Design of a prioritization system of the surgical
Inducción
waiting de novatos
list in a third-level hospital.
II Término académico 2015-2016
Carlos Angulo Muñoz
Jhalmar Lombeida Tufiño
Industrial Engineering
Edwin Desintonio, [Link].
Faculty of Mechanical and Production Sciences Engineering
2017/02/23
AGENDA
Content
• Background
1
• Problem Statement
2
Inducción de novatos
• Data Collection - Analysis
II Término académico 2015-2016
3
• Improvement
4
• Implementation of solutions
5
• Conclusions and Recommendations
6
Background
Hospital of third level of care
Inducción de novatos
Surgical Specialties
1 PROCESS
2
• Cardiovascular
II Término académico 2015-2016
• Gynecology
• General
• Plastic 3
• Neurological
• Ophthalmology
• Others
Problem Statement
Time Series Plot of Patients waiting for surgery
180
160
140
Inducción de novatos = average waiting time for surgery
Quantity of patients
120
100
II Término académico 2015-2016
2,86 = months
80
60
40
20
A patient should be
0
may jul sep nov ene mar may jul sep operated in one month
Month
2015 2016
Objectives
General objective
Reduce the average time that a patient wait from surgical record
Inducción de novatos
filling out until surgery in order to improve the healthcare services
II Término académico 2015-2016
Specific objectives
• To establish prioritization criteria for scheduling patients on surgical
waiting list
• Purpose improvements actions for appropriate management of the
surgical waiting list
Data Collection
No. VARIABLE DATA TYPE ¿HOW IT IS MEASURED? RELATED CONDITIONS
It compare the date in which between the surgical What: Waiting time
Inducción de novatos
Elapsed days between the surgical record is filled and is Where: Surgical scheduling
1 register in the surgical waiting list Discrete record was fill up and the date that is register in department / surgical waiting list
surgical list When: Daily
2 II Término académico 2015-2016
Elapsed days between a patients is register in surgical
waiting list and is operated Discrete
Comparing dates between patients is register in
surgical waiting list
and is operated
What: Waiting time
Where: Surgical committee /
surgical waiting list
- Consolidated (January to
November)
When: Weekly
Data Analysis
Elapsed days between the surgical record is filled up and is register in the
surgical waiting list
Inducción de novatos
>7 Dias
>30 Dias
5%
>100 Dias
6%
3% TOTAL
II Término académico 2015-2016 TOTAL
SIN DATOS
378
84
0 Dias 0 Dias 160 54%
54% >7 Dias< 92 31%
>7 Dias< >7 Dias 10 3%
31%
>30 Dias 15 5%
>100 Dias 17 6%
Data Analysis
Elapsed days between a patients is register in surgical waiting list and is operated
I-MR Chart of C1
480
1
360
UCL=316,4
Individual Value
240
Inducción de novatos
_
120 X=114,1
30
0
LCL=-88,1
POLICY
1 3 5 7 9 11 13 15 17 19 21 23
II Término académico 2015-2016 400
Observation
1
300
Moving Range
UCL=248,5
200
100 __
MR=76,0
30
0 LCL=0
1 3 5 7 9 11 13 15 17 19 21 23
Observation
As the p-value < so is rejected, the data has not a normal
distribution.
Analysis of Causes
Inducción de novatos
II Término académico 2015-2016
FMEA
Inducción de novatos
II Término académico 2015-2016
15 causes are
found with the
5 critical causes
obtained by
stakeholders help criteria of higher
NPR value
Verified causes
Ambiguity or lack of the fields in the
surgical record
Inducción de novatos
II Término académico 2015-2016
Surgical record is not
delivered by the Physician
to the surgical
programming department
Verified causes
Patient is in the SWL
without being suitable
for surgery Dr does not anticipate
Dr fill up the surgical the resources and
record to patient with supplies need for
Inducción de novatos
incomplete or expired
exams
surgical intervention
II Término
Add patients
académico 2015-2016
No inputs and
without considering resources are
trans-operative managed or lack
needs of stock
TOTAL 4103
Suspended 460 11%
Unfit 20 4%
Verified causes
Scheduling surgery of
patients with random
Inducción de novatos method
II Término académico 2015-2016
There are no
prioritization
criteria
Implementation plan
What? Why? How? Where? When?
Improve action Purpose of action Tasks to a manage Scope Date
Design of a Prototype
Improve LEQ management
tool for the Programming surgical
including prioritization programming in VBA excel 16 Jan. - 24 Jan.
management of the department
criteria
SWL
Define prioritization criteria With the help of the
Design of a prioritization Include prioritization criteria
Inducción de novatos
with leaders of surgical participants of the 20 Jan.
system in programming
specialties surgical commission
With surgical
Remove ambiguity and place
Change in Surgical Designing and coding new programming, surgical
useful fields for 23 Jan. - 27 Jan.
II Término académico 2015-2016
record Format
Elaboration of protocol
programming
Define an appropriate work
surgical record format center and quality
department
Establish procedures for the Since the surgical part is
for the management of correct management of the elaborated until is 23 Jan. - 27 Jan.
schedule
the waiting list SWL operated
Giving the ability to handle
Training for prototype Prepare Staff to appropriate Programming surgical
the tool with your 25 Jan. - 26 Jan.
usage use of the tool department
applications
Communicate to staff about
Communicate to
prototype management and With the the surgical
Socialization of the plan stakeholders the changes in 27 Jan.
protocol for SWL commission participants
the programming process
management
Give operation to the Track prototype Programming surgical
30 Jan. - 17 Febr.
Prototype test phase prototype performance department
Implementation of solutions
• Prioritization of patients
Six measurable and applicable criteria where
obtained:
Inducción de novatos 1. Life quality impact of the pathology
associated with the surgical procedure
II Término académico 2015-20162. Risk of complications during waiting
3. Waiting time of patients on SWL
4. Date of preanesthetic examinations
5. Use of health resources and services
6. Estimated time of surgery
Implementation of solutions
Implementation of solutions
• Prioritization of patients
22%
3 2 1
life quality impact 6 3 0
Inducción de novatos 44%
Waiting risk 3 3 3
Waiting time on surgical
II Término académico 2015-2016 waiting list
0 3 6
33%
Physicians leader qualified
Life quality impact each criteria to calculate its
weight.
Waiting risk
Waiting time on SWL
Implementation
Implementation of solutions
of solutions
• Prioritization of patients
COLOR TAG SYSTEM
NON URGENCY LESS URGENCY URGENCY
Inducción de novatos
0,444
CV
1
0,333
RE
1
0,222
T_LEQ
60
1
P
14
2 2 60 15
II Término académico 2015-2016
3 3 60 16 0< X >16
1 1 120 27
2 2 120 28
3 3 120 29 16< X >29
1 1 180 41
2 2 180 42
3 3 180 42 X >29
Expiry time of preanesthetic examinations
6 months
Implementation of solutions
Implementation of solutions
• Surgical waiting list management
Inducción de novatos
II Término académico 2015-2016
All the fields has
been included, and
the ambiguity fields
were erased
Implementation of solutions
Implementation of solutions
• Surgical waiting list management
Search engine
Inducción de novatos
II Término académico 2015-2016
Bottoms
Implementation of solutions
Implementation of solutions
• Policies stablished
• Add patients unsuitable for surgery.
• Physician stay with the surgical record
1 • Patients are not registered in SWL
Inducción de novatos
• Surgical record filled out incorrectly
II Término académico 2015-2016
2 Set Policy
Socialization and training
3
Before and after improvements
Number of surgical records filled correctly
proportions of surgical record filled incorrectly before the improve
proportions of surgical record filled incorrectly after the improve
Sample Size for Estimation
Method Inducción de Before
novatos 60
After
3
Parameter Proportion 𝑝 1= 2=
𝑝
Proportion II Término académico 2015-2016
Distribution
Confidence level
Binomial
0,5
95%
𝑝1=0,576
104
0,028
104
Confidence interval Two-sided
=0
Results
: <0
Margin Sample
of Error Size
0,1 104
Difference = p (1) - p (2)
Estimate for difference: 0,548077
95% upper bound for difference:
0,632211
Test for difference = 0 (vs < 0): Z =
10,72 P-Value = 1,000
Verified causes
Before and after improvements
Elapsed days between the surgical record was elaborated and is register
in the surgical list
RECUENTO TOTAL
TOTAL TOTAL 297
C. General 90 30% TOTAL 378
SIN DATOS 0
SIN DATOS 84
Ginecología
Oftalmología Inducción de novatos
104
49
35%
16% 0 Dias
>7 Dias<
160
92
54%
31% 0 Días
>7 Días<
261
27
88%
9%
C. Vascular 14 5%
II Término académico 2015-2016
>7 Dias 10 3% >7 Días 9 3%
>30 Dias 15 5% >30 Días 0 0%
C. Plástica 15 5% >100 Días 0 0%
>100 Dias 17 6%
Urología 11 4%
>7 Días< > 7 Días
Otorrino 10 3% 9% 3%
C. Torácica 4 1% >30 Dias >100 Dias
6%
5%
Traumatología 0 0%
>7 Dias
3% 0 Dias
>7 Dias< 54% 0 Días
Neurocirugía 0 0% 31% 88%
C. Cardiaca 0 0%
TOTAL 297
BEFORE AFTER
SIMULATION
Assumptions
No one patient reject the
Inducción de novatos
surgery
All the surgical Schedule
II Término académico 2015-2016
patients are operated
• Died patients
• Patients attending for
emergency
The patients on surgical
waiting list are suitable for
surgery and don’t change in
the time.
Before and after improvements
Simulation Results
elapsed day mean that wait a patient for surgery before solutions
elapsed day mean that wait a patient for surgery after solutions
𝐻
0 : 𝜇 1 − 𝜇 2=0
Inducción de novatos
<0
II Término académico 2015-2016
Difference = mu (Before) - mu (After)
Estimate for difference: 10,86
95% upper bound for difference: 14,99
Test for difference = 0 (vs. <): T-Value =
4,43 P-Value = 1,000 GL = 39
Before After
As p-value is grater than we cannot reject , being
the elapsed day reduced in the after scenario
76 days 65 days
Conclusions and Recommendations
Conclusions
• With the policy Physician fill the surgical record correctly and deliever to the
Inducción de novatos
surgical scheduling department in a time less than 7 days.
• Establishing prioritization criteria, patients will reduce their surgery waiting
time into a 15% on average without any extra cost..
II Término académico 2015-2016
Recommendations
• Develop a software application on the hospital main information system based on
the prototype created to remove the surgical record paper and change it for a
digital surgical record.
• Update the surgical map to level the demand with the supply.