Cath Lab Digest

With increasing health care costs, decreasing reimbursement and an increasing baby boomer population, the healthcare industry will soon realize the necessity of looking at process flow improvement in order to achieve cost savings. With information and quality measures steering consumer decisions, it is imperative that the healthcare industry not only meet these measures, but exceed them. This must be achieved while improving consumer satisfaction and providing safe and financially responsible healthcare. With this vision on the horizon, the proposal is not to work harder, but to work smarter, a goal that can be achieved with the implementation of standardized work, proactive and organized change, and the use of advancing technology.

Financial Gains

The growing cost of health care resources continues to place enormous pressure upon all aspects of the world market. Designing a healthcare system that is customer-focused and financially accountable will make healthcare organizations part of the solution rather than part of the problem. The continued survival of healthcare while finding permanent solutions to rising healthcare costs is attainable by using process flow redesign and lean principles. Organizations with a forward-thinking vision can use these savings to their advantage with a solid reinvestment strategy and through capital avoidance. Capital avoidance is the process of using process redesign, flow and throughput to avoid new construction, multi-million dollar additions, and freestanding clinics. These savings are then reinvested into areas with increased growth potential. The use of existing assets to provide savings, growth and financial stability, can be achieved without the associated costs of using borrowed money. At Appleton Medical Center (ThedaCare Health System), we have delayed the building of an additional cardiac catheterization lab by redesigning process flow, creative case scheduling, and building a collaborative partnership with our partners at the Appleton Heart Institute. The redesign of flow created capacity within current schedules and increased production capability. This capital avoidance savings, estimated to be approximately 1.6 million dollars, will allow for resources to be used to expand other services.

This level of collaboration could not be achieved without the clear communication of goals, a collaborative effort between partners, and the flexibility of physicians and staff. To date, ThedaCare Rapid Improvement Events (R.I.E.), have achieved a projected savings of over ten million dollars. Organizations successful in achieving budget-neutral status and reinvesting their savings may ultimately pass on lower costs to the consumer. This business practice can increase market share, provide business stability, and position organizations to be leaders in the industry.

Discussing the bottom line is always a hot topic. At some point it is important to bridge the gap between financial gain and providing world-class healthcare. The gains that can be realized by increasing flow through an area are many. For some facilities, it may mean saving millions of dollars by deferring or eliminating projected building projects. For others, it may mean changes to create capacity within an area, by improving the flow and reducing waste. Waste can come in several different forms, including wasted resources and wasted human talent.

Many hospitals have been faced with patient bed census problems. By creating standard work, flow and throughput, a large patient volume may be moved through an area in a shorter time period. This reduces inpatient bed space needs, staffing, and the potential for errors, meaning less risk for patient incidents or infection, less overtime on nursing units and improved satisfaction of staff. Providing a standardized workflow and developing the ability to care for patients in a safe, timely and patient-centered manner results in a win-win concept. It can also be seen as a marketing win, as a pleasant patient experience can drive some financial markets. The exact dollar figures are variable, as each institution will need to evaluate their own overall cost savings.

A Focus on Length of Stay

In the Cardiac Special Procedures Area (CSPA) at Appleton Medical Center, flow and throughput have successfully been redesigned to directly improve the care delivered to patients. The continuous movement towards providing best practice standards of care and continuous improvement are based on the lean principles of automotive manufacturing, specifically, the Toyota Production System. At ThedaCare, these principles have been mentored by Simpler Consulting Inc.¹ As a result, Appleton Medical Center has been able to safely decrease the length of stay for most PCI patients to less than 5 1/2 hours.

The CSPA at Appleton Medical Center was originally designed as a four-bed overflow unit to support the cardiac inpatient floor. In times of high inpatient census, the unit was opened to accommodate patients that would be short stay (between eight to twelve hours). This was staffed with one RN and a clinical technician. As the daily volume increased, it was not uncommon to care for six patients per day in this four-bay area.