City of Hope staff understand that providing patients with the best experience requires that hospital processes be in their best condition. With that in mind, two teams set out to improve how patients prepare for surgery and to make lab test order processes more efficient.
The initiatives were part of City of Hope’s Accelerating Care Excellence (ACE) program, which tasks medical center teams with rapid improvement events that analyze problems and create solutions to improve service and care for patients and their family members. The teams reported their achievements March 5.
Preparing patients for surgery
Cancer patients face health challenges both from their disease and the treatment they undergo. Each treatment option has potential side effects that physicians and patients must carefully consider.
 From left, Ben Calnon, Sharon Steingass and Galene Reese perform a skit in which they pretend to be lab test orders stuck in jail. (Photo by p.cunningham) |
“Patient safety is in the forefront of our minds with every procedure we conduct, but our process of ensuring that patients are cleared for surgery was sometimes frustrating,” said Louis Magdits, surgical business administrator in City of Hope Helford Clinical Research Hospital. Magdits led a team charged with improving patients’ readiness for surgery.
Before surgery, patients undergo blood tests, heart and health assessments and are provided with education on effects following anesthesia as part of a pre-anesthesia testing clinic. The clinic is available to all patients who will receive general anesthesia and focuses on finding pre-existing conditions that might affect how surgery is performed or that may rule out a procedure.
According to Magdits, however, fewer than half of available patients were sent to the pre-anesthesia clinic, sometimes resulting in treatment delays and rescheduled surgeries because patients were found to be unready for procedures.
The same rapid improvement team also noted another problem: Services were distant from one another requiring long walks, and patients sometimes had difficulty navigating to their next appointments and finding the right staff members and services.
The team worked to simplify the process for patients. Clinic appointments now take place in one location, Helford Hospital, and most tests are brought to the patient. This has significantly reduced the time and walking distance required of the patient.
The result: Clinic visit times shrank from 102 to 67 minutes.
Managing lab test orders
Building on last month’s achievements, which reduced unnecessary copies of lab orders by scanning documents and delivering them electronically from some clinics, a second rapid improvement team set out to further improve quality control measures and eliminate redundant paperwork completely.
 Louis Magdits, team leader for a rapid improvement effort for the preanesthesia testing clinic, discusses key measurements. (Photo by p.cunningham) |
“The first team made excellent progress toward simplifying the communication of lab orders for both patients and staff,” said Douglas Stahl, Ph.D., vice president of clinical research operations and leader of the current lab test order team. This team expanded upon previous efforts and introduced some innovative new ideas, he said.
They established scanning locations on all three floors of the outpatient clinics and developed a new system to help simplify rescheduling.
The team’s efforts to eliminate extra paper copies had an immediate effect on decreasing the number of missing lab test orders during the week. Stahl believes moving to the new, primarily digital process will eventually eliminate missing lab test orders.
The next two rapid improvement events are scheduled for April 5 through 9. They will address operating room scheduling and physician consultation tracking and communication.
For more information, please visit www.coh.org/ACE. Questions about ACE also may be addressed to Tricia Kassab, vice president of quality and patient safety, at tkassab@coh.org.
Patients see sustained improvements in care The ACE program has conducted nine rapid improvement events over the past five months, involving more than 100 employees. While teams focus for one week exclusively in one area to make immediate improvements, they also ensure improvements continue beyond that week. “It takes many people working together closely to effectively address our issues and improve the quality of our patient care,” said Sharon Steingass, R.N., M.S.N., vice president of ambulatory services. “We encourage staff to volunteer and participate in these rapid improvement events.” Achievements continue: - The blood-draw area has sustained improvements for more than 90 days, with increased productivity and few patients kept waiting at any given time.
- On average, patients calling City of Hope for the first time can book initial appointments after 32 minutes and see a clinician within eight days.
- 41 percent of new surgical services patients were able to see a City of Hope surgeon within three days of their initial phone call.
- New patients can easily download consent forms from City of Hope’s Internet site to grant permission for staff to collect medical records on their behalf.
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