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Massachusetts General Hospital's Pre-Admission Testing Area (PATA)
Jireh Philip B. Acabal Bachelor of Science in Accountancy - III Daverah M. Banagodos Bachelor of Science in Accountancy – Accountancy – II II Carla Marie F. Primicias Bachelor of Science in Accountancy - III Gyle Angela V. Sabacahan Bachelor of Science in Accountancy - II Vnzichro V. Sarno Bachelor of Science in Accountancy - III
Master your semester with Scribd Bachelor of Science in Accountancy - III Read Free Foron 30this Days Sign up to vote title & The New York Times Useful Not useful Aileen E. Suminguit
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I. Brief Description
The Massachusetts General Hospital was founded in 1811 and has been committ
delivering standard-setting medical care. The hospital has 907 beds in a 4.6 million square
campus as one of the largest hospitals in America. Also, it consistently ranked as one of th
five hospitals in the country. country. It is considered the the cradle of anesthesia since it was there i
Ether Dome where the ether was first supplied during a surgical procedure in the year 1846
Department of Anesthesia, Critical Care and Pain Management (DACCPM) was accredit
1938 and since then has maintained a leading position in the field of innovation and resear
anesthesiology. They have 278 physicians and 198 nurses in the hospital. The department i to support patients before, during and after their surgery.
With that, the hospital has a Pre Admission Testing Area (PATA), where the
responsible for outpatients having 43% of that had undergone surgery. They are ones evaluate safety anesthesia before surgery, who inform the patients, and who obtains the
acknowledgment and consent from the patients. The purpose of PATA was to thoro
evaluate each patient To determine if they could withstand anesthesia during the operation perform all laboratory tests prior to surgery. surgery.
PATA was an outpatient clinic with 12 exam rooms, a lab, and a waiting room. Pa typically spent about 80-90 minutes of face time with providers in PATA, but even in the
case scenario, appointments lasted at least two hours. The average appointment was two-a Master your semester with Scribd ReadupFree Foron 30this Days to vote title half hours and many patients spent over four hours Sign in PATA. Long waiting times & The New York Times Useful Not useful Cancel anytime. particularly troubling due d ue to the goal of high quality patientpatient - and family-focused care that
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II. Central Problem
The Pre-Admission Testing Area (PATA) of the Massachusetts General Hospita
been struggling with their inefficiencies. Patients would be waiting for a long time, and thi been happening for the past two years. They would be in the clinic for four hours, but
span the patients only have one hour and a half of face time. With that, patients are frustrate
providers would have to overtime to cater the patients’ the patients’ needs. This long wait was due t
clinic’s goal of having high quality patient and family focused care that the Massachu General Hospital aim.
III. Minor Problem
Due to the long wait problem of PATA, it caused a domino effect where other area affected. One of these minor problems is when registered nurses and medical doctors have to
overtime. Instead of finishing their work by 5:00 pm, they have to stay and finish their jo late as 7:00 pm or 8:00 pm.
Surgeons are also affected in the PATA’s dilemma of long wait, another minor pro
for the clinic. They are tasked to book the patient’s appointments in the PATA. Since the cl
Master your with Scribd capacity semester is limited, they had to make priority for complex cases, but their lack of guidelines Read Free Foron 30this Days Sign up to vote title resulted to sickTimes patients not being sent to the PATA. & The New York Useful Not useful Special offer for students: Only $4.99/month.
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Another minor problem is the presence of many unhappy patients that would wal
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IV. Key Analysis
SWOT ANALYSIS
WEAKNESS
STRENGTH • The quality of care and concern for the patients' safety was very high. • The staff remained committed to thorough pre-admission work-ups to ensure a safe and uneventful surgery
• Long wait time • Insufficient number of rooms, physicians and nurses
OPPORTUNITY • Considered as one of the top five hospitals • Known as the birthplace of anesthesiawith Scribd semester
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THREATS • Due to long waits, other potential patients would rather go to other clinic. Read Free Foron 30this Days Sign up to vote title
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PROCESS FLOW DIAGRAM AND CAPACITY Arrival rate = 8 pts/hr
7 am-12 and 2-3pm
Arrival rate = 4 pts/hr
12-2pm (Lunch)
Calculating PATA Process Capacities 3. RN Visit: Check-in: 2. Vitals + EKG in Lab: Master 1.your semester with Scribd Read Free Foron 30this Days Sign up to vote title Service time =43 min/pt = 2 min/pt Service time =10 min/pt & The NewService Yorktime Times Useful Not useful
Service = 30 pt/h Special offer for students: Only rate $4.99/month.
Service rate =6 pt/h
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Chart review = 5 min
o
Visit with patient = 2
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Service time = 64 min/pt
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6. Check-out:
5. Blood Work in Lab:
4. MD Visit:
Honest Tea Case Study
Service time = 6 min/pt
Service time = 1 m
o
Chart review = 10 min/pt
Service rate = 10 pt/h
Service rate = 60 p
o
Visit with patient = 37
m = 3 technicians
m=1 attendant
Capacity = 30 pt/hr
Capacity = 60 pt/h
(lunch: 20 pt/hr)
min/pt o
Chart write-up = 17 min/pt
Service rate = 0.94 pt/h
m = 8 MDs
Capacity = 7.5 pt/hr
(lunch: 3.75 pt/hr)
PROCESS CAPACITIES Non-Lunch
Lunch
Step
Service Time (min/pt)
Service Rate (pts/hr)
# of Employees
Capacity (pts/hr)
# of Employees
Check-in
2
30
1
30
1
Vitals + EKG in Lab
10
6
2
12
1
Master yourRNsemester with Scribd Visit 43 1.40 VisitTimes 64 0.94 & The NewMD York Special offer for Blood students: Only $4.99/month. Work in Lab
6
10
5
7 2 Read Free Foron 30this Days Sign up to vote title 8 Useful 7.5 Not useful4 Cancel anytime.
3
30
2
Cap (pts
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PROCESS FLOW DIAGRAM AND CAPACITY (BOTTLENECK)
Bottleneck
Before the registered nurse step, the patients can flow through at the arrival rate unt
waiting room is full. The capacity of the waiting room was not mentioned; therefore it
assumed that it is large that it never fills up. Then the flow rate at steps before the regis nurse is eight patients per hour in non-lunch times and four patients per hour during lunch.
the registered nurse step and afterwards, the RN capacity limits flow, thu Master yourDuring semester with Scribd Read Free Foron 30this Days Sign up to vote title flow rate would be seven patients per hour in non-lunch times and 2.8 patients per hour d & The New York Times Useful Not useful Special offer forlunch. students: Only $4.99/month.
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UTILIZATION ANALYSIS
Non-Lunch
Lunch
Step
Flow Rate (pts/hr)
Check-in
8
1
30
0.27
4
1
Vitals+EKG in Lab
8
2
12
0.67
4
1
RN Visit
7
5
7
1.00
2.8
2
MD Visit
7
8
7.5
0.93
2.8
4
Blood Work in Lab
7
3
30
0.23
2.8
2
Check-out
7
1
60
0.12
2.8
1
# of Capacity Employees (pts/hr)
Util.
Flow # of Capa Rate Employees (pts (pts/hr)
In this process, the registered nurses are overloaded. They build up a backlog of wor
would only work after the patients would stop arriving. With the use of the inventory bui diagrams, it can be easily analyzed the backlog of the registered nurses.
Analyzing Inventory Buildup at the Registered Nurse Station Capacity 7 am – am – 12 12 pm: 7 patients per hour
Master your with 12 pm – pmsemester – 2 2 pm: 2.8 patients per Scribd hour 2 pm – pm – end end Times of day: 7 patients per hour & The New York Special offer for students: Only $4.99/month.
Arrivals
Thus, the backlog accumulates at 7 am – am – 12 12 pm: 1 patients per hour 12 pm – pm – 2 pm: 1.2 patients perhour Read Free Foron 30this Days Sign up to vote title 2 pm – pm – 3pm: 3pm: 1 patients per hour Useful Not useful
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3 pm+: -7 patients per hour
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INVENTORY BUILD UP DIAGRAM
Average Inventory at RN Station Time
Length (hours)
Start Inventory
End Inventory
Avg Inventory
7 am - 12 pm
5
0
5
2.5
12 pm - 2 pm
2
5
7.4
6.2
2 pm - 3 pm
1
7.4
8.4
7.9
1.2
8.4
0
4.2
3 pm - 4:12 pm
Master your semester with Scribd Grand Average & The New York Times Thus the average patients that are waiting is 4.11. Special offer for students: Only $4.99/month.
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Other stations have utilizations less than 1. Waiting times in front of other stations will be dr by randomness in arrivals/processing. This can be analyzed using queueing tools.
Waiting at Vitals + EKG (Queue 1, 9 am to 12 pm only) Arrivals
Arrival rate = 1/a = 8 patients/hr
Average Interarrival time = a = 60/8 = 7.5 minutes Master your semester with Scribd Read Free Foron 30this Days Sign2a) up to title Std Dev of Interarrival Times from 9 am to 12 pm (Fig =vote 8.9 min & The NewCVa York Times Useful Not useful = Std Dev/Mean = 8.9/7.5 = 1.2
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Waiting Time Analysis at MD & Blood Work Vitals + EKG
MD
Blood Work
a [min]
7.5
8.6
8.6
Std Dev a [min]
8.9
1.7
3.4
CVa
1.2
0.2
0.4
p [min]
10
64
6
Std Dev p [min]
3.5
29
2
CV p
0.35
0.45
0.33
m
2
8
3
u
0.67
0.93
0.23
Tq [min]
6.38
11.77
0.02
Queue 1
Queue 3
Queue 4
The arrival rate (1/a) after registered nurse equals the capacity at RN is 7/60 which is equal 1/8.6. Thus, the total waiting time from queueing queu eing effects is about 18 minutes.
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PROCESS FLOW DIAGRAM AND TOTAL FLOW TIMES
This diagram shows that the total wait time is 58 minutes, 98 minutes for total service time, an average flow time of 156 minutes.
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V. Alternative Course of Action
1. Extend hours to 6:30 pm and increase the time between appointments to 45 minutes. The current system’s schedule of appointments during non-lunch non-lunch times is 4
arrivals for every 30 minutes, which is equivalent to 8 patients per hour. While durin
lunch, there is an estimate of 2 arrivals for ever y 30 minutes deriving to 4 patients p atients pe
hour. The new proposed schedule of appointments during non-lunch times will have
patients per hour as a result of 4 arrivals for for every 45 minutes, and 2 arrivals for ever minutes resulting to 2.67 patients per hour during lunch time. Thus, with the new
proposed schedule of appointments, there is a need to extend scheduled arrivals from pm to 6:30 pm to maintain the same number of total arrivals (56) in 1 day.
Advantage: The new proposal eliminates build-up at the registered Disadvantage: Eliminates build-up at RN
only queueing times remain
waiting time at RN is not zero! Reduces queueing waiting times at other steps (lower arrival rate) Total average waiting time is down from about 1 hour to less than 15 minutes 2. Patent
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Advantage: Disadvantage:
4. Letting Advantage: Disadvantage:
VI. Implementation Strategy
The hospital should hire additional registered nurses to avoid nurse fatigue. The pr utilization rate of nurses in MGH is 100%. They have been working past their normal
risking their own health leading to inefficiency in their workplace. Hiring additional nurses
lead to the elimination of inventory buildup (bottleneck) in the registered nurse visit. D
increase in capacity of patients per hour in the registered nurse visit, the bottleneck i
operations is now passed on to the medical doctor visit. To eliminate this patient build up,
should hire medical doctors to increase their capacity of patients per hour. Currently, the me
doctors have a utilization rate of 93%, and adding medical doctors will reduce waiting tim 2.68 minutes per patient. Timeline:
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VIII. Recommendations
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• Add 3 additional RNs to match the number of MDs • Proactively display current wait times to patients in the waiting room
Implementation Strategy
Conclusion
Recommendation
Key analysis (Fishbone diagram, SWOT matrix, STEEPLE, Porter’s Five Forces, Environmenta scanning, or any other business tools, technique, or theories to help you in your analysis; a analysis should be included) Alternative Course of Action (the ideas should come from the different key analysis, it may be the possible but can be of consideration)
Implementation strategy (should be based on the ACA and a timeline should be given which would include the operational and marketing strategy)
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