E0632 - The Supply Scavenger Hunt: Use of Procedure Bundles to Improve Efficiency of Paracentesis Care

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Patrick J. Carey, MD

University of Kentucky College of Medcine, KY

Patrick J. Carey, MD¹, Emma Scott, MD²
¹University of Kentucky College of Medcine, Lexington, KY; ²University of Kentucky College of Medicine, Lexington, KY

Introduction: Physicians report that 20-35% of their work time is preventable waste time. Moreover, time searching for equipment is a top contributor to preventable waste time. Bedside procedures, including the paracentesis, provide excellent examples of physician waste time and supply chain inefficiency. This quality improvement project's goal was to create pre-assembled procedure bundles to improve internal medicine resident physicians' paracentesis preparation time by 50%.

Methods: This project followed a traditional plan, do, study, act (PDSA) format. Utilizing LEAN principles, an analysis of the pre-intervention state found that paracentesis preparation time had significant waiting waste, motion waste, and variability by location. The outcome measure was paracentesis procedure preparation time, defined as the time (in minutes) from the start of supply assembly until the patient was marked for the procedure. The in-scope groups of focus for the project were internal medicine inpatient teaching teams.

Internal medicine residents, who served as project stakeholders, were surveyed to determine the contents of the paracentesis bundle. A uniform supply list was created, as shown in Table 1, and procedure bundles were assembled by the project team and stored in a common work area. Pre-intervention procedure preparation times were measured to establish a baseline. Once procedure bundles were introduced, post-intervention preparation times were measured.

Results: PDSA cycle #1 included 26 data points, 15 pre-intervention and 11 post-intervention. Figure 1 shows a run chart of the data. The median for the entire data set was 30 minutes. All 11 post-intervention data points fall below the median and represent a shift, supporting that the observed improvement is likely attributable to the intervention rather than chance. The average procedure preparation time improved from 55 minutes to 14 minutes, marking a 74% reduction. Additionally, the maximum preparation time improved from 145 minutes to 25 minutes.

Discussion: PDSA cycle #1 served as a proof of concept for procedure bundles to improve paracentesis preparation time and, as a result, decrease physician waste time. The 74% reduction in preparation time exceeded the original goal of 50%. Future plans include standardizing blood culture bottles for ascitic fluid studies given their improved diagnostic culture yield and preparing procedure bundles for other bedside procedures like central venous catheters and arterial lines.

Figure: Figure 1. Run chart of data set. The Median is represented by the orange line.

1	Collection bucket with lid
1	Safe-T-Centesis kit
2	Wall suction tubing packs
1	Aerobic blood culture bottle
1	Anaerobic blood culture bottle
2	Medium Tegaderm
1	Package of 4x4 gauze
1	Heparin lock for patient marking
1	Chloraprep stick

Table: Table 1. Paracentesis Bundle Supply List

Disclosures:

Patrick Carey indicated no relevant financial relationships.

Emma Scott indicated no relevant financial relationships.

Patrick J. Carey, MD¹, Emma Scott, MD². E0632 - The Supply Scavenger Hunt: Use of Procedure Bundles to Improve Efficiency of Paracentesis Care, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.