Is the patient on the table yet Hayder

Is the patient on the table yet? ! Hayder Hashim, MD FACC Med. Star Washington Hospital Canter

Hayder Hashim, MD FACC I have no relevant financial relationships

Room Utilization Case Volume % of on time start % of overtime hours Turnaround time % of sheath pulls % of after hours cases Cath Lab Efficiency Cost savings

Efficiency Improvement Process • Recognize Efficiencies – – – • • • Late days in lab Inability to add cases Inability to finish all cases Overtime Physician and nurses dissatisfaction Analyze process and data collection Set goals for different measures Innovations Implementation Sustain improvements

Grant W. Reed et al. JCIN 2018; j. jcin. 2017. 09. 025

Analyze Process and Data Collection Average Time: Preping Patient in the Lab 0: 21: 37 0: 20: 53 0: 20: 10 0: 19: 27 0: 18: 44 0: 18: 01 0: 17 0: 16: 34 Jul Aug Sep Monthly Average Oct Nov Dec

Analyze Process and Data Collection Average Time: Waiting for Physician 0: 17 0: 14: 25 0: 11: 32 0: 08: 39 0: 05: 46 0: 02: 53 0: 01 Jul Aug Sep Oct Monthly Average Nov Dec

Analyze Process and Data Collection Average Time: In the Lab After Off Table 0: 10: 05 0: 08: 39 0: 07: 13 0: 05: 46 0: 04: 20 0: 02: 53 0: 01: 27 0: 01 Jul Aug Sep Oct Monthly Average Nov Dec

Set Goals • Improving on-time starts: 1. Obtaining consent from the first scheduled patient on the evening before the procedure 2. Alerting patient transportation to pick the patient up a few minutes early

Set Goals • Cost saving strategies: Ø Add the cost of each item to the ordering system. Ø Pay careful attention to expiration dates. Ø Replace the pricey options with cheaper ones and as effective.

Innovations (Same Day Discharge PCI)

Sustain the Improvements • Certain aspects of the plan to be made unit policies • Examples: (to ensure early start) v Staff must arrive on time and prepare the procedure room upon arrival to the department. v Charge nurse must alert the performing physician at least 20 minutes prior to the start of procedure.

Sustain the Improvements • Cooperation and initiative of several other departments, management, and personnel. • Committee meetings with quarterly reports serve as a checks and balances review, and hold all parties accountable

Thank You