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The impact of non-clinical transfer delay (TD) from the ICU to a general care unit on the progress of the patient's care is unknown. We measured the association between TD and: (1) the patient's subsequent hospital length of stay (LOS); (2) the timing of care decisions that would advance patient care.This was a single center retrospective study in the United States of patients admitted to the surgical and neurosurgical ICUs during 2013 and 2015. The primary outcome was hospital LOS after transfer request. The secondary outcome was the timing of provider orders representing care decisions (milestones) that would advance the patient's care. Patient, surgery, and bed covariates were accounted for in a multivariate regression and propensity matching analysis.Out of the cohort of 4,926 patients, 1,717 met inclusion criteria. 670 (39%) experienced ≥12 hours of TD. For each day of TD, there was an average increase of 0.70 days in LOS (P 0.001). The last milestone occurred on average 0.35 days later (P 0.001). Propensity matching analyses were confirmatory (P 0.001, P 0.001).TD is associated with longer LOS and delays in milestone clinical decisions that progress care. Eliminating delays in milestones could mitigate TD's impact on LOS. more...

This work studies a medical product development, assembly, and packaging company that uses a paper-based method to track jobs through their assembly process. The paperwork often has errors, which must be corrected before distribution, causing delays in manufacturing and shipment and resulting in lost time and money. The project team analyzed the company's production process to identify areas for improvement. Through statistical analyses of the company’s process data, the team established error categorization, location, and probability of occurrence. In order to address sources of error, the project team diagrammed the company's manufacturing floor and created a list of issues within each step of the manufacturing process as well as potential solutions to these problems. The team created a simulation of the manufacturing process and used this tool to analyze potential process changes to decrease the number of employee hours wasted in order to fix discrepancies. The simulation proved to be an invaluable tool that helped the company better understand their process. It helped to identify which jobs create the most errors, how many errors occur per month, and how much money the company loses on time spent correcting the errors. Eleven potential solutions were considered, but two of them appeared to yield the best results. Implementing a total quality management (TQM) system would conservatively reduce error counts by 71.3%. Implementing a start quantity to the company's electronic system would conservatively reduce mean hours wasted from 22.60 to 21.73 hours per month and mean salary lost from $519.82 to $499.80 per month. Using insights from the simulation, the project team then coordinated with management to decide whether error rates or time and salary spent to correct errors were more important to address. As of this writing, as a result of this study, the company is taking steps to implement a TQM system in order to decrease errors in their job tracking process. more...

ABC Medical Manufacturing is a medical product development, assembly, and packaging company that has a paper-based method to track jobs through their assembly process. The paperwork often has errors, which can delay manufacturing steps and shipment, and cause the company to lose time and money. The project team conducted an in-depth analysis of the company's production process to look for areas of improvement. Through statistical analyses of data provided by the company, the team established error categorization, location, and probability of occurrence. To address this situation, the project team diagrammed the company's manufacturing floor and created a list of issues within each step of the manufacturing process as well as potential solutions to these problems. The team created a simulation of the manufacturing process and used this tool to analyze potential process changes to decrease the number of employee hours wasted in order to fix discrepancies. The simulation was created using probabilities based on assumptions that the management team and project team worked through together. The simulation helped visually represent what jobs create the most errors, how many errors occur per month, and how much money the company loses on time spent correcting the errors. Implementing a total quality management (TQM) system would conservatively reduce error counts by 71.3%. Implementing a start quantity to ABC's electronic system would conservatively reduce mean hours wasted from 22.60 to 21.73 hours per month and mean salary lost from $519.82 to $499.80 per month. Using insights from the simulation, the project team then coordinated with management to decide whether error counts or hours wasted and salary lost were more important to address. Currently, ABC is considering implementing a TQM system in order to decrease the number of errors each month. more...