Introduction: College Community Hospital (CCH) is a 200-bed facility offering adult medical, surgical, orthopedic, and psychiatric care. The hospital provides
a full range of diagnostic and therapeutic services, including CT and MRI scanning and an eight-bed intensive care unit. The 200 beds are distributed over six
3A Acute Medicine
3B Diagnostic Medicine
3C Intensive Care
4A Acute Psychiatry
4C General Surgery
One year ago, faced with decreased patient and staff satisfaction and rising costs, the management of CCH adopted a Total Quality Management strategy.
They formed a Quality Council and chartered several performance improvement projects. Over a nine month period, projects were successfully completed in
Dietary, Nursing, Psychiatry, Materials Management, Pharmacy, Health Information, and Outpatient Surgery, they are now ready to begin the second round of
One major source of dissatisfaction for physician and nursing staff has been slow turnaround time (TAT) for laboratory tests. The lab performs about 3000
blood tests per week, the most common being CBC (complete blood count), serum electrolytes (sodium, potassium, chloride and CO2), BUN, a kidney
function test, and blood sugar.
Given the high level of complaints about slow lab test turnaround time, the Assistant Administrator asked the Quality Council to initiate a Performance
Improvement project team to tackle the problem of improving the number of tests completed within the hospital standard. The Quality Council agreed,
chartered a team, and asked the Assistant Administrator to act as Team Leader.
The Assistant Administrator was familiar with Total Quality Management concepts and recruited a team, including the Transport Supervisor, who had
recently attended a class in PI Methods and Tools. When all the recruiting was done, the team members were:
Lotta Paper, Assistant Administrator – Team Leader
Tom Trotter, Transport Supervisor – Quality Advisor
Beth Harrast, Floor Secretary, 3A
Harry Hiteck, Day Supervisor, Lab
Sam Drawit, Day Phlebotomist
Steve Spinner, Evening Lab Tech
Cathy Filer, Health Information Management
Problems with scheduling the team meetings made in impossible to include a representative from the lab night shift.
Now, it’s time for the first team meeting. Use your imagination and “pretend” you are Cathy Filer and you are attending this meeting! Notice the personalities
and behavior of each of the different team players.
Lotta: First, I want to thank you all for volunteering for this team. I think we have…..
Sam: (interrupting) I wouldn’t exactly say we all volunteered. In fact, I’d say I was drafted.
Lotta: Well, I suppose some of you were picked. I asked the managers for people who really know what goes on in this process. So, you’re the experts. And I
asked Cathy Filer to join us because she may be able to help us to use the EHR system more effectively to help with this improvement opportunity.
Cathy: I hope I can help!
Lotta: Let me describe the problem. We’re getting too many complaints about long turnaround times for lab tests – I mean from the time the physicians
decide blood work is needed until the time the results are available to them. Harry helped me pull some data together that will give us a picture of how big the
problem is. Everyone take a look at your handout.
Harry: This bar chart shows the percent of tests that got done within the standard for the past year. The average is about 84%.
Beth: What are the standards, anyway? No one ever told me there were standards. I thought everything was stat, stat, stat! I know I spend a lot of time calling
down to see when results are going to be available.
Sam: Maybe that’s because we’re not making the standards all that often, whatever they are.
Tom: Let me explain these standards. When the doc’s fill out the request, they indicate whether it is STAT, Urgent or Routine. There are different turnaround
time standards for each priority. STATs are 2 hours, Urgents are 6 hours and it’s 24 hours for Routines. The times are from when the test is ordered to when
the results are available to the doc.
Tom: Hold on, hold on. We’re supposed to be flowcharting now. These are good thoughts, so let’s write them down in our idea log and make sure they get
included with our minutes so we don’t forget them. Let’s get on with this process.
Lotta: Well, the requests go to you, Beth, don’t they?
Beth: Right. I stamp them with the patient’s name and medical record number. Then I put them in the floor out box for lab pickup.
Steve. The Routines go into the box, but you call us on the STATs and Urgents.
Beth: That’s right.
Sam: Then the lab notifies me and I go up, pick up the request and do the draw. That’s assuming the patient is there.
Lotta: What do you mean “assuming the patient is there?”
Sam. Just that. Sometimes I go up and there’s an empty bed. Maybe I was given the wrong room numbers, or maybe the patient is visiting Radiology or PT, or
whatever. There’s nothing like having a STAT order and you can’t find the patient.
Lotta: So, what do you do then?
Beth: Usually, he comes over and harasses me – like I’m not busy enough already.
Tom: OK, let’s put that on our chart as a problem. If it happens fairly often, it could be part of the turnaround time problem. But, let’s say the patient is there.
You do the draw, right?
Sam: Right. Then I take the specimen down to the lab and put it in the in box. (Under his breath)…..Where it grows old.
Steve: OK Sam, I heard that.
Tom (intervening) Everyone did. Let’s keep one eye on the ground rules until we get used to working as a team.
Harry. The lab people are always checking the in box and, when there’s a specimen, we take it, set up the equipment and do the test.
Steve: We put the results on the form and put it in the out box. The messenger picks up the results when they come by on their rounds, and takes them back
to the floor.
Beth: When I get them , I put them with the chart and flag it. Usually, if it’s a STAT, I make sure the doc knows the results are there.
Cathy: OK, that sounds like the whole process, except when do the results get put into the patient EHR?
Beth: We don’t. The results get sent down at discharge with the rest of the paper chart and I think they get scanned. I’ve seen scanned result slips before.
Cathy: OK, another thing for me to think about.
Lotta: OK, let’s get to work flowcharting this process.
You will create a Team Charter for this case scenario. Use the information in your Lesson to guide you through the process of creating the charter and use
the information and people in this project packet to complete the charter. Your charter must include: