The problem
Where the time was going
When a patient needs a medication, the time it takes to arrive can be the difference between comfort and pain, and sometimes between far more than that. The stretch from when a drug is prescribed to when it reaches the patient is full of handoffs, and at this hospital those handoffs had become a real problem.
Staff were often slow to transcribe and fill physicians' orders. The lag from the time an order was written to the time the medication reached the patient could run as long as eight to twelve hours. That delay lengthened hospital stays and put patients at risk, especially those waiting on pain medication or on antibiotics needed to arrest an infection.
The team set out to find where and why the delays happened, with a clear target in mind: bring the time to transcribe an order down to one hour after it was written, identify the resources needed to request and administer a medication, and make sure the nurse was told once a drug reached the care unit.
What we modeled
Mapping the process, then testing the fix
Walking a group of people through the entire process takes enormous time and effort, so the team used ProcessModel to build a system map that let everyone view the whole picture at once. A plain flow chart would not carry the weight the working committee needed to show decision-makers where the bottlenecks were, so they turned to simulation for something more visual and demonstrable.
The model laid the process out so each department could finally see how its own role fed the others. With the flow in plain view, the team could test changes to protocol and to the way pharmacies were notified of new orders before asking anyone to change how they worked.
The result
The proof, and the payoff
The model made the core problem obvious: each department had been working independently because none could see how its part affected the system. Once that was visible, the hospital changed protocol so the departments worked together and medication orders moved through far more quickly.
One change put electronic handling in place of a manual one. Where pharmacy technicians had picked up orders in person and carried them to the pharmacy, the hospital began expediting orders electronically, with plans to add electronic order-entry software the following year. The pharmacy also identified staffing savings that the new equipment and software would make possible.
Part of our work in healthcare.