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Birth Defects Data Collection and Review Kaizen Event

This kaizen event aims to improve the efficiency and consistency of the birth defects data collection and review process. The goal is to decrease wait times, reduce handoffs, and increase the accuracy of collected data. Recommendations include streamlining coding processes, improving the user-friendliness of MEDSS, and optimizing the use of physician consultation. The future state will result in focused team meetings, quicker finalization of cases, improved communication with parents and healthcare providers, and a better understanding of MEDSS. Lessons learned include the importance of dedicated team time and clear scope definition.

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Birth Defects Data Collection and Review Kaizen Event

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  1. Birth Defects Data Collection and Review Kaizen Event August 8, 2013

  2. Kaizen Team

  3. Goals for the Future State Decrease time between initial report and nurse review by 50% over the next 6 months Decrease number of handoffs by 25% in the next 3 months Increase consistency of data collected by 25% in the next 6 months Decrease team reviews by 25% over the next 6 months

  4. Kaizen Event Scope Starting Point When list of likely cases is reported to birth defects program Ending Point When selected cases are identified for physician consultant review

  5. Current State

  6. Observations of Current State The wait time between team review and consultant review has an easy solution. We wonder if there needs to be an alert to 2nd abstractor, seems duplicative. The process is simple but MEDSS makes this more complicated. The longest wait time could be reduced significantly. The wait from the 2nd alert could be reduced.

  7. Observations of current state (cont) We send too many cases to ream review. It involves handoffs to many people. Sometimes minor errors get sent to team review. Not all deceased children need to be team reviewed. The nurse reviewer has a lot of tasks! There are huge variations in wait times.

  8. Observations of current state (cont) It looks more simple than we thought. Cases are not easy to average in terms of time. Some outliers (way outside the norm) are not documented here. Most cases are not complicated (difficult to code) if we follow our guidelines.

  9. Observations of current state (cont) All handoffs are electronic  The process is proportional to job functions. Long waits are due in large part to meeting times (holidays, etc.). Abstractors are only in the office 1 X per week. There are conflicting priorities for their time.

  10. Recommendations Issue: We need to streamline the process from the report to a case entering BDIS. Solutions: • Establish a more efficient process for resolving coding questions. • Establish a real-time process for physician consult.

  11. Recommendations Issue: MEDSS is not user friendly. Solutions: • Revisit the way MEDSS is set up to try to simplify and improve it. • Dedicate time for a thorough inspection of the MEDSS Birth Defects module. • Automate some handoffs in MEDSS.

  12. Recommendations Issue: Team review is a bottleneck. Solutions: • Look at more efficient ways of using team review. • Move most team reviews to after physician consultation.

  13. Recommendations Issue: There is a need to put all coding criteria sources in one document. Solutions: • Merge sources. • Add better documentation of clarifications and changes. • Make master file more accessible.

  14. Future State

  15. Benefits of Future State More focused team meetings to get through the case load. Reduced time from case report to finalization. Notify parents and LPH earlier to better assure connection to services. More consistent data. Better understanding of how MEDSS works. Optimize the use of physician reviewer time and expertise.

  16. Current & Future Process Metrics • 84% reduction in total wait time • 82% reduction in total process time (shortest scenario) • 76% reduction in total process time (longest scenario)

  17. Development of the Action Plan

  18. Action Plan

  19. Parking Lot Quality assurance process Use of physician consultants Use of review team Should all cases of deceased infants be referred for physician review? Need for doing a time study for steps in the process Prep work/follow up for semi-annual meetings for the Birth Defects Work Group How will MEDSS align with the data reporting system for newborn screening for critical congenital heart defects?

  20. Lessons Learned There is a right and a wrong time to do a Kaizen. Waiting until August was a good decision. The process itself was a good experience. A good future state process comes from reviewing the current state and “tweaking” it. Sometimes little things can have big rewards.

  21. Lessons Learned It is important to have uninterrupted dedicated team time. Every member of the team has to commit. It is important to have “removed” facilitators. A manageable scope with clearly defined start and stop points is vital. Lead-time for planning prior to the event is helpful. The process or structure of a Kaizen over a sustained time period lends itself to a variety of learning styles.

  22. Questions?

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