Transcript Neobili Screening

From Flash to Finish
Staff
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Dr. Yu
Dr. Foxx
Dr. Powell
Dr. Higginson
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Residents
Katie Charnock
Candice Snyder
Bridget Cunningham
Michael Cunningham
Jenny Jaskiewicz
FOCUS-Find
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Inefficiency of the Bili process?
Appointments are inconvenient
Leaving house is a challenge
Time is precious
FOCUS-Organize
• Tuesday Continuity Group
• Corpsman
• Resident and Staff Sampling
FOCUS-Clarify
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Check-in
Vital Signs and TCB
Appointment and review TCB
Order Neobili
Obtain Neobili
Wait for lab result
Disposition
FOCUS-Clarify
• Check-in
• Vital Signs and TCB
• Review TCB, Order and Obtain
Neobili
• Appointment
• Wait for lab result
• Disposition
FOCUS-Understand
• Is there a problem?
• 73 Newborn Appointments in Jun-Nov
– Obtain TCB:
– Order Neobili:
– Send to Lab:
– Lab Processing:
– Time from Check-in:
18m (13-28)
34m (13-53)
33m (0-53)
44m (31-57)
134m
(112m-158m)
Median time in min (IQR)
Median Times from Check-in to Neobili Result
Obtain TCB
14%
Lab Processing
34%
Order Neobili
26%
Send to Lab
26%
Time to Order Neobili from TCB vs # of Patients
FOCUS-Understand
30
# of Patients (total N=73)
25
20
15
10
5
0
Before Vitals
0-10 minutes
11-20 minutes
21-30 minutes
31-60 minutes
> 60 minutes
FOCUS-Select
Obtain Tcb:
18m (13-28)
Order Neobili:
Send to Lab:
34m (13-53)
33m (0-53)
Lab Processing:
Time from Check-in:
44m (31-57)
134m
(112m-158m)
Median time in min (IQR)
Plan-Do-Check-Act
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Review data in the America Building
Triage the patients
Empower the corpsman
Earlier physician notification
– Order Neobili sooner
Plan-Do-Check-Act
• TCB and Neobili Guidance
– Phototherapy as inpatient?
– Neobili for all TCB ≥ 15, if under 5 d/o
– Place heel warmer for TCB = 11-14
• Educate on Phototherapy Curve
Plan-Do-Check-Act
• Corpsman meeting March 26, 2011
• Gather Data
– Before and After Intervention
– New Clinic
– 32 encounters before and after
Plan-Do-Check-Act
• 32 Newborn Appointments Jan-Mar
– Obtain TCB:
– Order Neobili:
– Send to Lab:
– Lab Processing:
– Time from Check-in:
17m (11-23)
40m (15-65)
18m (0-38)
45m (37-58)
124m
(104m-158m)
Median time in min (IQR)
Plan-Do-Check-Act
• 32 Newborn Appointments Mar-May
– Obtain TCB:
– Order Neobili:
– Send to Lab:
– Lab Processing:
– Time from Check-in:
10m (6-17)
29m (12-45)
24m (0-46)
40m (32-54)
111m
(100m-140m)
Median time in min (IQR)
Number of Patients Time from TCB to
Physician Order
12
Number of Patients
10
8
6
4
2
0
Before Vitals
0-10 minutes 11-20 minutes 21-30 minutes 31-60 minutes > 60 minutes
Before
After
Plan-Do-Check-Act
Get TCB
Order NB
Send to
Lab
Lab Time
Total
Time
Median
Time
Before
17 min
Median
Time
After
10 min
Net
Time
p-value*
(7 min)
0.055
40 min
18 min
29 min
24 min
(11 min)
6 min
0.20
0.28
45 min
124 min
40 min
111 min
(5 min)
(13 min)
0.33
*Wilcoxian Rank Sum
Plan-Do-Check-Act
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Triage has improved efficiency
Reinforce Guidelines to Corpsman
Monthly to Quarterly Training
Training for New Corpsman