...BAMA Triage Improvement Plan Control Team Blue SYM 630, MOD 7 June 15, 2010 Introduction The control phase of DMAIC is critical to sustaining the gains achieved from the previous phases. Control plans help add discipline and accountability to goals of the project improvement. A comprehensive control plan allows there to be a documented guideline that can be easily followed to make sure that the improvements of a Six Sigma project are maintained. This paper will show the development of a robust control plan in terms of the four components including discipline, documentation, score keeping, and process management plan. Healthcare is a critical industry that can benefit from the Six Sigma mindset. Review of BAMA Broderson Army Medical Authority (BAMA) is a fictitious 425 bed Level One Trauma Center owned and operated by the United States Army. BAMA offers a wide range of critical treatment opportunities such as a world-class burn institute, traumatic brain injury institute, poly-trauma center and a center for the rehabilitation of amputees that is based on cutting edge technology. Because of this specialized capability, the majority of BAMA’s new patients come through on an emergent base. Six Sigma Issues The ER of any hospital is considered a high visibility department secondary to their emergent demographic. BAMA has approximately 40,000 visits to the emergency room (ER) each year. This can have the entire above-mentioned patient load in various states of repair...
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...How to Use a 5-level Triage System Western Governors University Topic: The importance and application of a 5-level triage system. INTRODUCTION Attention Getter: I am currently a Charge Nurse in the busiest emergency room in Nevada. We see an average of 300 patients a day with wait time in the lobby upwards of 12-14 hours. Purpose: The purpose of my presentation is to inform. I want my audience to understand why a 5-level triage system is best practice and I want my audience members to have a basic understanding of a 5-level triage system and to be able to begin training in an ER triage setting. Audience: The ideal audience for my presentation are nurses that are newly graduated or new to the ER setting. My topic is specific for my intended audience and is beneficial for them. This presentation can be easily altered to address nurses that will be working in a pediatric ER. Significance: The ability to correctly triage a patient in an ER is crucial to patient safety and patient care. In a busy ER patients generally have to wait to be taken out of the waiting area. A triage nurse needs to be able to sort through the patients and decide who the priorities are. The intended audience will become the nurses making these decisions. Thesis Statement: Research shows that a 5-level triage system is best practice because ESI and CTAS provide dependability and reliability and because the implementation of a standardized ER triage process improves patient care. ...
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...INTRODUCTION This incident plan for 2/300 FA Battalion Aid Station (BAS), has been developed in order to respond to massive incidents involving multiple casualties. Mass casualties occur when the numbers of patients overwhelm the local medical resources in place. Examples of these incidents may result from vehicular accidents, fire related hazards, hazardous resources, and is deemed necessary by the 2/300 FA Physician Assistant (PA). This plan assigns responsibilities and makes the best use of available medical resources at the BAS. It is the purpose of this SOP to familiarize personnel with this plan and enable them to follow the proper procedures to provide effective response and Level I and II medical care. PURPOSE: To ensure proper triage, medical treatment, and necessary evacuation of casualties. 1. INTRODUCTION: This plan shall be placed into action in the event of any incident that results in mass casualties or deemed necessary by the 2/300 FA PA or his representative. a. MANPOWER/EQUIPMENT: BAS personnel shall supply all medical resources for any incident which involves casualties that occur within our AO. In the event that an incident arises and exceeds the ability to provide adequate medical care, the PA shall coordinate with all assets within close proximity to receive additional resources. b. COMMAND and CONTROL: 2/300 FA BAS shall provide Level II medical care to any and all casualties during any incident and shall coordinate any additional...
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...service. On average, how long does a car spend in the drive-through line? Answer: Based on problem data we have to use Little’s Law in order to solve the problem. We have the I (average inventory) and T (average flow) and we need to calculate R (throughput). I = 10 cars T = 1.5 cars/min (2 cars with 25% of customer leaving without placing orders) R = I / T R = 10 / 1.5 R = 6.67 min/car 3.5) A triage system has been proposed for the ER described in Exercise 3.4. Under the proposed triage plan, entering patients will be registered as before. They will then be quickly examined by a nurse practitioner who will classify them as Simple Prescriptions or Potential Admits. While Simple Prescriptions will move on to an area staffed for regular care, Potential Admits will be taken to the emergency area. Planners anticipate that the initial examination will take 3 minutes. They expect that, on average, 20 patients will be waiting to register and 5 will be waiting to be seen by the triage nurse. Recall that registration takes an average of 2 minutes per patient. The triage nurse is expected to take an average of 1 minute per patient. Planners expect the Simple Prescriptions area to have, on average, 15 patients waiting to be seen. As before, once a patient’s turn comes, each will take 5 minutes of a doctor’s time. The hospital anticipates that, on average, the emergency...
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...discuss applying technology to create an objective response to the adverse trend of abandoned calls in the Telecare clinical setting. Telecare Overview Telecare triage nurses manage symptom-based calls from patients at the Department of Veterans Affairs (VA) Outpatient Clinic incoming call center. Currently, there are seven nurses that staff telephone triage with a volume of approximately 250 to 300 calls per day. The office hours in Telecare are Monday through Friday from 8:00 a.m. to 4:00 p.m. with observance of all federal holidays. The Telecare nurse is responsible for answering calls efficiently at approximately 32 calls per day. The Telecare nurse triages symptoms from the patient and obtains urgent access to the clinic via an evidenced based triage program called Veteran’s Health Gateway (VHG). This program helps the nurse make clinical decisions per protocols and provides evidenced based education recommendations based on the triage disposition (Document Storage Systems, Incorporated, 2014). All calls in Telecare are monitored by software connected to the phone lines to ensure management can report the trends related to clinical calls. Abandonment Rate Adverse Trend The abandonment rate in Telecare is the percentage of calls from patients in the phone queue that hang up before the triage nurse answers. The abandonment rate...
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...1. With the help of process flow diagrams, compare the pre-triage and the post-triage systems in terms of total system time and total waiting times. Is the new system an improvement over the old? 2. Look at the patient arrival rates and compare them to the available MD and NP capacity. An hour-by-hour or day-by-day analysis will show some interesting patterns. Based on what you have learned about waiting lines and utilization, comment on the current assignment fitness between supply and demand? | | | |Patients waiting |Patients waiting | | | | | | | |67% |33% |MD |NP |Availability | |Patients per hour treated | | | |Arrival |MD |NP |Beg of HR |Serviced |End of HR |Beg of HR |Serviced |End of HR |MD |NP |MD |NP | |8am - 9am |18.2 |12.194 |6.006 | - | 6.19 | 6.01 | - | 3.66 | 2.35 |2.0 |2 |3.0927835 |1.8292683 | |9am - 10am |17.6 |11.792 |5.808 | 6.01 | 7.73 | 10.07 | 2.35 | 7.32 | 0.84 |2.5 |4 | | | |10am - 11am |16.8 |11.256 |5.544 | 10.07 | 14.85 | 6.48 | 0.84 | 7.32 | (0.93) |4.8 |4 | | | |11am - 12 noon |15.2 |10.184 |5.016 | 6.48 | 9.90 | 6.77 | (0.93) | 7.32 | (3.24) |3.2 |4 | | | |12 noon - 1pm |11.8 |7.906 |3.894 | 6.77 | 8.04 | 6.63 | (3...
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...Improving Access to University Health Services A Case Study ► Process Improved: The system for triage and making appointments for students utilizing University Health Services ► Unit (s): Student Affairs – University Health Services ► Customers of the Process and Their Needs: UW-Madison students were the users of the process, although the problem impacted R.N. and Program Assistants (PAs) staffing University Health Services ► Problem/Opportunity Statement: Students were dissatisfied with access to medical services at UHS. Specific complaints included prolonged waiting times on hold or getting the “busy signal” when calling UHS. The limited capacity of the system for incoming calls meant that people waited a long time or were disconnected. All medical/illness-related questions were referred to one nurse. (When the nurse was on the telephone with a caller, messages were taken from ill students or those seeking same-day appointments. The messages stacked up and often, by the time the nurse was available to call the patient back, the patient would not be available. Many opportunities for contact were missed. Getting an appointment was very much a matter of luck.) The long waits for the nurse meant that students were “triaged” by PAs who were non-medical personnel. More students came in for care without appointments. (“I couldn’t get through on the phone, so I came in.”) The decentralized appointment structure meant that a patient calling for a women’s clinic appointment called directly...
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...Chapter 3: Process flow measures 3.3 Solutions to the Chapter Questions Discussion Question 3.1 The opposite of looking at average is looking at a specific flow unit’s flow time, and the inventory status and instantaneous flow rate at a specific point in time. Because flow times change from flow unit to flow unit, it is better to look at the average over all flow units during a period of time. Similar for inventory and throughput. [pic] Discussion Question 3.2 In practice, one often tracks inventory status periodically (each day, week, or month). Flow rate is typically also tracked periodically (even more frequently than inventory status because it directly relates to sales). It then is easy to calculate the average of those numbers to obtain average inventory and throughput during a period. In contrast, few companies track the flow time of each flow unit, which must be done to calculate the average flow time (over all flow units during a given period). [pic] Discussion Question 3.3 First, draw a process flow chart. Second, calculate all operational flows: throughput, inventory, and flow time for each activity. Third, calculate the financial flow associated with each activity. If the activity incurs a cost (or earns a revenue), the cost or revenue rate is simply the throughput times the unit cost or revenue. If the inventory incurs a holding cost, the inventory cost rate is simply the average inventory times the unit holding cost. Fourth,...
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...This plan will be illustrating the care pathway for the 2 physiological disorders and the roles of the practitioners involved. The two physiological disorders are eczema and nephrotic syndrome. The practitioners involved in eczema are the GP and pharmacist. General Practitioners (GP): GPs look after the health of people in the local community and deal with a wide range of health problems. They take into account physical, emotional and social factors when diagnosing treatment and recommending the required treatment (AGGAS, 2013). If a GP is unable to deal with a problem themselves, the usually refer the patient to a hospital for tests, treatment, or to see a consultant with specialist knowledge (NHS Choices, 2013). For example in eczema, if the GP sees that the condition is not getting any better, or is worsening, the will refer the patient to see a dermatologist. Also, they assess, plan, implement and monitor the progress and response to treatment; and provide advice and counselling to the patients (AGGAS, 2013). Goal/Objective Completion Date Action to be taken To identify the physiological disorder Immediately 1) Baseline assessment i.e. medical history to identify clinical background and to identify and themes, patterns etc. 2) Assess baseline measurements: pulse and respiration; and observe the affected area i.e. inner elbows. 3) Confirm diagnosis and identify any potential allergies. To successful control the disorder On-going 1) Prescribe mediation i.e. 2) Refer...
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...creates toxic gases and now we have a disaster that eventually causes mass casualties and mass fatalities. The winds are blowing to a hot zone and make the area dangerous to life and health toward downtown. The ammonia vapors start to spread into the subway and low areas where people are using the subway. The gases have now started to circulate all through the downtown area and the Clinic buildings. As the incident commander I would first make sure that the area is evacuated so that there will be less casualties and deaths. Next call in the necessary help to determine the levels of protection so I will know what type of protective clothing will be needed. Next I would access the amount of mass casualty and fatality and prepare for triage. Also notify the area hospitals and connecting hospital, law enforcement and firefighters. Now I would prepare for transport of the bodies with the corrective bagging to allow for decontamination. According to Pope (2005), the decontamination process should consist of a series of procedures performed in a specific sequence. For chemical protective ensembles, outer, more heavily contaminated items (e.g., outer boots and gloves) should be decontaminated and removed first, followed by decontamination and removal of inner, less contaminated items (e.g., jackets and pants). Each procedure should be performed at a separate station in order to prevent cross contamination. Once all of this is done I would prepare the area for cleanup and decontamination...
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...Triage * Triage classifies emergency patients for assessment and treatment priorities * Triage decisions require gathering objective and subjective data rapidly and effectively to determine the type of priority situation present * Emergent situations are potentially life-threatening; they include such conditions as respiratory distress or arrest, cardiac arrest, severe chest pain, seizures, hemorrhage, severe trauma resulting in open chest or abdominal wounds, shock, poisonings, drug overdoses, temperatures over 105°F (40.5°C), emergency childbirth, or delivery complications * Urgent situations are serious but not life-threatening if treatment is delayed briefly; they include such conditions as chest pain without respiratory distress, major fractures, burns, decreased level of consciousness, back injuries, nausea or vomiting, severe abdominal pain, temperature between 102 and 105°F (38.9 and 40.5° C), bleeding from any orifice, acute panic, or anxiety * Nonemergency situations are not acute and are considered minor to moderately severe; they include such conditions as chronic backache or other symptoms, moderate headache, minor burns, fractures, sprains, upper respiratory or urinary infections, or instances in which a patient is dead on arrival Triage nursing involves the care of more injured individuals than the available resources can handle. Triage, which comes from ‘trier’, a French word meaning ‘to sort,’ is the system used by emergency and medical personnel...
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...3 individuals that appear to be suffering from possible illness. Simulation Prebrief and Debrief question guide * Prebrief- Discuss the following ; o Discuss common/frequent community diseases and why/how they are transmittable. o Discuss triage process and disaster planning. Triage is identifying and separating individuals quickly according to injury severity and treatment needed. Disaster triage focuses on sorting the greatest number of people as fast as possible. Triage performed at the site and again at the treatment area is very different from triage that is routinely conducted in the emergency department. The focus of disaster triage is to do as little as possible, for the greatest number, in the shortest time. One triage system that is used by first responders is START. START stands for “simple triage and rapid treatment.” This system describes what to do when first arriving at a multiple casualty or mass casualty incident. Disaster triage of an injured person should occur in less than 1 minute. This system also describes how to use people with minor injuries to help. As a decision is made regarding the status of an individual, the person is labeled with a colored triage tag. Green on the triage tag is for the walking wounded or those with minor injuries (e.g., cuts and abrasions) who can wait several hours before they receive treatment; yellow is for those with systemic but not yet life-threatening complications who can wait 45 to 60 minutes (e.g.,...
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...Decision-Making Case Study Bonny Kimberlin HCS/514 February 11, 2013 Vinnette Batiste Decision-Making Case Study The truth of the matter is there is no longer such a thing as “middle class” Americans. The sad reality is either one lives in the low-income bracket living check-to-check, or one lives with no worries in the world. Even more sad, is that the lower-income class bracket also includes the elderly, disabled, homeless, and unemployed. Not to sway away from subject but this country allows men and women to gross millions, some even billions of dollars to hit a ball-around a big stadium, or a puck around on an ice-rink; and yet government insurances scrutinize a doctor’s request for an elderly or disabled person to receive a wheelchair. There is something seriously wrong with this picture. Another perfect example a brain surgeon, and scientist making less salary than a baseball player and yet they save lives, and find cures. Many become angry at the mere thought of the homeless, disabled, and mentally ill leaving on the streets, and yet it seems the one program that helps the lower-income bracket Americans is the one program that keeps receiving budget cuts, restraints, and reduction in services. Affect of Budget Cuts According to Curry (2013), “The new health reform is said to bring “massive automatic cuts” and “deep indiscriminate cuts” too so many departments and programs it is a wonder doctors or...
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...In the ever-changing world of the “world-wide web,” healthcare is in the forefront of innovative computerized management systems and the provision of excellence in quality care is dually the journey and goal to enhance patient safety. Before venturing out this journey, it is of importance to understand the ‘why’ and the “how” and “what” will come naturally in succession. The patient is the “why” clinical information transformation is the push for all care providers within the four walls of a hospital, and private and satellite physician offices. Patient safety is the shared vision why pioneers of Health Information Technology (HIT) created computerized systems such as Electronic Health Record to meet the demands of healthcare today and tomorrow. As an example, Cerner Corporation and Dell Corporation- two big giants in the IT industry- are in a continuum to enhance their products and services. In addition, these products, services, and “solutions” are the “platform” that shell the delivery of safe patient outcomes and equip multi-disciplinary clinicians to guide and drive this patient-centered care; best practice and evidenced-care medicine is now the expected and standard of care for what is right for the patient. Furthermore, the present millennial generation drives or is driven by the “cloud’ world and the product is fast and smart, safe and secure, information gathering and sharing that is access anytime and anywhere. For example, a mobile device- IPhone- allows...
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...Emergency Department and by improving customer service through a patient-oriented culture. The proposed efficiency model can reduce the waiting time for simple fracture patients requiring procedure to just 123 minutes from 317 minutes. Our detailed recommendations for management are as follows: * Reduce the long waiting times by optimizing processes and following efficient practices. Long waiting times are patients’ biggest concern. Patients have to wait long since many processes in ED are inefficient due to duplication, disorganization and lack of technology. Eliminating data repetition and embracing technology powered best practices will help optimize processes and reduce lead times. * Eliminate duplication of data in Triage: In the triage area, the nurse documents the “History and Physical” (H&P) information about the patient on a sheet of paper, which takes up four minutes. Thereafter, the nurse enters the same information in EMR. This duplication...
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