Confronted with the high cost incurred in purchasing expensive equipment for Cardiac Catheterization Labs and the constraints that accompany reimbursements, many hospital systems are working to improve throughput while increasing the efficiency and effectiveness of the equipment being used.  Children’s Hospital of New York determined that first case start time was a major contributor in lost productivity and subsequent scheduling disruptions.

Senior leadership was involved, a project charter was developed, and the team was formed. Data revealed that 62% of the first cases were starting late. Basic tools such as process mapping and the cause and effect diagram were used to develop a list of factors that contributed to delaying the start of the first case By collecting and analyzing more data, the team was able to reduce the list to include those factors which were most important. Regression analysis was used to determine which factors were statistically significant. The team determined that timely completion of the cardiology assessment was

a key driver in starting the daily schedule on time. The process was improved by setting priorities within the process so that the assessment was completed accurately and timely.

A new process flow map was completed and timely completion of the cardiology assessment was designed into the process. Responsibilities of the process workers were clearly defined. The desired goal for on-time first case starts was achieved. A control plan, which consisted of a dashboard, delineation of responsibilities, alert flags, and required action, was put in place.