Using a Continuous Improvement Approach to Reduce Waste in Operation of a Pediatric Sleep Center

Abstract

Background:

Pediatric Sleep Medicine is a complex field that requires a multi-disciplinary clinical team to support operations. To ensure a positive patient and family experience collaboration from the sleep clinic appointment through the sleep study to patient results follow up is necessary. Our pediatric sleep laboratories provide services for approximately 1,650 patients annually in two locations. Associates within the sleep medicine department reported increases in burnout driven by busy work within their roles which was managed by the creation of a continuous improvement (CI) event. We aimed to assess the impact of a continuous improvement driven approach to reduce waste in operations of the pediatric sleep laboratory.

Methods:

A multi-disciplinary team was formed to evaluate waste in the operations of the sleep medicine department and included: CI specialist, RT, SDS, APRN, RN, and MD. Time studies were completed to identify waste (Figure 1). An event team was formed, and 5-day event was scheduled to evaluate waste and opportunities. The team targeted a reduction in manual or redundant work from 27 hours to 18 hours per week (33% reduction). An IRB exempt review of the continuous improvement process and results from time saving post implementation was assessed.

Results:

Waste was identified in manual and redundant work in sleep laboratory operations in most non-clinical activities. The use of central scheduling, pre-authorization alerts in the EMR (Electronic Medical Record), inclusion of inpatient studies on the outpatient schedule, and a shared electronic file of patient data were the main activities impacted by reduction in manual and redundant work. For the first week post go live the team met the target and reduced manual and redundant waste with the new processes from 27 hours to 15 hours (45% reduction). Most time savings were made with reconciling data and chart review (Figure 2). Empirically, the team reported increased satisfaction with the new workflow processes.

Conclusions:

A continuous improvement process identified opportunities for time savings within the multi-disciplinary sleep medicine team. By reviewing operational activities, the team was able to reduce redundant and manual work by 45%. Further studies must be done to evaluate the long-term effects of this work.

Figure 1 details the time study information for 4 associates before implemtnation of countermeasures to reduce waste and redundancy.

Figure 2 details the time study infomration from 4 associates post implementation of new processess to reduce waste and redundancy.