Carolyn H. Brown, RN, MS, Director, Performance and Outcomes Management
Joan Smith, RN, MA, Director, Patient Care Services
Cheryl Dewey, RN, Nurse Manager, Pediatrics/Pediatric Intensive Care Unit
Jan Crowley, RN, Nurse Manager, Pediatrics, Valley Health Center
Catherine Albin, MD, Chair, Department of Pediatrics
Ira Lubel, MD, Medical Director
Betsy Collins, RN, MS, Nursing Quality Improvement Manager
Sheila Conner, LVN, Treatment Authorization Coordinator
Maria Ferrer, Financial Analyst
Kathy Fullerton, Medical Unit Clerk, Pediatric Intensive Care Unit
Ellie Kamkar, Medical Admitting Clerk, Pediatric Clinic
Debra Lopez, Manager, Diagnostic Imaging
Diana Stewart, Supervisor, Admitting

To reduce the total length of time required for referral, scheduling and provision of service for pediatric conscious sedation procedures to one month or less.

• Patient/case volumes
• Appointment “no-shows”
• Appointment cancellations
• Physician satisfaction
• Appointments made with family input and accommodation of preference
• Turnaround time from authorization to completion of procedure

A Quality Improvement Team redesigned the processes for management of pediatric patients requiring conscious sedation, eliminating handoffs and delays in referral, authorization, scheduling, and billing, improving communication, and promoting family involvement.

• Centralized management of referrals and requests for service by internal and external providers.
• Streamlined the processes for obtaining authorizations for procedures from third party payers.
• Centralized the scheduling of procedures and tests requiring conscious sedation.
• Established expectation that 100 percent of appointments are scheduled in collaboration with parents to accommodate individual needs and preferences.
• Created a new position, Pediatric Short Stay Coordinator, to manage and facilitate the process from start to finish.
• Created a job description for new position, with specific responsibilities for data management and tracking.
• Eliminated backlog of patients waiting for appointments
• Reduced wait time for procedures.
• Improved patient/parent satisfaction by providing single point of contact, resource and support.
• Improved physician satisfaction by improving timeliness of service.
• Improved teamwork among hospital, clinic, and administrative staff, allowing for improved problem solving at the staff level.
• Increased volume of procedures completed through improved coordination of provider availability and appointment scheduling.
• Added procedure codes to the billing rate file for procedures not previously listed.
• Created standardized charge slips with procedure list.
• Reviewed and revised room rates for Pediatric Intensive Care Unit to reflect use by conscious sedation patients.

Redesigning the processes for managing the care of pediatric patients requiring conscious sedation has created significant improvements in the quality of service delivery. Changes support and demonstrate our Organizational Values of “One team working together” and “Patients are our priority.” Patients and families have benefited from the improvements in efficiency and the support provided by a coordinator whose responsibilities include assistance and resource, and improved management of this population of patients has resulted in revenue enhancement for the organization.

• Include all the stakeholders in the improvement process. They will be important participants during implementation and will understand and commit to the changes more fully if brought in early.
• Begin your effort with process mapping and involve the whole group. It is a great way to build shared understanding of current processes and issues and is an effective first step in assessment.
• Identify and involve an executive management sponsor for the team effort. This person can be a powerful advocate for the team when recommendations are presented.
• Use subteams to permit multiple phases of work to be undertaken simultaneously, thereby shortening the total time required for the improvement effort.
• Develop and implement communication plans during assessment, redesign and implementation.
• Be patient. Actions required of Human Resources and Information Systems, especially if you are part of a large public organization, can be require extra time and effort.
• Recognize and acknowledge the contributions of team members and participants.

Carolyn H. Brown, Director, Performance and Outcomes Management
Santa Clara Valley Medical Center
Carolyn.brown@hhs.co.santa-clara.ca.us

[Storyboard presentation at IHI's National Forum, December 2004]