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Using_Process_Flow_Charts

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					Using Flow Charts to
Understand Care Processes
      What is a Flow Chart?
• Picture of the sequence of steps in a
  process
• Maps out the action steps and decisions
  within a process, from beginning to end
• Different steps or actions represented by
  boxes or other symbols
• Help you identify and understand a
  process
Mapping Out Processes of Care
 • Sources of information:
   – Chart Audits
   – Discussions with Providers
   – Interviews with Patients
    Constructing Flow Charts
• Often focus first on index case –
  – “What happened in this case?”
• Then can flow chart the usual course of
  events
  – “What usually happens?”
• Once you have established an overview
  of the usual process, if needed, you may
  drill down to progressive levels of detail
  to understand nuances of the process.
Antibiotic Orders in Pneumonia
       • Community-acquired
         pneumonia improvement team
       • ER admits - antibiotic
         administration times much
         improved
       • Ongoing delays noted on
         patients admitted directly to
         ward from clinic
       • Why the delays?
   Antibiotic Orders in Pneumonia
             Admit     Orders     Orders      Pharm       R. Ph.         Med
Pt arrives                                                               Med
             orders    taken     faxed to       Tech      verifies
                                                          Verifies    prepared
 on ward                                                                given
             written     Off    pharmacy    fills order    order      in pharm.



                                 Nurse       Nurse          Med         Med
                                 gives      retrieves     placed in   brought
                                  med         med          med rm     to floor
   Antibiotic Orders in Pneumonia
             Admit     Orders     Orders      Pharm       R. Ph.         Med
Pt arrives                                                               Med
             orders    taken     faxed to       Tech      verifies
                                                          Verifies    prepared
 on ward                                                                given
             written     Off    pharmacy    fills order    order      in pharm.


  *          *          *         *             *           *
                                 Nurse       Nurse          Med         Med
                                 gives      retrieves     placed in   brought
                                  med         med          med rm     to floor


                                   *
   Antibiotic Orders in Pneumonia
             Admit     Orders     Orders      Pharm       R. Ph.         Med
Pt arrives                                                               Med
             orders    taken     faxed to       Tech      verifies
                                                          Verifies    prepared
 on ward                                                                given
             written     Off    pharmacy    fills order    order      in pharm.


  *          *          *         *             *           *
                                 Nurse       Nurse          Med         Med
                                 gives      retrieves     placed in   brought
                                  med         med          med rm     to floor


                                   *

       * Only steps for which secondary measurements of time
             intervals readily available
   Antibiotic Orders in Pneumonia
             Admit     Orders     Orders      Pharm       R. Ph.
Pt arrives                                                           Med
             orders    taken     faxed to       Tech      verifies
                                                          Verifies
 on ward                                                             given
             written     Off    pharmacy    fills order    order
    Review of Flow Chart for
 Community-acquired Pneumonia
• Study the three patients represented on
  the flow chart.
  – Where are the areas of greatest delay?
  – Is this consistent or variable?
  – What questions does this suggest?
  – What additional information is needed in order
    to better understand the process?
  – Is any variability in practice noted?
   Antibiotic Orders in Pneumonia
             Admit     Orders     Orders      Pharm       R. Ph.
Pt arrives                                                           Med
             orders    taken     faxed to       Tech      verifies
                                                          Verifies
 on ward                                                             given
             written     Off    pharmacy    fills order    order
   Antibiotic Orders in Pneumonia
             Admit     Orders     Orders      Pharm       R. Ph.
Pt arrives                                                           Med
             orders    taken     faxed to       Tech      verifies
                                                          Verifies
 on ward                                                             given
             written     Off    pharmacy    fills order    order




                         Interval in Minutes
   Antibiotic Orders in Pneumonia
             Admit      Orders      Orders      Pharm       R. Ph.
Pt arrives                                                             Med
             orders     taken      faxed to       Tech      verifies
                                                            Verifies
 on ward                                                               given
             written      Off     pharmacy    fills order    order

       The orange boxes represent high impact areas for further
      intervention




                          Interval in Minutes
   Antibiotic Orders in Pneumonia
               Admit        Orders     Orders      Pharm       R. Ph.
Pt arrives                                                                 Med
               orders       taken     faxed to       Tech      verifies
                                                               Verifies
 on ward                                                                   given
               written        Off    pharmacy    fills order    order


              What about                                       Can we     Notify RN
Antibiotics
                 order                                         stock in      on
in clinics?
              priorities?                                      Pyxis?      arrival?



 Are shift    What is the
 changes       optimal
a problem?    antibiotic?
       Process Flow Charts
• Summary
 – Great way to grasp “usual” care delivery
 – Highlight delays and inefficiencies
 – Often uncover variable approaches to care
 – May frame additional information needs or
   evidence-based questions
  Moving from Identifying Problem
       Areas to Causation

• Mapping out a flow chart may allow to you
  identify problem areas within the process
  you are trying to improve.
• Within each problem focus area, you will
  need to dig deeper to understand the
  cause of the problem.

				
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posted:5/19/2014
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