O1069 Oct.4: 4:56pm - Using Lean Healthcare to Improve Transport Mobilization times in Pediatric Critical Care Transfers

Background:
The Lurie Children’s Critical Care Transport Team coordinates transfers for over 5000 patients per year, with almost 30% (1629) of those being Team Transports. Transport Team mobilization time (time from call start to team departure) has averaged 67 minutes for FY18 with an industry standard time of under 30 minutes. Lack of a standard process to coordinate these transfers results in increased mobilization times and bed denials.

Methods
Lean methodology training and the IHI’s Model for Healthcare Improvement were introduced, along with creating a new internal Process Improvement role to establish lean culture. Value stream mapping identified 4 primary areas of focus, with process development and improved communication as central themes (Fig 1). After establishing a global aim to reduce the mobilization time from 67 minutes to less than 30 minutes for critically ill patients at referring hospitals by December 31, 2020, our team’s initial focus was on addressing communication and establishing a process. In addition, it was noted that by adding a “dispatch” time stamp within the call record, it was more clear which part of the process was the barrier. We focused on the process metric of “call start to team dispatch time” decreasing from an average of 39 minutes in FY19 to 15 minutes by August, 2020. A multidisciplinary team was assembled, and biweekly meetings were held during the 3 months prior to the first test of change. A pick chart was used to prioritize pilot ideas. A series of plan-do-study-act cycles (PDSA) were tested between August 2019 and February 1st 2020, led by a process change which moved the decision to dispatch the team to an earlier point in the call, followed by modifications to the
Center’s intake form.

Results:
Following PDSA cycle 1, call start to dispatch time improved from 39 minutes to 32 minutes (Fig 2). Dispatch to depart times remained stable. Changes made to the intake form did not affect the length of time between call start and dispatch time. Additional transfer volume through the Transport center appeared to adversely affect mobilization time.

Conclusion:
For lean principles to take root, leaders must first work to create an organizational culture that is receptive to lean thinking. Shortly after the initial PDSA cycle, competing priorities and poor communication led to loss of interest among the front-line staff and disengagement by leadership, leading to project failure. The commitment to lean must start at the very top of the organization, and all staff should be involved in helping to redesign processes to improve flow and reduce waste. Restructuring of our team’s leadership is the current focus of this group.