Service Line QI. Support of the ASC.
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Ryan Larson
Director, System Quality Improvement & Specialty Program Development
TRIA Orthopedics
5/10/2024
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QA & QC monitor current level of
performance/ quality of the process
QI responds and Process Owner “hands over” process and provides
necessary staff to act as team members. QI Identifies causes with
team and implements solutions.
Process Owner “takes back” process
and promotes improvements
QA & QC monitor new level of
performance/ quality of the process
5/10/2024
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An operational question needs to be answered
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Data can either already exist (pull from data base), or needs to be gathered (manual observations)
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Development of operational KPIs to improve process understanding and control
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Educating and coaching team on QI tools and principles
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The cause of a process issue is known and a solution is relatively simple
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Usually contained to one team or department
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Begins with an issue, the cause of which is unknown and improvement is needed
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Focus is on processes and operations
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Can span multiple departments or facilities
5/10/2024
TRIA PPT Template
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5/10/2024
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Our goal is to safely perform all
appropriate Total Joint Arthroplasty
cases at our ASC’s in a timely manner
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Our ability to do this has been variable
by geography (east vs. west)
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The primary barrier has been access
to operating time
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Is more time the solution?
5/10/2024
TRIA PPT Template
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THA
THA
TKA
TKA
40-45 Min
Longer
20-25 Min
Longer
10 Min
Longer
7 Min
Longer
5/10/2024
TRIA PPT Template
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Trial Observation (10 cases) to develop scope/areas of focus
Scope:
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“Patient In” to “Patient Out”
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Procs:
Anterior THA, Posterior THA, TKA, Robotic TKA
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Locations:
TRIA BL, TRIA WB, Methodist, Lakeview
Areas of Focus defined by trial observation:
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“Patient In” to “Time Out” – Process Focus
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Number of instrument handoffs
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Time from Request to Handoff
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Closure – Assist Experience
*To Date we have completed more than 50 observations with 12 of our surgeons
5/10/2024
TRIA PPT Template
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In Room to Incision
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Anesthesia Type (General vs. Spinal)
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Equipment/Table Selection
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Linear vs. Concurrent “Flow”
Cut to Close
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Anterior vs. Posterior Approach – Anterior adds 10-20% to case length vs. posterior
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Robot/Navigation
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Tech Experience – <200 cases/year = 33% longer per instrument handoff vs. >200 cases/year
Closure
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Varying techniques, product use, skillset/confidence/trust can drive as much as a 50%
difference in time
5/10/2024
TRIA PPT Template
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Remember our goal:
Our goal is to safely perform all
appropriate Total Joint Arthroplasty cases at our ASC’s in a
timely manner
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It isn’t just about a single metric (time), we need to balance
this with an outcome metric(s) to ensure we are providing both
efficient care/access to care but also optimal care
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TRIA Orthopedics offers comprehensive Quality Improvement (QI) support for Ambulatory Surgery Centers (ASCs). Led by Director Ryan Larson, the QI process focuses on promoting improvements, monitoring performance, identifying causes, implementing solutions, and supporting various operational activities. The team facilitates analysis, metric creation, education, coaching, and project management to enhance processes and operations. The ASC locations provide full-service care, addressing operational issues like optimizing total joint arthroplasty procedures efficiently.
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Presentation Transcript
Service Line QI Support of the ASC Ryan Larson Director, System Quality Improvement & Specialty Program Development TRIA Orthopedics
QI is not QA (Assurance) or QC (Control) Process Owner takes back process and promotes improvements 16 14 QA & QC monitor current level of performance/ quality of the process 12 QA & QC monitor new level of performance/ quality of the process 10 Errors 8 6 4 2 0 0 5 10 15 20 25 Time QI responds and Process Owner hands over process and provides necessary staff to act as team members. QI Identifies causes with team and implements solutions. 5/10/2024 2 2
QI Activities We Support Analysis An operational question needs to be answered Data can either already exist (pull from data base), or needs to be gathered (manual observations) Metric Creation Development of operational KPIs to improve process understanding and control Education & Coaching Educating and coaching team on QI tools and principles Just-Do-It The cause of a process issue is known and a solution is relatively simple Usually contained to one team or department Tool Facilitation Facilitation for a group or team currently engaged in an initiative is required (i.e. brainstorming session, issue identification and prioritization, process mapping, 5-whys/ root cause analysis, etc.) QI Project: Begins with an issue, the cause of which is unknown and improvement is needed Focus is on processes and operations Can span multiple departments or facilities 5/10/2024 3
TRIA Locations Framing the Problem Full-service site: ASC, Clinic, Ortho Urgent Care, Rehab Clinic / Doctors Rehabilitation 5/10/2024 TRIA PPT Template 4
Operational Issue/Question Our goal is to safely perform all appropriate Total Joint Arthroplasty cases at our ASC s in a timely manner Our ability to do this has been variable by geography (east vs. west) The primary barrier has been access to operating time Is more time the solution? SURGEON 2 SURGEON 1 SURGEON 2 SURGEON 1 SURGEON 2 SURGEON 2 SURGEON 1 SURGEON 2 SURGEON 1 5/10/2024 5
Initial Data Analysis 7 Min Longer THA TKA 10 Min Longer 40-45 Min Longer 20-25 Min Longer 5/10/2024 TRIA PPT Template 6
Time Study Trial Observation (10 cases) to develop scope/areas of focus Scope: Patient In to Patient Out Procs: Anterior THA, Posterior THA, TKA, Robotic TKA Locations: TRIA BL, TRIA WB, Methodist, Lakeview Areas of Focus defined by trial observation: Patient In to Time Out Process Focus Number of instrument handoffs Time from Request to Handoff Closure Assist Experience *To Date we have completed more than 50 observations with 12 of our surgeons 5/10/2024 TRIA PPT Template 7
Preliminary Time Study Findings In Room to Incision Anesthesia Type (General vs. Spinal) Equipment/Table Selection Linear vs. Concurrent Flow Cut to Close Anterior vs. Posterior Approach Anterior adds 10-20% to case length vs. posterior Robot/Navigation Tech Experience <200 cases/year = 33% longer per instrument handoff vs. >200 cases/year Closure Varying techniques, product use, skillset/confidence/trust can drive as much as a 50% difference in time 5/10/2024 TRIA PPT Template 8
Closing Note Remember our goal: Our goal is to safely perform all appropriate Total Joint Arthroplasty cases at our ASC s in a timely manner It isn t just about a single metric (time), we need to balance this with an outcome metric(s) to ensure we are providing both efficient care/access to care but also optimal care 5/10/2024 TRIA PPT Template 9
