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Quality Update
TOOLS: Building Success
Six Sigma proves its mettle in removing obstacles to quality patient care.
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| Richard Wahl, M.D., led the effort to increase patient flow to the country's first PET/CT imaging service. |
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Last year, Johns Hopkins Nuclear Medicine Chief Richard Wahl and the staff of the country’s first commercial PET/CT imaging operation were trying to figure out how to meet a growing demand for its services, increase patient flow and take full advantage of this cutting-edge technology. It was a situation ready-made for the PET Center staff, who shared a desire to improve patient and staff satisfaction and enhance the operation’s financial performance, to use Six Sigma.
A statistical term, Six Sigma measures the extent to which a process varies from perfection. It has become a corporate mantra for improving efficiency by reducing errors or defects, and thereby increasing profits. And it has been gaining a slow but steady hold in health care. At The Johns Hopkins Hospital, Six Sigma has flourished mainly in Radiology, which has used the quality improvement analysis in several major projects. Now, the Hopkins Center for Innovation in Quality Patient Care is applying the same techniques to improve the safety and level of care for patients.
Hospitals can have thousands of systems, each with as many as 100 steps. The Six Sigma doctrine is to streamline a process, because the more steps involved in delivering care, the higher the statistical chances for mistakes. The Center for Innovation has used Six Sigma in a number of its patient safety projects, including ones aimed at eliminating medication errors and reducing surgical site infections on the cardiac surgery intensive care unit. “We’ll be applying Six Sigma on more projects,” says Laura Winner, the center’s head quality improvement coach and an advanced Six Sigma expert, “to complement our rapid-cycle approach to fix system breakdowns before they put patients in danger and diminish the quality of their medical care.”
In applying Six Sigma to the issues facing the PET/CT operations, the staff, including registration clerks, technologists, physicians and the pharmacist began to identify areas of potential improvement. They agreed that workflow and communication problems caused delays that limited their efficiency. The staff began their analysis by dividing up the workflow into time units, tracking patient arrivals, registration, prep time, waiting time after radioisotope injection, the length of the scan and how long it took to discharge the patient. Each staff member documented the times they began and ended each step. The data showed that patients often arrived late and delays occurred during the prep phase of the scan that resulted in down time between scans.
Because the 45-minute wait after the injection and the 30-minute scan were clinical care protocols that couldn’t be changed, the staff decided to set other time goals. One was to get the first patient through registration and prepped in 30 minutes. To accomplish this, the pharmacist designed a new scheduling format, and registration clerks and their manager, Julita Nieve, improved patient education and streamlined the registration process.
These and other changes have increased the number of clinical PET/CT scans per day to 10 and nearly doubled annual charges. “The success of Six Sigma,” says Peg Cooper, nuclear medicine’s technical manager who’s experienced in the process improvement technique, “relies not only on the quantitative analysis, but on the entire staff working together to implement changes.” |
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