1. 4/14/2017
Using RTLS, Business Intelligence and Integrations to Improve Pump Management
The use of organized team efforts to facilitate change in culture backed by data.
Chris Gutmann, Director of Clinical Engineering
In conjunction with Darcy Hennessey and Brooke Spadaccino (not presenting at HIMSS)

2. Project Goals Ensure EVERY patient will have a pump when needed
Multi Disciplinary Team:
Materials Management
Nursing
Pharmacy
Clinical Engineering
Information Services
Operations Support
How will we achieve this?
Staff will readily release pumps when not in use
Pumps will be available when they call/request
Patients will arrive on units from procedure areas/OR’s /ED with pumps in place, ( receiving unit staff will give back a pump)
Each area will have the appropriate “safety stock” for unexpected situations
Identify the “safety stock" needed at entry points in the care continuum

3. Yale – New Haven Health System

4. Y-NHH: A Tradition of Excellence
Nursing continually looks to for opportunities of systems redesign which solidify our team approach.

5. Yale – New Haven Hospital
The history of Yale-New Haven Hospital extends back to 1826 when the General Hospital Society of Connecticut was chartered as the first hospital in Connecticut and the fourth voluntary hospital in the nation. The hospital rented temporary quarters and raised US$5,000 toward purchase of land and construction. A new 13-bed hospital opened in 1833 on seven and a half acres of land bordered by Cedar Street and Howard, Davenport and Congress avenues.
2013:
5 Million Square Feet owned and operated by YNHH
4 main pavilions = 2,000,000 ft2
60 Operating Rooms, 25+ procedure rooms
1,120 Patient Beds
Level 1 Trauma in Pediatrics and Adult Emergency Medicine
Park St. - Lab and Pharmacy = 130K ft2
Physicians Building and Psych. Hospital = 100K ft2
Yale School of Medicine adjacent/attached to hospital
Former Hospital of St. Raphael’s = 1,000,000 ft2

6. 688-9000 SOS Alert Please call the SRC for pick-up now.
Continual crisis episodes sent routine alerts
to the entire organization calling for pumps!
Continual issues add to the alarm fatigue…
Please call the SRC for pick-up now.

7. Project Charter: Sigma Pump
Participant/Process Representatives
Project Description / Problem Statement
Process Scope: Start/end
Project Sponsor:
Sue Fitzsimons – Chief Nursing Officer
Process Owner:
Carol Just - Director, Surgical Services
Chris Gutmann – Director, Clinical Engineering
Multi Disciplinary Team Members:
Clinical Engineering
Information Services
Materials Management
Nursing
Operations Support
Pharmacy
Cycle of distrust: Only broken when everyone cooperates
System to Locate Pumps does not identify “pump in use”
Inability to get a pump when needed induces lack of trust in process and hiding of pumps
Hiding pumps lead to a shortage of pumps
Sigma pump equipment management including:
Procurement
Movement throughout the hospital
Preventative maintenance
Allocation for each clinical area
Project Goals
Process Scope: In/Out
Ensure EVERY patient will have a pump when needed. How will we achieve this?
Staff will readily release pumps when not in use
Pumps will be available when they call/request
Patients will arrive on units from procedure areas/OR’s /ED with pumps in place, ( receiving unit staff will give back a pump)
Each area will have the appropriate “safety stock” for unexpected situations
Identify the “safety stock" needed at entry points in the care continuum
In Scope:
York Street Campus, Saint Raphael Campus
Out of Scope:
Bridgeport and Greenwich hospitals
Project Y / Key Metrics
Sigma pump monthly call volume
Sigma pump call volume by unit per month
Average monthly Materials sigma pump job completion time
SIPOC / High Level Process Map for Unit
Call Service Response Center and/ or Off Shift Executive and/or Off Shift Nursing Leader to deliver pumps and/or go floor by floor in the hospital to collect unused pumps
Sigma pump needed but none available
Customer CTQ’s
Pump(s) received
Pump available when needed
Store the pumps in a safe location in case they are need for the next patient
Remove the pump(s) from patient departing the unit
Place pump(s) on patient

8. Defining the Available Supply
1400 pumps purchased in 2009 no additions to date!

9. Sigma Pump Process Map

10. Do We Have Enough Pumps?
All Stakeholders need to buy-in to the process…
Snapshot of audit on 1/26/2012
(5am contact census 923)
Vicious Cycle of Distrust:
No equipment churn
Patient criticality not driving need
Equipment not available
An episode of delay
Staff Hoard equipment
Total in fleet – 1375
Entry Points buffer - 359
IR, HVC Labs, OR, PACU,
L&D & EDs
Oncology infusions
Remote Locations - 31
Ambulatory, Psych
Dialysis, Pedi Clinic, Urgent care
Maintenance Process - 17
Pumps in Waiting - 45
Material’s pool for distribution
1375 (total)
- 452 (non-circulating)
= 923 Available
1500
Crisis Calls per Month

11. Defining the Demand
Data Collection through the call center for materials and Baxter pump
data on infusions started at entry points over the course of a day.

12. Streamlining the Movement Process

13. Streamlining the Movement Process
Process for units:
Rounding 3x daily
Safety stock set as a profile for each unit
5S storage areas to define storage location of “safety stock”
Unused clean equipment placed in green bins
Units looks in green bin or safety stock before calling materials for delivery
Process for EVS staff:
Clean equipment is placed in green bin for pick up
(no clean pumps to be left in rooms)
 Process for SOS alert:
Unit leadership or assigned staff person to round as soon as alert issued and check with all staff for unused sigma pumps
Place unused sigma pumps in green bin and call SRC for pickup
Process for materials staff:
Check with charge RN that safety stock (red tape with par number) is filled before removing sigma pumps from units
Collect equipment from green bin  

14. Driving Results through Culture Change
In face of rising census the need to call the Service Response Center for pumps has decreased.
A plateau in reducing the number of calls for sigma pumps and are look to reinforce rounding and pilot technology to continue the downward trend. 14

15. State Monitoring -> Utilization
At Material’s storage location in WP basement ready for shipment to unit
Undergoing service at clinical engineering
In transit for use
In use at patient bedside
Not in use, at patient bedside
Not in use, in green bin or safety stock. Ready for usage by next patient

16. Data Validation Pilot
Running: time between the “start infusion” button is pressed and the pump completes drug delivery or is stopped
Not Running: amount of time the pump is not infusing
Available: amount of time the pump is physically in green bin or safety stock
Delivered: amount of time the pump travels from materials storage to a unit before used for an infusion
Pilot participants: SP 6-1, SP 6-4 and EP 7-7

17. Dashboard Concept – Info @ Front Lines
Pilot Studies on clinical units for profile setting of departments.
Actionable Data
Management Report
Managers can view multiple floors to see a snapshot of the past 24 hours.

18. Demand is a function of Patient Acuity
Worked with units individually to understand flow and patient acuity mix to set the proper PAR levels.
SICU
Not all units created equal…
Step Down
ORTHO

19. Improved Utilization
Trust of the front line patient care groups feed a process which allows for less “stagnant” assets
Step Down 71.5%
SICU 69.6%
ORTHO 68%
SICU 50.6%
Step Down 47.2%
ORTHO 41.2%

20. Questions? Chris Gutmann, Director of Clinical Engineering
4/14/2017
Questions?
Chris Gutmann, Director of Clinical Engineering
In conjunction with Darcy Hennessey and Brooke Spadaccino (not presenting at HIMSS)