Problem: Research shows timely intervention, including antibiotic administration, can improve outcomes in patients suspected to have sepsis. In FY2020, the total process cycle time from order placement to antibiotic administration in a high-volume, urban, academic Adult Emergency Department was 82 minutes (above the target goal of < 60 min).
Measurement: The DMAIC framework and an A3 were used to define the project’s scope. Through direct observation and medical record timestamps, the team determined the median minutes spent in each process step. Analysis tools included: stakeholder assessment, Fishbone Diagram, Waste Walk, a Value Stream Map, and Prioritization Matrix.
Analysis: Order-to-administration time was tracked for antibiotics stocked in the ED’s automated-medication dispensing units. This helped highlight the most common path to administer antibiotics. Though the cycle time for each step remained consistent, median wait times between steps reduced over the course of our project.
Implementation: Simplified workflows, better access to supplies, and feedback to clinicians were key interventions. Workflow disruptions during COVID-19, staffing shortages, and supply-chain issues were recurring obstacles. These were mitigated through iterative process improvements with support from Hospital and Departmental leaders, guidance from frontline caregivers, and continued monitoring of performance.
Results/Discussion: Total median process cycle time decreased (82 minutes to 65 minutes) and the percentage of patients receiving antibiotics within one hour of order placement increased (58% to 75%). Ongoing monitoring, reporting, and weekly case reviews help provide timely feedback to clinicians and to better understand reasons for delays.
