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A Quality Improvement Project to Reduce Inappropriate Referrals to a Specialized Ventilation-Weaning Unit FREE TO VIEW

Mazen Al-Qadi, MD; Sanjay Chaudhary, MD; Erin Frazee, PharmD; Vicki Loeslie, RN; Jon Steuernagle, MD; John Park, MD
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Mayo Clinic, Rochester, MN

Chest. 2013;144(4_MeetingAbstracts):538A. doi:10.1378/chest.1705011
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SESSION TITLE: Cost and Quality Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Our objective was to apply Lean Sigma, a quality improvement project to eliminate waste and improve efficiency of patient transfer to a specialized ventilation-weaning unit. The project goals were to decrease the number of inappropriate consults and streamline the transfer process.

METHODS: We prospectively evaluated the process of patient’s transfer to the Respiratory Care Unit (RCU). Requested consults placed during the months of November through December 2012 were measured and analyzed for appropriateness and outcome. The frequency of inappropriate RCU consults and most common barriers to smooth transfer to the RCU were recorded. An intervention was implemented which provided a brief outline of the RCU purpose and transfer criteria to consultants and charge nurses via email, as well as paper documentation for medical residents and fellows in the workroom and for the workstations on wheels.

RESULTS: Upon follow-up evaluation, RCU appropriateness increased from 76% to 82%. In all cases where the consults were inappropriate, contact was made with the primary service, which was an increase during the follow-up period by 22%. Future opportunities identified include expanded use of clinical notes to communicate RCU consult inappropriateness with primary service and integration of a computer-based intervention screen during RCU consult placement regarding criteria.

CONCLUSIONS: Use of Lean Sigma principles in a ventilation-weaning unit led to reduction in the inappropriate consults. Process mapping, improved education and communication among providers, and engagement of leadership and staff were key to improvement.

CLINICAL IMPLICATIONS: The Respiratory Care Unit (RCU) is a specialized unit designed for patients who repeatedly failed weaning attempts from mechanical ventilators. RCU providers are under increasing pressure to see greater volumes of patients while maintaining high quality of care. Furthermore, long wait times are undesirable among referring physicians and can decrease their satisfaction. These factors highlight the great need to optimize the efficient use of the RCU providers’ time in evaluating patients referred to the RCU.

DISCLOSURE: The following authors have nothing to disclose: Mazen Al-Qadi, Sanjay Chaudhary, Erin Frazee, Vicki Loeslie, Jon Steuernagle, John Park

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