standard work in the form of a new medication and treatment protocol, obtained consensus for the new protocol by physician, nursing, and pharmacy leaders in the organization.
• Developed an education and communication plan to implement the new protocol.

Results

Based on a review of the data, the team projects that the new protocol could maintain and improve the safety and quality of care for these patients and reduce ICU utilization by an average of one day (from 3.6 down to 2.6 days) in the ICU. The savings to the institution was calculated to be $2,000,000/year.

Testimonial

One of the RIE participants, Dr. Tim Olsen, a medical resident, noted on his participant survey that his participation as a team member on this RIE was "The most educational and empowering non-clinical activity of residency thus far!"

Westside Family Medicine Clinic Peds/Teen Provider Flow Cell | Oct. 2006

Overview

A Rapid Improvement Event (RIE) was conducted by physicians, nurses, and health care partners (HCP) in a busy urban pediatric/teen clinic in order to:

• Increase provider and health care provider productivity
• Decrease waiting
• Improve patient cycle time
• Improve customer and employee satisfaction

Tactics

• Changed patient/provider interaction time from sequential to parallel flow by implementing a HCP/provider flow cell, reduced redundancies of HCP/provider tasks with DYAD format.
• Implemented new standard work created for providers and HCP staff.

Results

Using LEAN process improvement, the team was able to reduced cycle time from 46 minutes to 24 minutes on first day of implementation, reduced movement/motion for HCP and provider, create tight connections between HCP and provider, and use multiple/rapid PDSA to make adjustments. Results have been sustained long after the initial RIE, through 2011.

Testimonial

Dr. O'Connor, clinic provider, remarked, "I can't believe we got all of this done in one week!"

Before and after spaghetti diagrams used to identify (and eliminate) wasted motion and transportation

LEAN System Implementation Resulted in Bronze Shingo Prize | April 2011

Denver Health Community Health Services wins the Bronze Shingo Prize for implementing LEAN systems to improve patient care at Denver Health.