Disney Medical Center

NIKKO ALMASCO

KAREN HUACASI

CHRIS STANLEY HCIN 542

AARON YEE
Emergency Department
Steady decline in quality of care, ED
Out of a sample size of 500 patients, identification errors occurred in 150 cases (30%):
◦ 90 cases led to readmissions to the ED within 24hrs
◦ 4 cases led to sentinel events
◦ Only 56 were not adversely affected
Reduce Patient Identification Errors, ED
Reducing identification errors directly increases patient satisfaction, improves process of care and promotes patient safety.
June 2018 – February 2019

Goal Statement Measurement

Our goal is to reduce the percent of patient identification errors in
the emergency department from 30% to 15%

Team
Sponsor: Peter Pan
Project Manager: Mickey Mouse
Administrative Staff: Donald Duck, Olaf, Princess Tiana
Team: Names of team leaders
Data Analytics: Fairy Godmother
Providers/ End-Users: Winnie the Pooh, MD
Technical: Stitch
Implementation Team: Simba
Business: Mulan

Organizational Goals Measurement Method

One of our organizational goals is to pursue national quality by providing safe, patient An audit of 500 charts was performed. 150 patient identification errors were found
centered, effective and equitable care. This project will improve the safety and which lead to 100 readmissions within 24 hours and 4 deaths. Only 25 patients were
effectiveness of care provided in the emergency department by improving patient not affected by identification errors. Another audit will be performed after project
identification. implementation to measure percent decrease in patient identification errors.
Project Scope
In Scope Out of Scope
• Adult • Pediatric/Infants
• Medical/Surgical • Behavioral
• Walk-Ins • Patients that arrive by ambulance
Current State – ER Work Flow (UTI)

Pt with pain and End

Start discharge upon

Patient (Pt)
urination enters ED

Pt walks to restroom
Pt completes
to provide urine
registration forms
sample
Yes
Patient takes paper
order to pharmacy
Pt returns to waiting
room

Clerk enters Pt Pt returns urine

information on EHR sample to clerk

Clerk provides No

Clerk
Clerk places hospital Clerk communicates patient teaching
wristband on Pt Pt information to RN packet

Clerk instructs Pt to
provide urine
sample for urinalysis
Registered Nurse (RN)

RN reviews Pt chart

RN walks from
nursing station to RN takes Pt to exam
RN calls lab for UA RN communicates tx
waiting room to room for
results plan to pt
confirm Pt assessment
symptoms

No
Primary Care Provider (PCP)

MD comes to exam Are UA results

room available?

Yes

MD reviews results
MD gives verbal MD gives patient
and examines Paper order?
orders to RN med prescription
patient
Root Cause Analysis
Benefits of Improved Patient Identification
Improve patient safety
Decrease identity theft and insurance fraud
Decrease duplicate records and overlays
Increase revenue cycle efficiency
Enhance patient and staff satisfaction
Biometric Palm Scanner
Near-infrared light captures patient’s palm vein pattern
Biometric template is matched to patient medical record
Promotes productivity and efficiency
Benefits:

Accuracy Reliability

Security

Speed Cost Efficiency

Case Study: BayCare Health System
1 single duplicate record = $1,000 plus $95 in labor costs.
30,000 duplicate records 18,000 in 1 year ( 42%)
Cost to correct = $12.50 per record.
Cost savings 1st year from avoided duplicates = $158,337
Improvement Summary
Technological Intervention
◦ Biometric palm scanners

Non- Technological Intervention

◦ Educating all staff on expectations for the patient identification during check-in process and
throughout visit
◦ Educating Providers/prescribers about electronic-prescriptions
◦ Sign-in sheet
Improvement Timeline
Improvement Timeline cont’d
REFRESHER: Current State Flow
Current State – ER Work Flow (UTI)

Pt with pain and End

Start discharge upon

Patient (Pt)
urination enters ED

Pt walks to restroom
Pt completes
to provide urine
registration forms
sample
Yes
Patient takes paper
order to pharmacy
Pt returns to waiting
room

Clerk enters Pt Pt returns urine

information on EHR sample to clerk

Clerk provides No
Clerk

Clerk places hospital Clerk communicates patient teaching

wristband on Pt Pt information to RN packet

Clerk instructs Pt to
provide urine
sample for urinalysis
Registered Nurse (RN)

RN reviews Pt chart

RN walks from
nursing station to RN takes Pt to exam
RN calls lab for UA RN communicates tx
waiting room to room for
results plan to pt
confirm Pt assessment
symptoms

No
Primary Care Provider (PCP)

MD comes to exam Are UA results

room available?

Yes

MD reviews results
MD gives verbal MD gives patient
and examines Paper order?
orders to RN med prescription
patient
Future State – ER Work Flow (UTI)

NTI 3 &
Pt with pain and
Start discharge upon Technological
urination enters ED Intervention End

Patient (Pt)
Pt signs in on sign-in
Pt continues to wait
log and on palm
in exam room
scanner

Technological
NTI 1 Intervention
Clerk confirms pt
with two identifiers
and places hospital Pt checks out with
wristband the palm scanner
Clerk

Clerk walks pt to
bathroom to provide
urinalysis sample
Registered Nurse (RN)

NTI 1
RN provides the
RN takes pt to exam No right pt with the
Are UA results
room for nursing right pt education/
available?
assessment discharge
paperwork
Yes

No
Provider (PCP)
Primary Care

Yes
MD reviews results Does pt need
MD writes e-Rx
and examines pt medication?

NTI 2
References
Aller, R. D. (2016). Patient identification: Biometric or botched? [Powerpoint slides].
Retrieved from
http://www.himssconference.org/sites/himssconference/files/pdf/99.pdf

Thakkar, D. (2017, August 25). Biometrics for Accurate Patient Identification.

Retrieved April 30, 2018, from https://www.bayometric.com/biometrics-accurate-
patient-identification/