1. From Flash to Finish Staff Dr. Yu Dr. Foxx Dr. Powell Dr. Higginson Residents Katie Charnock Candice Snyder Bridget Cunningham Michael Cunningham Jenny Jaskiewicz

2. FOCUS-Find Inefficiency of the Bili process? Appointments are inconvenient Leaving house is a challenge Time is precious

3. FOCUS-Organize Tuesday Continuity Group Corpsman Resident and Staff Sampling

4. FOCUS-Clarify Check-in Vital Signs and TCB Appointment and review TCB Order Neobili Obtain Neobili Wait for lab result Disposition

5. FOCUS-Clarify Check-in Vital Signs and TCB Review TCB, Order and Obtain Neobili Appointment Wait for lab result Disposition

6. FOCUS-Understand Is there a problem? 73 Newborn Appointments in Jun-Nov –Obtain TCB: 18m (13-28) –Order Neobili: 34m (13-53) –Send to Lab: 33m (0-53) –Lab Processing: 44m (31-57) –Time from Check-in: 134m (112m-158m) Median time in min (IQR)

8. FOCUS-Understand

9. FOCUS-Select Obtain Tcb: 18m (13-28) Order Neobili: 34m (13-53) Send to Lab: 33m (0-53) Lab Processing: 44m (31-57) Time from Check-in: 134m (112m-158m) Median time in min (IQR)

10. Plan-Do-Check-Act Review data in the America Building Triage the patients Empower the corpsman Earlier physician notification –Order Neobili sooner

11. Plan-Do-Check-Act TCB and Neobili Guidance –Phototherapy as inpatient? –Neobili for all TCB ≥ 15, if under 5 d/o –Place heel warmer for TCB = 11-14 Educate on Phototherapy Curve

12. Plan-Do-Check-Act Corpsman meeting March 26, 2011 Gather Data –Before and After Intervention –New Clinic –32 encounters before and after

13. Plan-Do-Check-Act 32 Newborn Appointments Jan-Mar –Obtain TCB: 17m (11-23) –Order Neobili: 40m (15-65) –Send to Lab: 18m (0-38) –Lab Processing: 45m (37-58) –Time from Check-in: 124m (104m-158m) Median time in min (IQR)

14. Plan-Do-Check-Act 32 Newborn Appointments Mar-May –Obtain TCB: 10m (6-17) –Order Neobili: 29m (12-45) –Send to Lab: 24m (0-46) –Lab Processing: 40m (32-54) –Time from Check-in: 111m (100m-140m) Median time in min (IQR)

16. Plan-Do-Check-Act Median Time Before Median Time After Net Time p-value* Get TCB17 min10 min(7 min)0.055 Order NB40 min29 min(11 min)0.20 Send to Lab 18 min24 min6 min0.28 Lab Time45 min40 min(5 min)- Total Time 124 min111 min(13 min)0.33 *Wilcoxian Rank Sum

17. Plan-Do-Check-Act Triage has improved efficiency Reinforce Guidelines to Corpsman Monthly to Quarterly Training Training for New Corpsman