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Mayo Clinic

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on 24 March 2015

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Transcript of Mayo Clinic

62
ECG
bpm
Project Question
How can we decrease the number of low-risk pre-operative patients being seen in the Pre-Operative Evaluation (POE) clinic?
DMAIC Model
DMAIC refers to a data-driven improvement cycle used for improving, optimizing and stabilizing processes and designs (Clemens et. al, 2010).
Pre-Op DMAIC Model
Define
the Problem:
Saturation of Pre-Op Clinic. (~65% are low-acuity patients).
Measure
the Problem:
Survey Analysis - Healthcare Provider resistance
Patient Data Analysis - Low vs. High Acuity
Analyze
the Problem:
Fish Bone Diagram
Improve
the Problem:
Develop Medical History Questionnaire
Cost Analysis
Control
: Maintain the Solution
Improve and re-conduct pilot trials.
Gain Physician buy-in.
Make the Medical History Questionnaire a standard practice.
Data/Results: Measure the Problem -
Survey Analysis
Improve the Problem
Medical History Questionnaire
Created with medical practitioner in mind.
This forms requires a physician to make clinical judgements.
How It Works
1-2 Gray Boxes:
POE Clinic Visit is Unlikely. Needs clinical judgement to assess if the condition is well managed (i.e. hypertension).
3-4 Gray Boxes:
Medical Decision Making needed.
Patient Perception of Ailment
Anxiety
ED Visit for Laceration
5+ Gray Boxes: POE Visit Highly Recommended
Data reflects this recommendation.
Methodology
Yousef Haddad
Jessica Wagenfuehr

Mayo Clinic
Quality Improvement Project
Pre-Operative Evaluation & Optimization
Context/Rationale
The Mayo Clinic has an expansive patient base.
High-risk patients who need a pre-op evaluation are unable to be evaluated in a timely manner due to capacity constraints of the POE clinic.
Low-risk patients that are sent to the POE clinic make up ~65% of evaluations.
Due to capacity constraints, surgeries for high-risk patients are often prolonged.
Needs Assessment
POE Clinic Triage.
The project goal: Find a standardized solution for patients defined as "low-risk" who are going to the POE clinic for their pre-operative evaluation.


Project Scope
To create a tool that assists physicians in performing their own history and physical (H&P) and risk evaluation on their surgical patients.
Physicians would conduct a risk evaluation for low-risk patients only.
Risk Determination
American Society of Anesthesiologists (ASA) physical status classification system.
Six Categories:
ASA Level 1-Healthy Person
ASA Level 2-Mild Systemic Disease
ASA Level 3-Severe Systemic Disease
ASA Level 4- Severe Systemic Disease that is a constant threat to life.
ASA Level 5-A Moribund person that is not expected to survive without operation.
ASA Level 6-A declared brain-dead person whose organs are being removed for donor purposes.
ASA Levels 1 and 2 are considered low-risk.
Survey Results
Mostly agreement amongst all specialties.
Outliers: ORTHO and ENT.
They don't think they can take on the extra workload. Historically, they have always used the POE clinic for all their patients.
Data/Results: Measure the Problem -
Patient Data Analysis
Data/Results: Analyze the Problem
Results
Cost Analysis
View of whole organization.
N = 14 low-acuity patients seen in the POE clinic.
Organizational cost.
Red Line - % of patients who received those procedures.
Average price of test is above the blue bars.
Average Total Cost of all services - ~$1300.00 per patient.
Extrapolation of previous graph.
Cost within the POE clinic for standard services during a POE visit.
Doesn't include analysis of test or organizational fees.
Average cost per patient = ~$300.00!
Control -
Looking Towards the Future
Currently:
We are seeking out different specialties to conduct more pilots trials.
The Medical History Questionnaire is continually being improved for ease of use and efficacy.
First Pilot Trial:
Relayed promising results.
The positive results and positive user satisfaction has helped foster physician buy-in. Specialties are volunteering to be a part of the next pilot trial.
Future implication - Our end goal is to make the Medical History Questionnaire a standard practice.
Conclusion
Thus far, the project has been successful.
Barriers:
Physician Dissatisfaction - Not to thrilled about taking on extra work.
Solutions:
We included physicians in the drafting of the Medical History Questionnaire form.
For pilot trials, we pursued doctors who were open to change and had a strong influence on other professionals within Mayo Clinic.
Thus far, this has helped to facilitate buy-in from various departments.
Recommendations:
When making change, there will be resistance.
Bring resistant individuals on board an optimization project.
Sell an idea, not a methodology.
Let them be a part of the solution.
Relay the benefits to the patient.
The End!
Acknowledgments:
Roshy Didehban (Supervisor)
Robert Graber (Supervisor)
Natalie Landman (Mentor)
Thank you for your time.
Questions/Comments/Concerns?
Each practice has either PA's, NP's, residents or fellows that work with them.
As a surgical practice, there are more fours and fives than there are ones and twos.
ORTHO and ENT are resistant once again.
Their PA's have a separate calendar (may be difficult to reach or coordinate with).
PA/NP: Feel that they work hard enough.
Resident/Fellow: They do as their supervisor (surgeon) tells them to do. They are still in the learning stages of their education.
Surgeon: Depends on the Specialty.
Overall, most medical professionals within the Mayo Clinic believed this was important.
PA/NP: Feel that they work hard enough.
Resident/Fellow: Already conduct H&P's.
Surgeon: Depends on the Specialty.
Total Patients:5,292
Total Patients ASA 1 & 2: 3,451
Percentage: 65%
1. Clemens, S. L., Faulkner, W. C., Browning, E. B., Murray, J. S., Alcott, L. M., Stowe, H. B., et al. (2010). In Emerson R. W., Yeats W. B. and Frost R. L.(Eds.), Primarytitle [OriginalForeignTitle] (H. D. Thoreau, E. E. Dickenson Trans.). (Edition ed.). PlaceofPub: Publisher. doi:DOI(Clemens, Faulkner, Browning, Murray, Alcott, Stowe, & Sandburg, PubYear)
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