Introduction
Having healthcare workflow charts in an
organization is helpful in showing the organized processes it does and also
provides a summary for the tasks to be performed in ensuring a smooth delivery
of the healthcare services to patients. Workflows represent the simplified
methods that have been laid out in showing how certain tasks flow, the job
stages, the people doing the task and guidelines for executing the tasks. After
creating a workflow chart, it can be analyzed and streamlined to ensure that
the patient’s needs are catered for as well as ensuring that it is a safe and
efficient system for delivering healthcare services to patients. This paper
analyzes the workflow of patients being admitted to the emergency department of
a hospital after experiencing symptoms of stroke.
Explanation of the process
Workflow systems are crucial for examining and
determining the efficiency of healthcare delivery process in the healthcare
sector. Currently, there is the need for healthcare organizations to adapt the
ever-changing scientific and technological interventions, and the need to
digitalize all processes and statements in the healthcare settings (Sheehan
& Bakken, 2012). Thus it's crucial to put into consideration the nature of
tasks required by patients and the efficiency of the workflow systems that has
a way of promoting the efficacy and efficient in health care provision in the
hospital setting.
Cain and Haque (2008) indicate that the
workflow system can arise or evolve organically or it can be designed. They
also point out that a workflow system that has evolved or designed has to be monitored
by the organization’s management to ensure that it has a smooth flow and it’s
capable of promoting the efficiency of service delivery. Current organizations
have shown preferences in designing workflows that align with their operations
as well as the millennia requirements (Sheehan & Bakken, 2012). Thus the
development of the Microsoft Visio 2013 software has given many young people of
today with an excellent platform for designing their workflows using the BPMN
template.
The above diagram shows a workflow system
representing how patients with stroke symptoms have to be attended to after
arriving in the hospital. The system is a digitalized process in a way that
ensures that when patients arrive, they have to be attended to in a
patient-centered approach, given the necessary provisions in emergencies and
special cases under the directions of a triage nurse. The registration of
patient is followed immediately by electronic recording and scheduling for an
appointment while ensuring that these steps do not delay the necessary services
for a patient with stroke symptoms. Documenting the patient information
electronically helps to increase the quality of care that the patient receives.
Also, the scheduling appointment at the initial stage is crucial for ensuring
that the patients who need urgent medical attention can proceed to the
emergency department in the shortest possible time. Also, it ensures that the
limited and available resources at the hospital setting are kept in the best
possible use and ensures the handling of many patients possible. Patients
receive appointments can have the option of choosing to visit the patient
portal in which they can leave the hospital after clearing the bills.
For those in need of
emergency services, they will also have to fill in the soap notes with the help
of their family and other care teams. There is also the recording of
observations which also help to promote patient outcomes since the physician is
well knowledgeable about the system. Using the electronic recordings of the
information about the patient collected in the initial stages helps the doctor
know about the patient even before arriving at the doctor’s office. After
receiving the recorded information of the patient, the doctor sends this
information to other departments such as the emergency department, or the
physiotherapy department or the laboratory.
Patients having symptoms of stroke that are
suggestive of acute stroke are admitted to the hospital whereby they are first
examined neurologically in the emergency room. The neurologists, who are guided
by the requirements of National Institutes of Health Stroke Scale (NIHSS), will
take blood samples and place a peripheral venous catheter on the patient. Also,
a neuroradiologist will be called to do the imaging. The mostly used imaging
modality is the CT in cases of acute stroke, but it can be necessary for some
patients to use MRI. The decision to use either MRI or CT modality is under the
neuroradiologist discretion. The patient is then transferred to a respective
imaging facility which is mostly the no enhanced CT as well as CT perfusion
(CTP), and CT angiography (CTA) is carried out. The examination of MRI included
the T2-weighted sequences, diffusion weighted imaging, Time-of-Flight
MR-angiography, and perfusion. After imaging as well as exclusion of any
intracranial bleeding done by the neuroradiologist, the patient will be
administered with a recombinant tissue plasminogen activator (rtPA) if the
neurologist finds the patient to be eligible. After this, the patient is
transferred back to the emergency room for rtPA administration. The physician,
interventional neuroradiologist and the treating neurologist will evaluate the
images and discuss whether it is necessary to perform EVT. If that is the case
patient will be transferred to the angiography, and the anesthesiologist will
receive the information on the patients’ findings. The anesthesiologist places
an arterial catheter for measuring, intra-arterial blood pressure and a urinary
catheter before anesthetizing the patient. The interventional neuroradiologist
then prepares the patient for starting the treatment and for EVT.
The designing of the flow
chart shows that it gives room for an in-house lab, the prescription area, the
in-house pharmacy, and the insurance quarters. This system aims to be
patient-centered, and it allows the provision of care even before the patient
pays. Thus the system is guided by the laws of proving patent rights and dignity.
Billing is the last activity expected of the client meaning that the patient
will receive all the necessary care before finally paying for the care. Thus
the system values the client and when it's fully implemented it will boost the
outcomes as well as the efficiency of the health provider, the patient, and the
overall healthcare setting.
Metrics for measuring the
soundness of the workflow and its effectiveness
The quality of care at the ED is mainly
dependent on a clinical workflow that is efficient. The Centers for Medicare
and Medicaid Services (CMS) requires that EDs have to report all metrics on the
following aspects publicly
1. Median arrival time to the departures for
all admitted patients.
2. The median arrival
time to departure for discharged patients.
3. The median time from
the admitting discusses to departures for admitted patients.
These metrics have an impact on reimbursement.
And for the case of stroke, an efficient workflow as well as adhering to the
metrics is vital for a patient’s clinical outcome. An example of the measure is
as follows:
|
NQF #
|
Measure Title
|
Measure Description
|
Numerator Statement
|
Denominator Statement
|
|
0437
|
Ischemic stroke 4. Thrombolytic
therapy
|
Patients with acute ischemic stroke arriving
at the hospital within 2 hours of time last that is well known and those who IV t-PA was initiated within 3 hours after a well known
time
|
Patients with Acute ischemic stroke whom were initiated with IV thrombolytic
therapy within 3 hrs of last well known
time
|
Patients with Acute ischemic stroke whose arrival time is within 3 hours of time
last known well.
|
Metrics are crucial since they affect the
scores of patient satisfaction which are publically reported and also impacts on
the volume of patients being treated at the ED is a specific period of time.
Areas for improvements
The workflow is somehow
complicated, and it shows the inefficient use of all practitioners’ time that
is providing care and treatment to patients with stroke symptoms. A lot of time
is taken at the point of care desk whereby the assisting nurse is asking lots
of preliminary questions, taking her vitals, physical examinations, and Soap
notes and adding the information on the computer. This excessive delay is a
risk to the life and health of patients. Also sitting in the waiting room as
the patient waits for diagnostic tests and for the triage nurse to complete
with previous patients is an area that requires improvements. The nurse is also
interrupted severally with calls about patients and visits from other nurses as
the patients are answering questions for their SOAP notes.
In the end, the patient
can spend more than thirty minutes instead of the required 15 to 20 minutes.
Also, tests are delayed in that collection of sample urine takes place two
hours after patient’s arrival. Thus the flow chart of the ED can be improved
trough the use of throughput analytics and via Value-stream mapping. The value
stream mapping helps to pinpoint the potential areas of improvement of the
process. The throughput analytics are the benchmarks for tracking improvements
such as ED waiting times both during the day or night, average arrival to a
room, volumes over time, ED comparisons; ED visits by the clinical program.
Summary
Knowing the effectiveness of a workflow of a
process or activity is crucial for improving patient satisfaction scores. With
the current technology, patients can rate the performance of hospitals online,
and the outcomes are publicly reported. These ratings also get tied to CMS
reimbursements. If a patient has to wait for long durations before receiving
treatment, there is a high chance of other patients leaving the hospital
without being seen. Thus it reduces the possible admission and volume of
patients and also potentially dangerous to those patients who are undergoing
serious health issues. Thus using metrics enables health organizations to
improve the efficiency of their workflows which impact on improving patient’s
volume that the ED can treat in the shortest possible time. Also having an
extra soft capacity in workflow enables the EDs to get patients into beds in
the shortest time possible and reduces the time for testing as well as speeding
discharges.
Reference
Cain, C.,
& Haque, S. (2008). Organizational Workflow and Its Impact on Work
Quality - Patient Safety and Quality - NCBI Bookshelf.
Sheehan, B.,
& Bakken, S. (2012). Approaches to Workflow Analysis in Healthcare
Settings.
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