Improving Care Delivery: Location Timestamps to Enhance Process Measurement of a Clinical Workflow

Area of Science:

• Healthcare Management
• Process Improvement
• Pediatric Emergency Medicine

Background:

• Traditional quality improvement (QI) methods often use qualitative data or human observation, which can be inaccurate for time-sensitive workflows.
• Objective time measurements are needed to accurately assess and improve time-based processes in healthcare settings.

Purpose of the Study:

• To evaluate the effectiveness of integrating objective time measurements into traditional QI strategies.
• To use procedural sedation workflow in a pediatric emergency department as a model for this evaluation.

Main Methods:

• Applied the FOCUS-Plan-Do-Check-Act framework, incorporating additional clarification steps.
• Extracted objective time-based data from electronic health record (EHR) systems and real-time locating systems (RTLS).
• Compared traditional survey findings with analyses of timed workflow steps for procedural sedation.

Main Results:

• Traditional surveys produced ambiguous or conflicting results regarding delay sources across clinical roles.
• Timestamp analysis identified 5 measurable clinical subworkflows and significant bottlenecks.
• Workflow patterns and delays were clarified by measuring completion times for 54 sedation cases.

Conclusions:

• Objective time analysis provides a clearer understanding of workflow delays than traditional surveys alone.
• Combining EHR and RTLS timestamps with QI process maps effectively identifies workflow bottlenecks.
• This data-driven approach better informs QI teams in targeting interventions for improvement.