The Transport Dilemma
14/01/10 19:15
The problem was enduring and well-known. This hospital ward admitted patients around the clock, sometimes from the Emergency Department and sometimes directly from doctors. As the patients came in they were assessed and if they needed emergency scanning (x-ray, MRI, etc) they were sent. But the bulk of the patients waited until the day shift if they could.
As the patients were assessed their needs were entered, where possible, into the computer record. So, for example, Patient 1 would need an MRI in the morning, he was able to sit up and didn’t need oxygen for transport. This information was important for the transport team who would arrive on the ward in the morning with the required equipment. It looks like a system that should work well, but there were some problems.
1. The computer screen had no place to record the need for oxygen.
2. The condition of the patient could change dramatically in the hours between assessment and transport.
3. These two problems meant that a full-time person in imaging was required to call the ward to determine the condition of the patient before sending the transport team. They would bring oxygen if needed and send two people if the patient couldn’t travel by wheelchair and needed to be pushed in their bed
4. The receptionist on the ward would start receiving calls the moment she walked in. She didn’t know the condition of the patients, she had just arrived at work, so she had to run around and ask the nurses, who would then have to interrupt what they were doing to find out and answer. This would usually continue for 2+ hours as the night patients were sent for their scans.
We set up a Simple Lean meeting but couldn’t get all the players. We got the second-in-command from imaging, the receptionist from the ward and someone from the transport team. We didn’t have a doctor or someone from IT. That meant our solution had to leave these two groups out. We couldn’t solve this by asking the doctors to do something different (like finding a place to put the oxygen requirements or re-doing assessments closer to the time of transport. We couldn’t ask IT to add a field for oxygen needs or magically produce handheld devices so nurses could update patient condition at the bedside.
As the patients were assessed their needs were entered, where possible, into the computer record. So, for example, Patient 1 would need an MRI in the morning, he was able to sit up and didn’t need oxygen for transport. This information was important for the transport team who would arrive on the ward in the morning with the required equipment. It looks like a system that should work well, but there were some problems.
1. The computer screen had no place to record the need for oxygen.
2. The condition of the patient could change dramatically in the hours between assessment and transport.
3. These two problems meant that a full-time person in imaging was required to call the ward to determine the condition of the patient before sending the transport team. They would bring oxygen if needed and send two people if the patient couldn’t travel by wheelchair and needed to be pushed in their bed
4. The receptionist on the ward would start receiving calls the moment she walked in. She didn’t know the condition of the patients, she had just arrived at work, so she had to run around and ask the nurses, who would then have to interrupt what they were doing to find out and answer. This would usually continue for 2+ hours as the night patients were sent for their scans.
We set up a Simple Lean meeting but couldn’t get all the players. We got the second-in-command from imaging, the receptionist from the ward and someone from the transport team. We didn’t have a doctor or someone from IT. That meant our solution had to leave these two groups out. We couldn’t solve this by asking the doctors to do something different (like finding a place to put the oxygen requirements or re-doing assessments closer to the time of transport. We couldn’t ask IT to add a field for oxygen needs or magically produce handheld devices so nurses could update patient condition at the bedside.