The Anesthesia Assessment Center was started three years ago with an annual patient flow of 5,000 per year but quickly grew to over 21,000 per year. Processes and employees were put into place to meet growth, but this was done with little consideration of sustainability.Two anesthesiologists and a dozen other FTE's were initially hired, but grew to four anesthesiologists with a fifth planned and 29 personnel total. Currently the Center is having trouble meeting demand. Patients have experienced long wait times and it is common for surgeries to have to be cancelled and rescheduled.

Realizing the center need to rethink is work process to meet the increasing volume and reduce delays, the Center has ask the hospitals process improvement department to conduct a Kaizen Burst with the Center staff to develop an initial plan to improve the evaluation process. The Kaizen burst which consists of a series of meetings to consider the problem and propose a solution. In this initial planning phase the team identified following interventions:

Created set of practice guidelines based upon anesthesia and surgical literature that standardized preoperative testing and decision making.

Developed a 20 item questionnaire that screens for common co-morbidities.

Created a triage decision matrix based upon questionnaire and invasiveness of the surgical procedure.

Created new patient flow, eliminating "push" style and replacing it with a three lane parallel process.

Built a web-based tool, which automated task of comparing patient data to the decision matrix.

The aim of the interventions was to reduce the number of staff and anesthesiologists need to evaluate patients by 25% without increasing day of surgery cancellation rates.

The revenue impact/cost avoidance of the planned intervention was as follows:

Reduced anesthesiologists from 4 to 3, anticipate further reduction to 2.

Reduced nursing staff from 14 to 12.

Reduced medical assistants from 3 to 2.

Reduced administrative staff from 6 to 4.

The reduction of the additional anesthesiologists would not take place until year three of the project, depending on the success of the new evaluation process.

The implementation costs were as follows:

Kaizen Burst (Planning phase)

4 MD's (anesthesiologists) 10 hours each

1 RN 10 hours

1 support staff member 10 hours

1 Performance Improvement staff member- 50 hours

Development phase

2 MD's (anesthesiologists) 40 hours each

2 RN's 60 hours each

4 administrative support staff members 80 hours each

1 Performance Improvement staff member 80 hours.

Training

5 MD's, 12 Nurses, 2 MA's, and 6 admin staff - 8 hours each

Other implementation costs

One time software development fee $26,000

Survey development costs $8,000

Sustainment costs are estimated to be as follows:

Personnel

1 support staff member 40 hours per week but not currently staffed (an increase of 1 FTE)

System maintenance

Software upgrades, changes, updates - $1250 per year.

In addition to these benefits, the new program is also expected to significantly decrease the patient weighting time by 25% and the length of time it takes the patient to complete the process by 30%. Both of which are expect to lead to a 20% improvement in patient satisfaction ratings.

The salaries, benefits, discount and realization rates have been preloadedto the spreadsheet.

Using the ROI Tool calculate the ROI, the Net Present Value and the Internal Rate of Return.This is reported on the ROI summary report. Also consider qualifies benefits. This is reported on the Qualified Benefits report. You can submit a saved Excel file or you can just submit the ROI summary report and the Qualified Benefits report.