Wednesday, July 09, 2008


I know this might not seem as serious as the posts below about wrong-side surgery, but we have made good progress with a lot of call-outs through BIDMC SPIRIT. Some of these may seem somewhat trivial to you, but please remember that fixing even a "minor" item that takes up the time of a nurse or other caregiver creates more time to actually be with patients, improving the quality of care and reducing the chance of errors -- not to mention improving the work environment for that person and many others, too. Remember, too, that these resulted from real people on the floors calling out problems that previously would have resulted in perpetual work-arounds. I think this is good stuff.

So, here's just a running a list from the last several weeks:

The abandoned bikes outside the Farr building have been removed, freeing up spaces for employees to leave their bikes.

It is now easier to find precaution gowns in the ED.

BIDMC’s evening shuttle has expanded its service to provide transportation to Ruggles Station upon request between 9pm and 11:30pm.

The many incorrectly functioning aspects of the mobile computing unit used in the Trauma SICU have been fixed.

Several new documents have been posted to the SPIRIT site to assist with discussions about SPIRIT and its best use. Take a look under “Reference Documents.”

Chair alarms on Farr 9 are easier to track.

CC6A no longer runs out of menus for patients.

Surgical residents can respond to trauma team pages more quickly now by exiting the Palmer and Baker call rooms through doors previously locked at night.

Clinical staff no longer need to hunt around as much for missing suction set-ups on 11 Reisman.

A bathroom on Palmer 2 has reappeared (actually, just the sign had disappeared, but some staff did not know there was a bathroom there).

Nurses and respiratory therapists in the MICU 7 no longer have to tend to ventilator false alarms as often; an equipment default has been fixed.

Patient confidentiality is better assured in certain Dermatology exam rooms now that shredders have been placed in them.

Omnicell restocking on Farr 5 happens at a time more convenient for nurses and for distribution of morning meds.

There is a new process for completing updates to the OMR dictionary—new medications will be recognized more frequently.

CVICU staff no longer have to hunt around for a wheelchair; there is a designated wheelchair and space to store it.

Inpatient RNs have read access to webOMR.

The SPIRIT log has a built-in search function; please use it to gain insight into call-outs that might bear similarities to yours.

The Patient Profile on POE now lists the need for an interpreter when necessary so all care providers are aware of it.

The Farr 7 breakroom no longer receives calls for Psychiatry.

Incorrect instructions for patients scheduled for ambulatory surgery have been updated to include correct check-in location.

There is now a streamlined system for repairing patient call lights promptly on Farr 9.

Patients requiring an MRI or CT are no longer delayed by IV access needs.

New measures are in place to help prevent inadvertent activation of the code center disaster recording.

New signage is helping visitors to the Trauma SICU find the correct waiting room and prompt assistance much more easily.

Patients miss far fewer nuclear bone scan appointments because they now receive appointment reminders.

Patient phone jacks no longer get pulled from the wall on Reisman 11.

Staff in the ED now spend less time looking for tubes to send to the Blood Bank or STAT Lab.

Laptops on Farr 6 no longer need to be rebooted before use.

West Campus MRI techs are more easily and reliably reached via pager.

Vital sign log sheets will now be reinforced to prevent ripping and loss.

Sharps bins on Shapiro 9 and the PACU are being emptied on a schedule more aligned with their actual use.

The Deaconess 2 house staff lounge now has a speaker for broadcasting Code Blue signals.

Lunch is ready for ED patients when they need it.

Nurses on Farr 7 can find a pulse oximeter when they need one.

On 12 Reisman, blood pressure cuffs and parts are better organized and stored.

East Campus CT Techs now have a printer in their immediate workspace.

A better plan is now in place to supply the SICU A&B with enough pillows.

Employees should no longer receive a bill for care following an occupational exposure.

The Dermatology Unit now has a new system to maintain adequate supplies of essential medical items.

Discharge medication lists are now simpler and easier to understand.

Accounts Payable has a new mailbox for invoices to streamline processing.


Camilla said...

What a thoughtful blog - I never knew professionals blogged on blogger. I love the idea of solving problems instead of relying on work-arounds. Better to build a direct path than to pave roads where cows meander from place to place.

One minor comment: Dr. Wes (under related links) should be attached to the following URL:

There are far to many h's, t's and p's in the URL you provided.

Anonymous said...

You are really getting rid of the daily "Where's my pen" irritability of searching for items we use constantly. I'm sure it is saving time and money, but I bet the frustration level is way down. If I were a nurse, I would HATE looking for pillows. So yes, you've mentioned "small" things -- but I want to apply the techniques to my own office -- and mainly, my HOUSE!

Anonymous said...

It just goes to show that not all change is bad in a hospital environment and I bet all these minor changes that you make can help build the groundwork and mindsets for bigger changes to go through smoother!

Not all changes are bad or as bad as we think it might be. You are either moving forward or moving backward, there is no inbetweens!

Nice job!

Julia said...

Thanks for posting this, I've been an avid reader for several months now and it is so awesome to see how a large-scale improvement project has been able to deal with daily annoyances and workarounds in so many areas of the hospital. I would love to have this systematic way to attack roadblocks to providing patient care and I am sure those who work at BIDMC are truly grateful for this.

Anonymous said...

Things are looking pretty damn sharp Mr Levy! One thing that strikes me about streamlining is rather than being replaced by robots, humans are going to meet machines halfway (checklists, best practice protocols etc). More work will get done and fewer mistakes made but can the feeble human mind handle being tethered so!

Anonymous said...

The challenge now will be to maintain the improved processes. Things tend to return to the mean over time.
However, this looks like a great start!