Dec 20 2012

Anatomic Pathology’s lean learning path

by Cathy Mellett, contributing writer, PRMC Comments (0)
Lean

For a patient anxiously awaiting lab results—the good news, or the bad—time is of the essence. Learning that their tissue specimen was lost would be horrible.

“We aim to put patients first. That’s why we focus on breakdowns in process,” says Jeffrey Myers, M.D., A. James French Professor, and director of the Divisions of Anatomic Pathology and MLabs. AP provides diagnostic and consultative services in the areas of surgical pathology, cytopathology, neuropathology, dermatopathology, and renal and autopsy pathology for U-M and outside health care organizations.

The last time the Division of Anatomic Pathology lost a specimen was 1 year, 25 days ago, and counting. It’s an amazing feat considering that AP processes about 85,000 pathology specimens a year—and that every single one of those specimens goes through 17 separate steps.

Dr. Jeffrey L. Myers, director, Anatomic Pathology and MLabs, and John Perrin, quality assurance coordinator, Department of Pathology, stand in front of the “No Time to Lose” clock outside the Anatomic Pathology and Histology labs in the main hospital. The clock is Myers’ brainchild, and Perrin has the key. Every day, the AP team works to prevent errors—and no one wants to restart the clock.

If you do the math, AP’s current risk of losing a specimen is 2.94 per million opportunities. Their performance surpasses the Six Sigma level, the quality standard of “near perfection.”

They credit their success to a lean journey that began when Myers took the helm in 2006. Myers came to U-M from Mayo Clinic, where he also led lean endeavors.

By 2007, Myers began introducing lean training, lean teams and onsite gemba walks throughout AP that have paid off big by reducing lost specimen errors for weeks, months, years at a time—and by reducing lead times for selected services by 50 percent.

AP’s average turnaround time went from 7 days in 2005 to about 3 days currently.

These improvements occurred while AP’s workload rose 25 percent—from approximately 68,000 specimens in FY2007 to about 85,000 in FY2012.

As a result of lean thinking, AP has:

  • Implemented an operating room (OR) runner to bring specimens to the lab, freeing up OR nurses to spend more time with the patient. For permanent specimens alone, average time of delivery fell from 1 hour, 19 minutes to 7 minutes—an 88 percent decrease.
  • Eliminated the opportunity for specimens to go missing by creating an action plan to limit distractions for lab staff, reorganizing the lab bench to work towards single piece flow, and standardizing workflow.
  • Developed a lost-specimen policy and orienting new residents, pathology assistants, histotechnologists, fellows and faculty.
  • Created an environment in which technicians are encouraged to “stop the line” and ask for help when they are having difficulty with a piece of tissue. Read the rest of this entry »
Sep 19 2012

Standardizing patient education materials: Singing from the same songbook

by Cathy Mellett, contributing writer, PRMC Comments (1)
Lean, Patient-focused

Imagine you’re a patient just returning from the hospital. The nurse’s instructions say one thing. The brochure from the doctor’s office says another. Which one do you listen to? And how does it make you feel about the care you just received?

Several clinical areas across the Health System are addressing inconsistencies just like these.

“A lot goes into the cleaning, care and replacement of respiratory equipment for cystic fibrosis patients, and a lot of it is different for these patients than asthma and COPD patients, such as the need to rinse nebulizers in sterile water,” says Paulette Ratkiewicz, respiratory therapy supervisor, whose area takes care of more than 300 pediatric CF patients on a regular basis.

Two years ago, patients were getting individual sheets of paper from various parts of the Health System with conflicting information. Today, thanks to a Patient Education Advisory Committee grant, The Cystic Fibrosis Guidebook is given to every CF patient at Mott.

“Everything in it is in line with Cystic Fibrosis Foundation Guidelines. Patients and families can look at this and be confident they’re doing the right thing,” she says.

Throughout Mott Children’s Hospital, a team of advanced practice nurses and respiratory therapists came together to create the Trach Teaching Team. They teach families the ins and outs of taking care of the trachea and equipment, and use a 60-page book created by the Peds Otolaryngology staff which helps parents continue that intricate care when they leave the hospital.

“The book translates our care into the home setting and into the community by helping home care staff and the patients’ schools as well,” says Cathy Lewis, MSN, RN, clinical nurse specialist. Read the rest of this entry »

Aug 16 2012

Moving toward a culture of mobility

by Cathy Mellett, contributing writer, PRMC Comments (2)
Lean, Patient-focused

Early Mobility Program takes hold across Health System

It’s a Catch-22 situation. A critically ill patient must rest. But resting can mean new complications such as pressure ulcers, pneumonia, weakness or malnutrition. Now the Early Mobility Program at the University of Michigan Health System has critically ill patients out of bed early—and hospitals across the country are taking notice.

“Even though patients are on a ventilator, we can still get them up and walking. It may look awkward, but it works. Many patients actually prefer it. They don’t want to be tied down. New medical literature supports that this is a safe and feasible thing to do,” says Don Packard, MSPT, adjunct lecturer and a member of the lean team who developed the program.

The nursing teams on the Critical Care Medical Unit (CCMU) on 6D and the Surgical Intensive Care Unit (SICU) on 5D worked with Physical Therapy and physicians to develop new care plans that move patients earlier and more often. Read the rest of this entry »

Aug 15 2012

It’s not just all about fruits and veggies

by Cathy Mellett, contributing writer, PRMC Comments (0)
Bench to Bedside, Lean, Patient-focused

Our Registered Dietitians help our patients heal

A typical American diet consists of 30 to 40% fat, 10% protein, and 60 to 65% carbohydrates, but when you’re a young child with epilepsy, food becomes a medical therapy that can reduce or eliminate your seizures.

Such is the case with a three-year-old Health System patient whose EEG showed he was having about 100 seizures a night. But only two weeks after Health System registered dietitians put him on the Ketogenic Diet—85% fat, 10% protein and 5% carbohydrates—the boy was having fewer than two seizures a day. One month later, after a few tweaks to the diet, he was seizure free.

Three months later, he traveled with his family to Disneyland, an amazing feat for a child who had been exhausted and practically housebound for months.

“Patients tell us all the time, ‘I have my kid back,’” says Registered Dietitian Denise Potter, RD, CDE, who is part of the Ketogenic Diet program. “Up until then, they’d virtually lost them to the seizures—mentally and emotionally. Now they can go to school. They can grow and develop to their full potential.”

“These are the kinds of results our registered dietitians see daily with all sorts of patients throughout the Health System—adults and pediatric alike,” says Sandhya Padiya, MS, RD, CSP, manager, Clinical Nutrition Services and C&W. “The pediatric dietitian works with the medical team by understanding the medical necessities and the parents’ desires to feed their child.”

Typically, treatment also includes hours of teaching and counseling families before, during and after the special diet has begun. Read the rest of this entry »

Jun 18 2012

Lighting the way to safety

by Michael Steigmeyer, editor Comments (2)
Lean, Patient-focused

UH Cardiothoracic Unit uses Fostering Innovation Grant to reduce medication errors

In 2010, Clinical Nurse Specialist Regi Freeman, RN, MSN, CNS, began noticing a higher rate of medication errors – incorrect dose, time and route – on the UH 4C Cardiac & Thoracic Surgery unit.

Freeman works with Quality Improvement to enhance patient and family experience as well as nursing practice. The unit she oversees cares for lung and heart transplant patients including those with open heart, valve replacement surgery and ventricular assist devices.

“We started looking into the causes of medication errors and realized our unit administers more medication doses in a one-month period than any other unit in the Health System,” says Freeman. “Patients on 4C often need more than 20 medications per day during their hospital stay.”

Sarah Comstock, BSN, RN gets medicine for a patient in UH 4C's No Interruption Zone.

After interviewing and shadowing staff as well as reviewing the timing and frequency of medication errors, Freeman found that the 70 nurses in 4C were being interrupted multiple times as they counted, prepared and administered medication.

“Interruptions included everything from pages and phone calls from staff, to patients, family members and colleagues stopping nurses in the hallway to ask questions,” Freeman says

Once the cause was clear, Freeman and her team sprang into action to find a solution.

They applied for a Fostering Innovations Grant from the U-M Health System and used funding to create a “No Interruption Zone” in the unit’s medication room. Read the rest of this entry »

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