Loading presentation...

Present Remotely

Send the link below via email or IM


Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.


Mayo Clinic

No description

on 24 March 2015

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of Mayo Clinic

Project Question
How can we decrease the number of low-risk pre-operative patients being seen in the Pre-Operative Evaluation (POE) clinic?
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
the Problem:
Saturation of Pre-Op Clinic. (~65% are low-acuity patients).
the Problem:
Survey Analysis - Healthcare Provider resistance
Patient Data Analysis - Low vs. High Acuity
the Problem:
Fish Bone Diagram
the Problem:
Develop Medical History Questionnaire
Cost Analysis
: 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
ED Visit for Laceration
5+ Gray Boxes: POE Visit Highly Recommended
Data reflects this recommendation.
Yousef Haddad
Jessica Wagenfuehr

Mayo Clinic
Quality Improvement Project
Pre-Operative Evaluation & Optimization
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
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
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.
Thus far, the project has been successful.
Physician Dissatisfaction - Not to thrilled about taking on extra work.
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.
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!
Roshy Didehban (Supervisor)
Robert Graber (Supervisor)
Natalie Landman (Mentor)
Thank you for your time.
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)
Full transcript