Women's Center Improves Assessment Time by 55%

As a busy department with high patient satisfaction scores, the Women's Center at Avera McKennan Hospital & University Health Center was far from being labeled as "unproductive" or "inefficient."

And yet in a competitive market, a LEAN team found ways to bring a good department to an even higher level of excellence.

Obstetrics and gynecology is the No. 2 service line at Avera McKennan, with 3,658 discharges in 2006.
Although the Women's Center was built in 1994, rooms get hard use. Bathroom fixtures needed updating, and rooms had a cluttered feel. The unit has 14 LDRP (Labor, Delivery, Recovery and Postpartum) rooms on 3rd floor, and 17 patient rooms on 4th floor. Before remodeling began, however, the LEAN team evaluated all processes and planned a new LDRP room layout.

A key element was the AveraOpEx 5S Initiative - sort, set in order, shine, standardize and sustain.
The LEAN Team began videotaping processes in order to analyze them.

One concern at the forefront was a delay in labor inductions. Medications for induction couldn't be delivered to the unit until pharmacy staff had reviewed patient allergy information, which wasn't entered until the patient was admitted.

"The irony is, we get that patient allergy information three months into pregnancy. We had the information, we just weren't doing anything with it," said Doreen Hardy, RN, and member of Avera McKennan's Process Excellence staff.

Now, the needed information is processed in advance. "There's virtually no wait for an induction to begin," Hardy said.

Videotapes also showed that nurses were struggling to convert labor beds for delivery. The problem? An extra sheet that didn't need to be there, per manufacturer's instructions. "Taking off that extra sheet has saved labor, linen and frustration," Hardy said.

Other changes made during the LEAN implementation included:

• Rearranging rooms for better traffic flow as well as patient comfort.
• Selecting new monitors that record both fetal and maternal vital signs, eliminating the need for a separate epidural cart. Epidural supplies are now kept in a roll-up packet that can easily be added to the delivery cart.
• Placing computer terminals on the wall in patient rooms, allowing nurses to complete their charting there instead of taking notes and later entering those notes onto the computer.
• Replacing bathtubs with showers in 4th floor rooms. Because OB/GYN patients most often can't take baths or prefer showers, nurses were constantly running for shower chairs. New showers on the floor will be equipped with fold-down shower seats.
• Replacing an over-abundance of suture supplies with SIR (Suture In Room) packets, creating an estimated inventory reduction of 80 percent, and a cost savings of $3,600 to $13,200 on suture supplies alone.

Reducing unneeded inventory and clutter is a key LEAN principle. "We threw out a lot of expired and outdated supplies," Hardy said.

Then, the team set up a new system for ordering supplies, saving the secretary hours of time in looking up exact names and numbers of products.  Bins are labeled with bar codes which can be scanned for reordering.

"Nurses can now go into a room and know all the supplies they need are at their fingertips," said Terri Swenson, RN, Women's Center nurse manager.

Rooms are currently being remodeled one at a time, allowing patient care to continue in the Women's Center.  While Press Ganey patient satisfaction scores hit the 98th percentile in February 2007, Swenson said the Women's Center is shooting for the 99th.

"We're confident these changes will lead to even higher patient satisfaction," Swenson said.