Sustained Reduction in Intravenous Pump Turnaround Time Using Lean Methodology.

Intravenous pumps provide essential, life-sustaining medications to patients. Pumps must be in working order and available on short notice to be effective. We identified inefficiencies in our pump management process that inflated the cost and time to complete repairs. Methods: Our multidisciplinary team completed a 60-day before-after trial that followed the Toyota Production System Lean methodology and evaluated the sustainability of our improvements for the following 48 months. We used value stream mapping and manual time studies to identify areas for improvement. Device turnaround time (TAT) was the number of days from receiving a device for repair to its return to service. Interventions included: establishing a reliable system to receive and track repair requests, creating a better organized, more efficient workroom, streamlining the inventory of repair parts, and tracking delivery systems reliably. Results: We reduced mean intravenous pump TAT by 89% and sustained TAT at 74%-97% below baseline for 4 years, including during the COVID pandemic. Conclusions: We used Lean methodology to create a system to receive, track, and provide safe, functional equipment to providers promptly. Both clinical and nonclinical healthcare professionals can use Lean to produce a sustainable improved system.

Sustained Reduction in Intravenous Pump Turnaround Time Using Lean Methodology

Introduction: Intravenous pumps provide essential, life-sustaining medications to patients. Pumps must be in working order and available on short notice to be effective. We identified inefficiencies in our pump management process that inflated the cost and time to complete repairs. Methods: Our multidisciplinary team completed a 60-day before-after trial that followed the Toyota Production System Lean methodology and evaluated the sustainability of our improvements for the following 48 months. We used value stream mapping and manual time studies to identify areas for improvement. Device turnaround time (TAT) was the number of days from receiving a device for repair to its return to service. Interventions included: establishing a reliable system to receive and track repair requests, creating a better organized, more efficient workroom, streamlining the inventory of repair parts, and tracking delivery systems reliably. Results: We reduced mean intravenous pump TAT by 89% and sustained TAT at 74%–97% below baseline for 4 years, including during the COVID pandemic. Conclusions: We used Lean methodology to create a system to receive, track, and provide safe, functional equipment to providers promptly. Both clinical and nonclinical healthcare professionals can use Lean to produce a sustainable improved system.

Management of Isolation Precautions in Ambulatory Care Settings...Association for Professionals in Infection Control (APIC) Annual Conference, 13-15 June, 2022, Indianapolis, Indiana

Failure to discontinue transmission-based precautions (TBP) for eligible ambulatory patients may decrease stakeholder buy-in, adherence, and experience. Successful removal is hindered by unclear criteria and inadequate resources. We sought to create a pre-visit review process to identify TBP removal opportunities to support stakeholders without exhausting resources. Study period was 11/02/2020 – 11/30/2021. We generated an electronic medical record (EMR) report of ambulatory encounters in the coming week with a TBP flag. Interventions tested included: A spreadsheet macro to filter and format the EMR report (implemented 01/29/21);Standardized IP chart review and notification;Clinical stakeholder engagement to define and evaluate process expectations. We used a standard t-test for weekly encounter and percent no-change review comparisons. During 11/02/2020-01/28/21, 3,111 encounters were reviewed for TBP removal. Of those, 310(9.96%) had TBP status updated, 1,134(36.45%) required email communication to determine status, and 1,667(53.58%) had no change. These no-change encounters included cystic fibrosis patients (remain in life-long TBP) and ineligible long term TBP. We built the macro to remove no-change encounters to focus on encounters needing review. During 1/29/21-11/27/21, 6,060 encounters were reviewed, with 1,818(30.00%) updated, 1,646(27.16%) requiring email, and 2,596(42.84%) no-change. Macro implementation reduced average reviewed encounters weekly (246 to 142, p<.0001) and the proportion of no-change encounters (56.36% to 47.39%, p=0.0224). Subjectively, reviews took less time (approximately 15 hours to 5 hours per week). Process standardization and stakeholder engagement were well-received. Macro utilization increased review efficiency by removing no-change encounters. Despite a reduction in pre- and post-implementation proportions of no-change encounters, there is still opportunity to further reduce time wasted on no-change encounters. Standardizing our process allowed for cross training of IPs, alleviating burden on others. Stakeholder engagement improved relationships between IPs and ambulatory staff.

The impact of public health interventions on critical illness in the pediatric emergency department during the SARS-CoV-2 pandemic.

Study objective: The impact of public health interventions during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on critical illness in children has not been studied. We seek to determine the impact of SARS-CoV-2 related public health interventions on emergency healthcare utilization and frequency of critical illness in children. Methods: This was an interrupted time series analysis conducted at a single tertiary pediatric emergency department (PED). All patients evaluated by a provider from December 31 through May 14 of 6 consecutive years (2015-2020) were included. Total patient visits (ED and urgent care), shock trauma suite (STS) volume, and measures of critical illness were compared between the SARS-CoV-2 period (December 31, 2019 to May 14, 2020) and the same period for the previous 5 years combined. A segmented regression model was used to explore differences in the 3 outcomes between the study and control period. Results: Total visits, STS volume, and volume of critical illness were all significantly lower during the SARS-CoV-2 period. During the height of public health interventions, per day there were 151 fewer total visits and 7 fewer patients evaluated in the STS. The odds of having a 24-hour period without a single critical patient were >5 times higher. Trends appeared to start before the statewide shelter-in-place order and lasted for at least 8 weeks. Conclusions: In a metropolitan area without significant SARS-CoV-2 seeding, the pandemic was associated with a marked reduction in PED visits for critical pediatric illness.

Multisociety statement on coronavirus disease 2019 (COVID-19) vaccination as a condition of employment for healthcare personnel.

This consensus statement by the Society for Healthcare Epidemiology of America (SHEA) and the Society for Post-Acute and Long-Term Care Medicine (AMDA), the Association for Professionals in Epidemiology and Infection Control (APIC), the HIV Medicine Association (HIVMA), the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP) recommends that coronavirus disease 2019 (COVID-19) vaccination should be a condition of employment for all healthcare personnel in facilities in the United States. Exemptions from this policy apply to those with medical contraindications to all COVID-19 vaccines available in the United States and other exemptions as specified by federal or state law. The consensus statement also supports COVID-19 vaccination of nonemployees functioning at a healthcare facility (eg, students, contract workers, volunteers, etc).

Disinfection of Neonatal Resuscitation Equipment in Low-Resource Settings: The Importance, the Reality, and Considerations for the Future.

Preventable neonatal deaths due to prematurity, perinatal events, and infections are the leading causes of under-five mortality. The vast majority of these deaths are in resource-limited areas. Deaths due to infection have been associated with lack of access to clean water, overcrowded nurseries, and improper disinfection (reprocessing) of equipment, including vital resuscitation equipment. Reprocessing has recently come to heightened attention, with the COVID-19 pandemic bringing this issue to the forefront across all economic levels; however, it is particularly challenging in low-resource settings. In 2015, Eslami et al. published a letter to the editor in Resuscitation, highlighting concerns about the disinfection of equipment being used to resuscitate newborns in Kenya. To address the issue of improper disinfection, the global health nongovernment organization PATH gathered a group of experts and, due to lack of best-practice evidence, published guidelines with recommendations for reprocessing of neonatal resuscitation equipment in low-resource areas. The guidelines follow the gold-standard principle of high-level disinfection; however, there is ongoing concern that the complexity of the guideline would make feasibility and sustainability difficult in the settings for which it was designed. Observations from hospitals in Kenya and Malawi reinforce this concern. The purpose of this review is to discuss why proper disinfection of equipment is important, why this is challenging in low-resource settings, and suggestions for solutions to move forward.

Rewriting the playbook: infection prevention practices to mitigate nosocomial severe acute respiratory syndrome coronavirus 2 transmission.

PURPOSE OF REVIEW: Given the limited evidence and experience with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), this novel pathogen has challenged the field of infection prevention. Despite uncertainty, infection prevention principles and experience with similar diseases have helped guide how to best protect providers and patients against disease acquisition. RECENT FINDINGS: Guidance to date has relied on data from SARS-CoV-1 and MERS-CoV to guide practices on patient isolation and personal protective equipment (PPE) use. Although a face mask and eye protection are likely adequate for most clinical scenarios, published guidelines for PPE can be confusing and conflicting. Consensus for what constitutes a high-risk aerosol-generating procedure (AGP) is lacking, but most agree providers performing procedures such as bronchoscopy, intubation, and cardiopulmonary resuscitation would likely benefit from the use of an N95 respirator and eye protection. SUMMARY: Needed research to elucidate the predominant SARS-CoV-2 mode of transmission is not likely to be completed in the immediate future. Recommendations for PPE to mitigate procedure-associated risk remain controversial. Nonetheless, implementation of existing measures based on basic infection prevention principles is likely to prevent transmission significantly.

An Ethical Analysis of Hospital Visitor Restrictions and Masking Requirements During the COVID-19 Pandemic

Nonpharmaceutical interventions to minimize the transmission of the severe acute respiratory syndrome coronavirus 2 are necessary because we currently lack a vaccine or specific treatments. Healthcare facilities have adopted visitor restrictions and masking requirements. These interventions should be evaluated as public health measures, focusing on their efficacy, the availability of less-restrictive alternatives, and the minimization of the burdens and their balance with the benefits. These interventions, as well as exceptions, can be justified by the same analysis. For example, visitor restrictions are sound, as are exceptions for women in labor, adults with disabilities, minor children, and individuals who are dying. In implementing these policies, specific rules are preferable to general principles because they are more efficient and reduce possible bias. There should, however, be appeal mechanisms and retrospective review processes. Evaluating requests for medical exemptions to masking requirements is particularly difficult, given the prevalence of nonmedical objections, false claims of medical exemptions, and a lack of objective medical criteria. Requiring written statements by licensed healthcare providers that undergo subsequent substantive review may therefore be justified.