ED Cardiac Patient Flow The use of A3 Thinking tool in improving ED cardiac patient flow.

1. QHN Fall Forum 2008 ED Cardiac Patient Flow The use of A3 Thinking tool in improving ED cardiac patient flow.

2. QHN Fall Forum 2008 Team Members

3. QHN Fall Forum 2008 Background Reason for Action Improve cardiac patient safety by reducing door to ECG time Create additional bed capacity by improving utilization of cardiac bed space Patient cardiac flow not standardized, thus need for consistent team approach Reduce door to room time for acute care area

4. QHN Fall Forum 2008 BackgroundQI tool “A3 Thinking” tool was used in this project. This lean tool forced the team to think systematically and sequentially to solve the problem Standard A3 thinking process is: Reason for action , Initial condition, Target condition , Root cause/gap analysis, Solution approach, Rapid experiment, Completion plan, Confirmed condition and Lesson learned

5. QHN Fall Forum 2008 Patient Cardiac Flow-Application of A3 Tool

6. QHN Fall Forum 2008 A3 Thinking andapplication of other QI tools

7. QHN Fall Forum 2008 Intended and Achieved Outcomes Targets 1. Swipe to ECG time less than 15 minutes 2. Swipe to Acute Care Room 40 minutes 3. Utilization of new Acute Care Zone

8. QHN Fall Forum 2008 Key Success Factors Active Physician involvement to create criteria for Acute Care Zone Senior leadership support to commit resource for “A3 Thinking” event “Out of the box” thinking Thorough knowledge of the process Snap shot data of metrics in the ED

9. QHN Fall Forum 2008 Barriers Weekend Effect – communication gap Physical layout change need some time & planning Physician could not commit to full week event People tendency to jump to solutions

10. QHN Fall Forum 2008 Lessons Learned Silo thinking to system thinking by having cross-functional team Regular follow-up meetings help to move the project forward or any barriers Enhanced staff accountability by involving them in creating solutions

11. QHN Fall Forum 2008 Next Steps Control and Monitoring plan should be integral part of A3 Thinking. This will enforce sustainability Renovation of Acute Care Zone Continuous follow-up meetings to achieve target metrics Make “A3 thinking” as a standard approach for each improvement event

12. QHN Fall Forum 2008 Contact Information Lalit Bhushan Corporate performance improvement specialist North York General Hospital 4001 Leslie Street Toronto, Ontario M2K 1E1 4167566000 Ext. 6775