PHS175 - Decreasing Ebm order Set review and approval cycle time

Abstract

Problems were lack of a coordinated approach to review and approval of order sets across the 4-hospital division; lack of consistent formal review process; wide variability in utilization of order sets, and therefore opportunities for errors and misalignment with regulatory compliance. Order set review and approval cycle time (defined as from the time an order set is drafted or received from the system level to when the approval bodies have approved it and it is ready for build, QA, and implementation) was also lengthy, impacting key stakeholder satisfaction and deployment of order sets for Computerized Physician Order Entry (CPOE). Objectives were to create one improved process for all four hospitals within the division, with 100% of new order sets compliant with the improved process going forward, process cycle time decreased to less than 60 days initially, and an increase in staff understanding of terms. Methods utilized to improve the process included Lean Six Sigma tools such as project charter, Voice of the Customer (VOC), stakeholder analysis, communication plans, SIPOC, elevator speeches, project work plan, Value Stream Mapping of the current and future processes, data definitions and collection plan, data analysis including XmR control charts and capability analyses, fishbone/cause and effect diagram, Improvement Plan, Control Plan, and computer-based learning of order set terminology. Following successful phased implementation of the improved process, results were a decrease in cycle time from an average of 77.1 days at baseline to an average of 18.1 days in the post-improvement data collection period. In addition to decreased cycle time, the benefits of an improved process to review and approve order sets include decreased colleague time spent on the process, increased colleague understanding of terms and process due to developed education, increased goodwill with physicians due to more timely approval of requested order sets, potential decrease in regulatory issues and increase in quality of care, and improved CPOE adoption.