Page 122 - Lean six sigma demystified

Chapter 3 a Fa S ter Ho S pita L in Five D ay S 101

Faster Discharge

How long does it take to discharge a patient once the order is written? 2 to
6 hours. (Delays for lab, radiology, oxygen, medical equipment, family or other
transportation.) Target: 60 minutes.
Solutions: Get physicians to discharge pending improved results 24 hours in
advance. This allows nurses to do the paperwork and teaching required to pre-
pare the patient for ongoing recovery at home.
Prioritize discharge lab or radiology work ahead of other inpatients and after
ED/OR.
Set up home health requirements (e.g., oxygen, walker, etc.) in advance.
Get at least two phone numbers of family members who can pick up the
patient during the time when they are most likely to be discharged (when the
doctors do their rounds).

Faster Housekeeping

How long does it take to clean a bed after a patient leaves? 20 to 30 minutes
(delay in starting 15 to 90 minutes).
Solution: Eliminate the delay. Are you staffed for peak bed turnover times?
Probably not. Could the housekeeping team operate like a SWAT team, swarm-
ing a newly vacated room to cut cleaning time in half? Ask the housekeeping
staff; they have ideas.
Take the pulse of your hospital. What’s your rhythm? What’s your wait time?

The Problem Isn’t Where You Think It Is

Every department—ED, ICU, med/surgical nursing floors, radiology, lab, house-
keeping, bed management, and so on—think they are doing the best job they
can. Everyone is working hard, everyone wants to do a good job, everyone wants
to serve the patient, but . . .

INsIGHt 1 The patient is idle most of the time.

Rule 1. Stop watching your clinical staff. Start watching the patient, because
patient idle 57 minutes out of every hour of the total turnaround time.
Patient’s length of stay doesn’t increase all at once. It increases in 10- to
30-minute intervals.