New Zealand

Bayside Health

Lean Team Members

Anthony Ball

Leanne Smith

Project Aim & Plan

Project aim:

Reduce the lead time for urgent neurology referrals from ED to outpatients by 20% by 15/11/06

Project Plan:• Consultation with owners of process and stakeholders• Value stream map• Identification of waste• Root cause analysis• Kaizen Blitz• Look to long term IT based solution

Current State Value Stream Map

Phone enquiry from patient to ED

ED Ring Outpatiets to enquire about progress

Patient makes Phone enquiry to outpatients.

Check to see if an appoint is made on the system (usually not)

Information

Patient put on system or UR number retrieved

Medical records file and history

Referal Form Faxed and stamped (and put in medical records)

Faxed referal cleared daily M-F.

Triage by OP nurse (Anne).

Triage by Neurology VMO

Appointment made

(referring Dr notified)

flow processCheck UR no.

(no receipt, some don't go through, sometimes forget to check if bounced)

Attatch slip detailing, date, clinic and demographic

Stroke or TIA (urgent) If urgent

reminder letter 10 days prior (to address shown on records)

Faxed referal form filled in by Dr

Is there enough info?

Page referring Dr for more info if required

If non urgent (= wait)

Ring to remind about an

appointment. Fill in empty

spots with non urgent patients

Test results (if available) or referal indicated on form (usually)

Check progress on test results

attatch results to referal (if available). If not, hold off appointment til test results available.

If requierd, orders tests

.

Patient

ED Triage Dr Dr Referal to OP

Appointment

Waiting areaNurse

clerk

call neurology registrar or Dr

Orders tests if required.

(unclear what patient advised. Info on form variable)

enter wait

time ProductionLead Time 14days

enter value Processing

adding time 1 hr

Time: less than 4 hours hrs

Value Stream Map

7-14 days

ED process Outpatient process

INFORMATION FLOW

W

WW W

Key Wastes

Motion Rework Missing Information (defects) Misinformation (defects) Waiting

Key baseline statistics

Key stats for Neurology referrals: Appointments available per month: 70*

*26 of these appointment are available on the first Tuesday of the month, the remaining appointments are available each Friday

Number of total referrals to neurology: 120 Can only see 58% of referrals (assuming every patient arrives for

their appointment). It is essential that available slots are allocated to most urgent cases. Hence the importance of a comprehensive referral.

Key Stats for ED referrals: ED makes on average 16 referrals to Neurology outpatients per

month (4 per week) 100% of referrals from ED have been incomplete in terms of

missing information

Kaizen Blitz Actions:

Educate clerical staff on importance of updated patient information including address and phone details.

Redesign referral form to include tick box for information sheet

Education for medical staff on importance of listing investigations done and to give patient information form.

Outcome

Education of Medical and Clerical Staff Clerical staff are more confident / assertive in ensuring that medical

staff complete all sections of the form A new Outpatient Form Designed – see below