University of Twente Student Theses


The post-anaesthetic care unit of Mount Sinai Hospital : process improvement challenges and opportunities

Hofman, Laura (2012) The post-anaesthetic care unit of Mount Sinai Hospital : process improvement challenges and opportunities.

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Abstract:Motive The Post-Anaesthetic Care Unit (PACU) of Mount Sinai Hospital struggles with a long length of stay of patients in the PACU. A possible explanation is that it is not clear to the staff members when a patient is ready to go to the Inpatient Unit. This results in many uncertainties from the time the nurse records the time ready to the moment the bay is clean and ready to receive a new patient. The focus of this research is the time the inpatients wait to be transferred to the IP-unit (time nurse records time ready to the moment the patient leaves the PACU), since this time shows many inefficiencies and gives room for improvement. Objective and approach The objective of this research is to review the PACU processes and give suggestions to decrease the length of stay of patients in the PACU resulting in an improved patient experience without having a negative impact on costs. To accomplish the goal of this research, the research is divided into the following parts. First we use a general system approach to analyse the main components of the PACU: the input and output (patient flows), resources, and processes. With seven shadow days, and four preliminary shadow days, this research measures the duration of these processes and identifies the inefficiencies in the process using lean philosophy and workflow improvement tools. After this analysis, this research combines the literature and analysis to propose practical interventions to reduce the length of stay of patients in the PACU. Analysis This research provides an extensive systematic analysis and starts with uncovering the black box of the PACU by analysing the patient flow and supporting resources of the processes in the department. After the description of this environment, we describe the performance of the current processes in terms of the length of stay, and we identify inefficiencies by doing various measurements. The inflow and outflow shows a relatively stable daily and weekly pattern and gives input to adapt the daily and weekly schedule to the numbers of patients in the PACU. Currently, the PACU uses a static daily and weekly schedule for nurses, porters and housekeepers which is not adapted to the fluctuations in demand. The length of stay of patients in the PACU (2.75 hours for same day admits and inpatients) is strongly related to the number of patients in the PACU of every hour of the day and every day of the week. The process of transferring the patient to the nursing units is identified as the main cause of this relationship, since at busy times the impact of this process is higher than at quiet times. Besides the length of stay of patients in the PACU, we also analyse the excessive time between closing a patient to the moment the bay is clean. This analysis identifies where the PACU should intervene their processes and how many minutes this reduces the cycle time.
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:85 business administration, organizational science
Programme:Health Sciences MSc (66851)
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