Understanding Morning PA amp RN Workload on UH 4C Final Presentation December 12 2017 Team 1 IOE 481 Team 1 Ellie Arand Esha Bedi Dustin Sieh Support Team Ian Perry amp Allie Mukavitz Industrial Engineers ID: 762235
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Understanding Morning PA & RN Workload on UH 4C Final PresentationDecember 12, 2017 Team 1
IOE 481 Team 1 Ellie Arand Esha Bedi Dustin Sieh Support Team: Ian Perry & Allie Mukavitz - Industrial Engineers
Clients Sarah Comstock BSN, RN - Clinical Nurse Supervisor Louise Grondin - Clinical Nursing Director
Nursing StaffRegistered Nurses Unit 4C Staff Advanced Practice Team Physician Assistants Nurse Practitioners
Agenda Background Goals and Objectives Methods Findings and Conclusions Recommendations Expected Impact
Current State Unit 4C 2 Types of Discharge: Priority & Regular 32 Bed Unit Cardiac & Thoracic Patients
Problem Nurses and Advanced Practice Team in 4C have difficulty completing discharges in a timely manner due to heavy morning workload
Key Issues High morning workloads in Unit 4C cause delay in patient discharge Large gap between the time when discharge occurs
Discharge Processes 9:30am: Nurses off-board 1-2 patients 11am: Patients are discharged 2pm the day before: Physicians alert nurses Priority: Regular: No distinct process
Unit 4C Goals Prioritize workload from 7-11am for the Nursing & Advanced Practice Team Provide patients with an earlier discharge time
Goals and Objectives Create a task prioritization list for the Nursing staff and the Advanced Practice Team Analyze tasks to be completed during this time frame Identified factors not related to the discharge process that could be increasing the time to complete the morning workload
Project Scope Includes Morning tasks and patients in unit 4C Morning hours determined to be 7-11am Excludes Any task not associated with the morning workload Any non 4C hospital unit
Methods Literature Search Interviews Observations Time Studies Data Analysis
Methods: Literature Search Article on Nurse workload: observed similar behaviors in Unit 4C Documentation Medication Administration Care Coordination
Methods: Interviews 5 Nurses and 3 APT members Problems Discovered: Better discharge orders and plans needed High patient load creates unsafe environment Better communication in the Unit
Methods: Observations16 Nurses and 5 APT Staff Observed 6 Priority Discharges Observed Qualitative Observations Task List for Time Studies Created
Methods: Task List (Nurses) Morning Huddle Night Shift Report Answer Call Lights Charting on Computer Telemetry Test Get Supplies Get Patient Medications Check Vitals Clean/ Get New Room Ready Break Walk Patient Discharge Paperwork Patient Hygiene Patient/ Family Education
Methods: Task List (APT) Night Shift Report Look at Report Sheets Round with Physicians Computer Reporting (unless patient emergencies come up)
80 hours Of Time Studies Process Flow Map Created using data collected APT & Nurses Recorded how long each task took Methods: Time Studies
Methods: Obstacles Beeper Studies were cancelled → more in person time studies
Methods: Data Analysis Averaged time values for each task Determined number of times each task occurred Calculated Standard Deviation of each task
Findings and Conclusions Advanced Practice Team daily schedule Look at Report Sheets Round with Physicians Night Shift Report Computer Reporting 6-7 AM 7-8 AM 8-9 AM 9-11 AM
How much time it takes each nurse to complete a given task? Finding and Conclusions How many times on average a nurse complete that task? Questions to be answered by Finalized Task List
Findings and Conclusions Tasks were split into two groups: Essential Tasks Non- Essential Tasks
Findings and Conclusions Essential Tasks: Morning Huddle Night Shift Report Meet Patients Take Vitals Get Patient Medications Administer Patient Medications Computer Charting Print Telemetry Charts
Findings and Conclusions Non-Essential Tasks: Answer Call Lights Walk Patients Patient Hygiene Patient/ Family Education Clean Room Break
Findings and Conclusions Advanced Practice Team daily schedule Look at Report Sheets Round with Physicians Night Shift Report Computer Reporting 6-7 AM 7-8 AM 8-9 AM 9-11 AM
Work Process Diagram Mean Time Option 2: 26 Minutes Mean Time Option 1: 32 Minutes
Work Process Diagram Mean Time Option 1: 29 Minutes Mean Time Option 2: 34 Minutes
Work Process Diagram Non-Essential Tasks Time: 36 Minutes
Swim Lane Diagram
Key Takeaways No regular discharges observed during morning shift Not much of a time difference between the 4 nurse paths Nurses will end tasks before PA’s start discharges
Future Recommendations Quality of Care vs. TimeObserve Entire Day Shift & Night Shift
Expected Impact Decrease morning workload completion time Prioritize tasks creating efficient work process
THANKS! Any questions? You can email our point person at: elliea@umich.edu Team 1