Using lean methodology to optimize time to antibiotic administration in patients with sepsis.

PURPOSE: Results of a study to apply lean methodology to an inpatient pharmacy workflow to optimize timely administration of Centers for Medicare and Medicaid Services (CMS)-approved antibiotics for patients with severe sepsis or septic shock are presented. METHODS: This quasi-experimental study was conducted at an 802-bed institution using lean methodology to assess the inpatient pharmacy workflow for dispensing antibiotics to adult patients. The preintervention and postintervention phases occurred from February to September, 2015, and from October 2015 to May 2016, respectively. Patients were included if they were hospitalized with an intensive care department 9 or 10 code for severe sepsis or septic shock, had an order for a CMS-approved antibiotic, and met clinical criteria for severe sepsis or septic shock. Patients were excluded if they received first-dose antibiotics in the emergency department. The primary outcome was time from CMS-approved antibiotic order entry to medication administration. Secondary outcomes included timeliness of individual workflow dispensing parameters, patient outcomes, and compliance with the newly implemented workflow. RESULTS: A total of 102 patients were included, 54 in the preintervention and 48 in the postintervention group. Baseline demographics between the groups were similar. There was a significant reduction in the median time from order entry to antibiotic administration by 40 minutes (preintervention phase 120 minutes versus postintervention phase 80 minutes, p = 0.014). Time from order verification to administration was significantly reduced. There was no difference in other secondary outcomes. CONCLUSION: Lean methodology was successfully used to reduce time to antibiotic administration, which led to improved compliance with the newly implemented sepsis CMS core measure.

Creating objective and measurable postgraduate year 1 residency graduation requirements.

PURPOSE: The process of developing objective and measurable postgraduate year 1 (PGY1) residency graduation requirements and a progress tracking system is described. SUMMARY: The PGY1 residency accreditation standard requires that programs establish criteria that must be met by residents for successful completion of the program (i.e., graduation requirements), which should presumably be aligned with helping residents to achieve the purpose of residency training. In addition, programs must track a resident's progress toward fulfillment of residency goals and objectives. Defining graduation requirements and establishing the process for tracking residents' progress are left up to the discretion of the residency program. To help standardize resident performance assessments, leaders of an academic medical center-based PGY1 residency program developed graduation requirement criteria that are objective, measurable, and linked back to residency goals and objectives. A system for tracking resident progress relative to quarterly progress targets was instituted. Leaders also developed a focused, on-the-spot skills assessment termed "the Thunderdome," which was designed for objective evaluation of direct patient care skills. Quarterly data on residents' progress are used to update and customize each resident's training plan. Implementation of this system allowed seamless linkage of the training plan, the progress tracking system, and the specified graduation requirement criteria. CONCLUSION: PGY1 residency requirements that are objective, that are measurable, and that attempt to identify what skills the resident must demonstrate in order to graduate from the program were developed for use in our residency program. A system for tracking the residents' progress by comparing residents' performance to predetermined quarterly benchmarks was developed.