Transplant Program Enhancement: Application of Lean Processes to HSCT Program Improvement Efforts

HSCT procedures are on the rise and with the increase in volume comes payer pressure to decrease unproductive costs and enhance quality outcomes. Decreased availability of trained specialists and multiple competing demands within academic medical centers for resources have also been experienced. These factors force health systems and providers to continually examine internal processes and explore means to deliver value with improved outcomes, lower costs, and improved access. OHSU’s system for continuous improvement (OPEx) designed to drive rapid performance improvement using common vocabulary, tools, and Lean methods, was applied to the activities to improve the value of services provided. A qualitative analysis examined the current state, anticipated future needs, and prioritized interventions based on perceived impact and actionable effort. 12 areas were targeted for improvement after analysis by multidisciplinary teams. 4000 hours of professional time was invested in work by the multidisciplinary teams during a 17 month period. Table 1Outcomes of Process Improvement Activities.Content FocusOutcomesOutpatient Care SettingPatient prep room resourced to meet patient needsJust in time exam room assignmentsEPIC infusion plan simplificationRedesign of clinic flow around the patientCreation of a complexity scale for Infusion Room capacity management with just in time RN assignmentsNew model for Infusion Room patient scheduling;Staggered Clinic appointment start times with defined resource needs by appointment typeRevised Clinic room assignment algorithm.Inpatient Bed Availability and Discharge ProcessEstablishment of end of day inpatient team “Lightening rounds” for communication of discharge statusIncreased participation of RNs on roundsEnhanced team communication regarding target day and time for discharge and sharing of those expectations with patientsImproved readiness of medications from outpatient Pharmacy at dischargeEstablishment of criteria and process for early discharge for AML patientsEstablishment of structure and process for evaluating treatment shifts from the inpatient to the outpatient setting. Shifting of 3 regimens to the outpatient setting resulted in opening up 96 inpatient bed days and savings of $350,000 in pharmaceuticals over a 9 month period.Team CommunicationIP to OP sign-out via Epic dot phrase at time of patient dischargeStandardization can be achieved even in the complex academic/research, inpatient/outpatient care context of HSCT. Efforts to identify waste, to increase efficiency, and to provide care in the appropriate setting while ensuring safety, quality, affordability, and value for the patients need to remain a priority for health systems and providers particularly in light of the complexity and evolution in the field of HSCT. Open table in a new tab