Chris Gutmann, Director of Clinical Engineering

1. Using RTLS, Business Intelligence and Integrations to Improve Pump Management The use of organized team efforts to facilitate change in culture backed by data. Chris Gutmann, Director of Clinical Engineering In conjunction with Darcy Hennessey and Brooke Spadaccino (not presenting at HIMSS)

2. Project Goals Ensure EVERY patient will have a pump when needed Multi Disciplinary Team: • Materials Management • Pharmacy • Information Services • Nursing • Clinical Engineering • Operations Support How will we achieve this? • Staff will readily release pumps when not in use • Pumps will be available when they call/request • Patients will arrive on units from procedure areas/OR’s /ED with pumps in place, ( receiving unit staff will give back a pump) • Each area will have the appropriate “safety stock” for unexpected situations • Identify the “safety stock" needed at entry points in the care continuum

3. Yale – New Haven Health System

4. Y-NHH: A Tradition of Excellence Nursing continually looks to for opportunities of systems redesign which solidify our team approach.

5. Yale – New Haven Hospital The history of Yale-New Haven Hospital extends back to 1826 when the General Hospital Society of Connecticut was chartered as the first hospital in Connecticut and the fourth voluntary hospital in the nation. The hospital rented temporary quarters and raised US$5,000 toward purchase of land and construction. Anew 13-bed hospital opened in 1833on seven and a half acres of land bordered by Cedar Street and Howard, Davenport and Congress avenues. 2013: • 5 Million Square Feet owned and operated by YNHH • 4 main pavilions = 2,000,000 ft2 • 60 Operating Rooms, 25+ procedure rooms • 1,120 Patient Beds • Level 1 Trauma in Pediatrics and Adult Emergency Medicine • Park St. - Lab and Pharmacy = 130K ft2 • Physicians Building and Psych. Hospital = 100K ft2 • Yale School of Medicine adjacent/attached to hospital • Former Hospital of St. Raphael’s = 1,000,000 ft2

6. SOS Alert Continual crisis episodes sent routine alerts to the entire organizationcalling for pumps! Continual issues add to the alarm fatigue… Please call the SRC for pick-up now. 688-9000

7. Project Charter: Sigma Pump Participant/Process Representatives Project Description / Problem Statement Process Scope: Start/end • Project Sponsor: • Sue Fitzsimons – Chief Nursing Officer • Process Owner: • Carol Just - Director, Surgical Services • Chris Gutmann – Director, Clinical Engineering • Multi Disciplinary Team Members: • Clinical Engineering • Information Services • Materials Management • Nursing • Operations Support • Pharmacy • Sigma pump equipment management including: • Procurement • Movement throughout the hospital • Preventative maintenance • Allocation for each clinical area • Cycle of distrust: Only broken when everyone cooperates • System to Locate Pumps does not identify “pump in use” • Inability to get a pump when needed induces lack of trust in process and hiding of pumps • Hiding pumps lead to a shortage of pumps Project Goals Process Scope: In/Out • Ensure EVERY patient will have a pump when needed. How will we achieve this? • Staff will readily release pumps when not in use • Pumps will be available when they call/request • Patients will arrive on units from procedure areas/OR’s /ED with pumps in place, ( receiving unit staff will give back a pump) • Each area will have the appropriate “safety stock” for unexpected situations • Identify the “safety stock" needed at entry points in the care continuum • In Scope: • York Street Campus, Saint Raphael Campus • Out of Scope: • Bridgeport and Greenwich hospitals Project Y / Key Metrics • Sigma pump monthly call volume • Sigma pump call volume by unit per month • Average monthly Materials sigma pump job completion time SIPOC / High Level Process Map for Unit Call Service Response Center and/ or Off Shift Executive and/or Off Shift Nursing Leader to deliver pumps and/or go floor by floor in the hospital to collect unused pumps Sigma pump needed but none available Customer CTQ’s Pump(s) received Pump available when needed Store the pumps in a safe location in case they are need for the next patient Remove the pump(s) from patient departing the unit Place pump(s) on patient

8. Defining the Available Supply 1400 pumps purchased in 2009 no additions to date!

9. Sigma Pump Process Map

10. Do We Have Enough Pumps? All Stakeholders need to buy-in to the process… • Total in fleet – 1375 • Entry Points buffer - 359 • IR, HVC Labs, OR, PACU, • L&D & EDs • Oncology infusions • Remote Locations - 31 • Ambulatory, Psych • Dialysis, Pedi Clinic, Urgent care • Maintenance Process - 17 • Pumps in Waiting - 45 • Material’s pool for distribution Snapshot of audit on 1/26/2012 (5am contact census 923) Vicious Cycle of Distrust: 1375 (total) - 452(non-circulating) = 923 Available 1500 Crisis Calls per Month

11. Defining the Demand Data Collection through the call center for materials and Baxter pump data on infusions started at entry points over the course of a day.

12. Streamlining the Movement Process

13. Streamlining the Movement Process Process for units: • Rounding 3x daily • Safety stock set as a profile for each unit • 5S storage areas to define storage location of “safety stock” • Unused clean equipment placed in green bins • Units looks in green binorsafety stock before calling materials for delivery Process for EVS staff: • Clean equipment is placed in green bin for pick up • (no clean pumps to be left in rooms) •  Process for SOS alert: • Unit leadership or assigned staff person to round as soon as alert issued and check with all staff for unused sigma pumps • Place unused sigma pumps in green bin and call SRC 688-9000 for pickup • Process for materials staff: • Check with charge RN that safety stock (red tape with par number) is filled before removing sigma pumps from units • Collect equipment from green bin

14. Driving Results through Culture Change • In face of rising census the need to call the Service Response Center for pumps has decreased. • A plateau in reducing the number of calls for sigma pumps and are look to reinforce rounding and pilot technology to continue the downward trend. 14

15. State Monitoring -> Utilization At Material’s storage location in WP basement ready for shipment to unit Undergoing service at clinical engineering In transit for use In use at patient bedside Not in use, at patient bedside Not in use, in green bin or safety stock. Ready for usage by next patient

16. Data Validation Pilot Pilot participants: SP 6-1, SP 6-4 and EP 7-7 Running: time between the “start infusion” button is pressed and the pump completes drug delivery or is stopped Not Running: amount of time the pump is not infusing Available: amount of time the pump is physically in green bin or safety stock Delivered: amount of time the pump travels from materials storage to a unit before used for an infusion

17. Dashboard Concept – Info @ Front Lines Actionable Data Pilot Studies on clinical units for profile setting of departments. Management Report Managers can view multiple floors to see a snapshot of the past 24 hours.

18. Demand is a function of Patient Acuity Worked with units individually to understand flow and patient acuity mix to set the proper PAR levels. SICU Not all units created equal… Step Down ORTHO

19. Improved Utilization Trust of the front line patient care groups feed a process which allows for less “stagnant” assets Step Down 71.5% SICU 69.6% ORTHO 68% SICU 50.6% Step Down 47.2% ORTHO 41.2%

20. Questions? Chris Gutmann, Director of Clinical Engineering In conjunction with Darcy Hennessey and Brooke Spadaccino (not presenting at HIMSS)