A Quality Improvement Project to Reduce Inappropriate Referrals to a Specialized Ventilation-Weaning Unit

Abstract

PURPOSE: Our objective was to apply Lean Sigma, a quality improvement project to eliminate waste and improve efficiency of patient transfer to a specialized ventilation-weaning unit. The project goals were to decrease the number of inappropriate consults and streamline the transfer process. METHODS: We prospectively evaluated the process of patient's transfer to the Respiratory Care Unit (RCU). Requested consults placed during the months of November through December 2012 were measured and analyzed for appropriateness and outcome. The frequency of inappropriate RCU consults and most common barriers to smooth transfer to the RCU were recorded. An intervention was implemented which provided a brief outline of the RCU purpose and transfer criteria to consultants and charge nurses via email, as well as paper documentation for medical residents and fellows in the workroom and for the workstations on wheels. RESULTS: Upon follow-up evaluation, RCU appropriateness increased from 76% to 82%. In all cases where the consults were inappropriate, contact was made with the primary service, which was an increase during the follow-up period by 22%. Future opportunities identified include expanded use of clinical notes to communicate RCU consult inappropriateness with primary service and integration of a computer-based intervention screen during RCU consult placement regarding criteria. CONCLUSIONS: Use of Lean Sigma principles in a ventilation-weaning unit led to reduction in the inappropriate consults. Process mapping, improved education and communication among providers, and engagement of leadership and staff were key to improvement.