Domain | Opportunity | Project(s) | Status |
Supply chain management | Non-standardised OR supplies | Preference card standardisation, rationalisation | In progress |
Inconsistent naming taxonomy for surgical procedures | |||
Preference cards listed items as ‘open for procedure’ that were rarely used | |||
Operational efficiency | Delayed discharge because of waits for postdischarge beds | Revision of inpatient rehabilitation assessments; increased use of long-term acute care | In progress |
Delays for weekend discharges | Weekend discharge coordination staffing increase; warm handoff Friday rounds; weekend rounding initiatives | In progress | |
Intrainstitutional transfers delayed care | Right place, right time bed management; ICU admission criteria; ICU transfer project | Complete | |
Prolonged dwell time in ICU, step-down and PACU | Prioritise transfers out of those units to facilitate high-cost bed availability | Complete | |
Wide variability in individual physician practice | Value opportunity tool: analytics to identify specific areas of cost/quality that are outliers per physician | In progress | |
Lack of postdischarge coordination | Dedicated personnel assigned to medicine units to make postdischarge follow-up appointments consistent with patient preferences | Complete | |
Outliers | Non-standardised care promoted development of outlier cases | Epic-based clinical pathways for heart failure, pneumonia and colorectal surgery, GI bleed, paper-based lap sleeve pathway | Complete |
End-of-life patients account for disproportionate share of quality, cost, readmission and outliers | Supportive care initiative aimed at improving value of care delivered at end of life both in the outpatient and inpatient setting | In progress | |
Surgical patients with medical comorbidities had disproportionately length of stay outliers | Hospitalist comanagement programme on acute care surgery, general surgery, neurosurgery services | In progress | |
Resource utilisation | Excessive duplication of studies that did not generate new findings | EHR best practice alert to reduce ordering of repeat echocardiograms within 2 months of last exam | Complete |
Above benchmark use of intravenous medications | Pharmacists review dashboard of adult inpatients with enteral access receiving one of 18 target intravenous medications with equivalent oral bioavailability who met criteria for oral conversation | Complete | |
Corporate services cost disproportionately high | Corporate services challenge to generate ideas for cost reduction | Ongoing | |
Multidose medication vials were being wasted | Open drugs only as needed rather than in advance in cardiac catheterisation lab | Complete | |
Excessive use of reference lab testing | Alert created in EHR to display turnaround time and cost for 42 reference labs that accounted for 80% of cost. Required attestation when ordering lab that the test was required for inpatient management. Created just-in-time learning for six reference labs to improve ordering practices. Created mechanisms for monthly reporting and real-time feedback. | Complete | |
Excessively high rate of blood transfusion benchmarked to peer institutions17 | Packed red blood cell and platelet transfusion order set revised, clinical decision support applied in the EHR, hospital-wide educational campaign deployed | Complete | |
Excessive testing of serial troponins in postoperative patients | Created guidelines for obtaining postoperative troponin levels | Complete |
EHR, electronic health record; GI, gastrointestinal; ICU, intensive care unit; PACU, postanaesthesia care unit; VBM, value-based management; delete, please delete this footnote.