A Challenge Presents an Opportunity

The Problem

The women and infants department's lean journey began in early 2006 when a local hospital suspended its obstetrical services, leaving Barnes-Jewish as the only hospital within city limits to deliver babies. This resulted in a 14 percent increase in patient admissions, a 16 percent increase in deliveries, as well as a 21 percent increase in patients presenting to the pregnancy assessment center, bringing the 2006 number of visits to 9,500. This also caused unnecessary transfers of care, patient movement within departments and extended wait times. The women and infants department experienced nine reviewable adverse events (causing harm or serious risk) in less than one year.

The Solution

By applying lean/Six Sigma methodologies, the team was able to improve the patient experience and prevent patient bottlenecks. These methodologies included 5S: sort, straighten, shine, standardize, sustain and safety.
In the PAC, decisions were traditionally based on individual knowledge and experience versus standardized methods to determine acuity, perform triage assessment or determine when to escalate care. A standardized acuity scale is now used to determine the needs of each patient and the resources available, resulting in care that is more tailored to the individual patient. The patient's traveling distance was also cut by moving the assessment center, delivery room, special care and nursery department to the same floor. The distance between waiting room and assessment center was also decreased. The discharge process implemented a visual discharge board, standard patient care worksheet, patient education and a standard discharge timing process for mom and baby.