By targeting inefficiencies, a quality improvement program led to gains of approximately five or more hours per day in cath lab time. The approach could work as a model for other practices.
Smarter scheduling & processes
A team of healthcare professionals from the Cleveland Clinic described how a systematic effort to boost efficiency improved their catheterization lab start times by 17 minutes on average and reduced turnaround times by 4.1 minutes, leading to a gain of approximately 5.1 to 5.6 hours per day in cath lab time across eight rooms (JACC Cardiovasc Interv 2018; 11:329-38). The improvements were achieved without adding significant staff overtime, weekend or night cases. And, the team noted, employee satisfaction increased significantly after the program was implemented.
“The changes with the most impact on efficiency seemed to be switching from a block to a pyramidal nurse staffing system to address scheduling inefficiencies, instituting an electronic whiteboard to decentralize communication between caregivers, and reducing barriers to patient transfer through increased utilization of a preparation and recovery ‘holding’ area,” wrote Grant W. Reed, MD, MSc, and colleagues from the Cleveland Clinic's Heart and Vascular Institute. “In our experience, human resource management by promoting a culture of continual improvement and teamwork where each caregiver is appreciated and constructive feedback embraced was essential to realizing our goals and fostering employee ‘buy-in’ to the changes implemented.
Workflow analysis uncovers opportunities
The researchers analyzed all procedures for one year before and two years after the program’s June 2014 start date. To design the program, a multidisciplinary team studied the workflow in a typical intervention to identify how much time each step took, redundancies and where potential bottlenecks could occur.
They changed the schedule to allow more rooms to be open from 7:30 a.m. to 3:30 p.m. and adjusted the nursing schedule accordingly. Under the old system, four to five rooms had been open from 7:30 am to 7 p.m. With the new system, seven to eight rooms were available from 7:30 a.m. to 3:30 p.m., and then one or two rooms were open until 7:30 p.m.
“With this change, approximately 80 percent of cases could be completed by 3:30 p.m., allowing a greater number of urgent and add-on cases to be completed earlier in the day,” the authors wrote.
The authors encouraged other institutions to share their own efficiency improvement initiatives, which could “allow for comparison and standardization of delivery metrics in lab operations.”
While their study didn’t analyze patient outcomes, Reed and colleagues said streamlined workflow lends itself to better operational performance and improved care because staff members are more focused on their patients.
In addition, efficiency is crucial as healthcare shifts away from fee-for-service payment models. “In a bundled payments environment, the onus will be on the hospital and provider to use a fixed amount of resources to complete a given case, and thus reducing costs and utilizing resources as effectively and efficiently as possible will be paramount,” they wrote. “It is with this realization that quality improvement projects such as this one are essential to maintaining the financial health of providers and institutions.”
One approach will not fit all
In a related editorial, R. David Anderson, MD, and Michael R. Massoomi, MD—both with UF Health at the University of Florida—pointed out some of the scheduling changes implemented at the Cleveland Clinic would be difficult to implement at smaller institutions with less staff flexibility. They said such initiatives must be tailored to individual practices, but there are lessons from the study that can be more broadly applied.
“One of the most significant achievements of this work is the assembly of stakeholders across the spectrum of care for patients who interact with the catheterization laboratory,” Anderson and Massoomi wrote. “The importance of this type of teamwork should not be underestimated, perhaps now more than ever. This in fact may be the part of their work most easily translated to other institutions.”