1. Presented by: Maria Annissia Angeles, Michele Aguilar, Jhoenalyn Mendoza, Sandra Mendoza, Stacey Kim, & Kristine Sayavong

2. Los Angeles County – USC Medical Center (LAC-USC) 600-bed public teaching hospital located in the Boyle Heights neighborhood of Los Angeles County of California Jointly operated by Los Angeles County and the University of Southern California

3. Problem in LAC-USC Los Angeles Times reports that the hospital has an average Emergency Wait time of 12 hours Ambulances are being diverted Patients are being transferred to different hospitals for better care

4. Problem with Long Patient Wait-Times Bad Patient Outcomes patients leave due to long patient wait-time without even receiving care Health complications ambulatory diversion results in delayed care and progressive pain and suffering late diagnosis and treatment Death 2007: 200 emergency physicians said they’ve knew of patients who died due to long patient wait-time

5. Why the Need for Improvement? Faster and efficient care in case of an emergency Better and profitable healthcare services provided Patients receives the care that they need when they need it

6. Project Aim/Goal To Reduce patient wait time in the LAC-USC Emergency Room to an average of four-hours or less to avoid: Ambulatory diversion Bad patient outcomes Health complications Death Time-frame: 1-fiscal year

7. Fishbone Diagram

8. Pareto Chart

9. Possible solutions Make sure that there is always enough staff on the schedule especially during peak times as well as always have specialist on call so that they can come in case they are needed. Better staff training for proper identification of patient condition, so that they can diagnose non-emergencies quickly without taking up one of the emergency beds and redirect non-emergency patients to different providers. Make sure that the emergency room is equipped with the latest technology, enough medicine and supplies so that the ER could work faster and more efficiently. Other hospital policies, such as how the X-ray and lab departments prioritize patients, must be reviewed and whenever possible, aligned to meet the needs of the ER.

10. Plan Cycle 1: Reschedule shifts to make sure the number and type of staff line up with the numbers and timing of when patients present to the ER Cycle 4: Work with the X-Ray and lab departments and ask them to give ER patients priority to meet the needs of our department Cycle 3: Invest in technology, more supplies, and medicine, and be able to allocate them efficiently to have enough available Cycle 2: Better staff training to identify non-emergency patients and redirect them to other providers without taking up emergency beds

11. Do Each cycle was implemented individually one after the other for a period of three months. We recorded the waiting time for each patient in the ER to get an average for each cycle. CycleAverage 13.5 hours 25.0 hours 34.0 hours 44.5 hours

12. Study According to the findings, we conclude that every cycle helped reduce the waiting time in the ER significantly. However, the only cycle that was effective in achieving our goal was the first one by reducing the waiting time less than 4 hours.

13. Act Since all the cycles were effective in reducing the waiting time in the ER, we are going to implement them together to have better results. We will keep track of the wait time average in the ER so we maintain our objective constant.

14. How are we going to implement Change?

15. Team Development Stages Forming – schedule a time and day to meet up with our group and prepare a discussion Storming – collaboration of ideas; picking and choosing the most appropriate topic Norming – delegating tasks for each member Performing – executing tasks and meeting deadlines

16. Team Management Skills Delegation – Matching team members with tasks and explaining roles and goals Motivation Theory X and Theory Y Communication - You need to let your team know what's happening and keep them informed as much as possible

17. Implementing CQI Programs: Communication - lessens surprise Sponsorship - If there is not strong leadership behind the change, resistance will keep it from happening. Coaching - Provides hands-on help to move from A to B. Senior leadership coach management, who coaches their staff members to facilitate behavior change. Education - Builds knowledge and ability Understanding the resistance - helps deflect the defensiveness around change, which facilitates moving ahead. When people know ahead of time, there will be less resistance than if it is forced into place in a hurry.

18. References Billimoria, R. (2013, February 27). Plan Do Study Act [Powerpoint slides]. Retrieved April 9, 2013, from Beachboard website: https://bbcsulb.desire2learn.com/d2l/lms/content/viewer/main_frame.d2l?ou=182948&tId=1715355. https://bbcsulb.desire2learn.com/d2l/lms/content/viewer/main_frame.d2l?ou=182948&tId=1715355 Gorman, A. (2013, March 5). Officials consider adding more beds to County/USC Medical Center. Los Angeles Times. Retrieved from:http://articles.latimes.com/2013/mar/05/local/la-me-county-usc- 20130305.http://articles.latimes.com/2013/mar/05/local/la-me-county-usc- 20130305 Los Angeles County & USC Medical Center. (March 2013). Retrieved May 1, 2013 from Wikipedia: http://en.wikipedia.org/wiki/Los_Angeles_County%2BUSC_Medical_C enter. http://en.wikipedia.org/wiki/Los_Angeles_County%2BUSC_Medical_C enter Strategy to reduce emergency department wait times. (2012). Retrieved April 9, 2013, from Newfoundland Labrador website: http://www.health.gov.nl.ca/health/wait_times/emergency_departmen t_strategy.pdf. http://www.health.gov.nl.ca/health/wait_times/emergency_departmen t_strategy.pdf