UCSF Center for Healthcare Value - Caring Wisely 2.0

Crowd-sourcing innovative cost savings ideas from the front lines of care delivery systems

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The UCSF Center for Healthcare Value (CHV) called for the best ideas to reduce inefficiencies and health care costs as Phase 1 of the Caring Wisely initiative. The top 10 ideas at each site were selected as "Hot Spots" for Phase 2, which will be a call for proposals from within the UCSF and SFGH communities to address the areas of interest identified from the winning ideas in Phase 1.

Ideas (172 total)

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Transferring medications with floor/unit transfers

Submitted by Erika Gray (SFDPH) on March 12, 2014 - 5:05pm Last revised by Web Producer on March 13, 2014 - 12:38pm.
Idea Status: 
Selected as Phase 2 Hot Spot
  1. During floor/unit transfers, many expensive patient medications, (inhalers, IV medications, creams, ointments) do not accompany the patient. Consequently, when transfer orders are completed, the new RN does not have the necessary medication on the new floor/unit and requests a new dose from pharmacy. The medications listed above can easily cost upwards of $1000 per item. If the item is not found, the cost of medication is a loss to the pharmacy budget and consequently the city.

PT position to save on ICU stays

Submitted by Bryanna Lamberjack (SFDPH) on March 12, 2014 - 4:59pm Last revised by Web Producer on March 13, 2014 - 12:38pm.
Idea Status: 
Selected as Phase 2 Hot Spot

I am a Physical Therapist in Acute care at SFGH. My idea revolves around Early Mobilization in the ICU. 3 years ago 5E/5R MICU did a study of mobilizing ICU patients as soon as they were medically safe, instead of the old model of letting the patient rest in bed while in ICU. From the study, we found that the patients health improved faster, the patients had less days in ICU, less days in hospital and higher chances of having a home discharge. All of the above findings equals a cheaper hospital stay and less cost for the consumer and our hospital.

Waste disposal

Submitted by Winnie Tan (SFGH) on March 12, 2014 - 4:54pm Last revised by Web Producer on March 13, 2014 - 12:38pm.
Idea Status: 
Selected as Phase 2 Hot Spot

Different waste (biohazard and regular trash) in hospital dispose differently and the cost also differ.

I will see empty 4x4 packages, gauze, iv tubings dispose in sharp box. What if you discontinue pt iv, does that y set tubing together with plastic part angiocsth go to sharp box or biohazard container or trash?  What about an empty used urinary bag?  Knowing exactly where to dispose trash can reduce cost.  Education? Posters?

For SFGH

Preference Card Review in Surgery

Submitted by Kent Soo Hoo on February 10, 2014 - 11:16am Last revised by Web Producer on March 13, 2014 - 12:38pm.
Idea Status: 
Selected as Phase 2 Hot Spot

UCSF Medical Center should undertake a Preference Card review in the operating room.  The goal of this review is to analyze high volume surgical procedures to maximize clinical and financial efficiency.  The Preference Cards for multiple surgeons for similar procedures would be compared with respect to cost and efficiency.  During the review, surgeons sit down together and review preference cards with goals of introducing standardization, best practices and identifying waste. 

 

Ordering Wisely at SFGH

Submitted by Jordan Chase on February 6, 2014 - 8:25pm Last revised by Web Producer on March 13, 2014 - 12:38pm.
Idea Status: 
Selected as Phase 2 Hot Spot

In the course of busy workflow it is difficult for providers to integrate cost:benefit analysis while writing orders.  In order to provide meaningful clinical decision support to providers in order to change ordering behavior, we propose to create a list of the 10-15 most expensive diagnostic and/or therapeutic orders which have equivalently effective, evidence-based, more cost-conscious alternatives.  An example: ionized calcium (an expensive lab test), which could be safely replaced in many cases by a calcium and an albumin level (inexpensive tests) and simple math.

Decreasing Overuse of Continuous Pulse Oximetry

Submitted by Lawrence Haber on February 6, 2014 - 2:56pm Last revised by Web Producer on March 13, 2014 - 12:38pm.
Idea Status: 
Selected as Phase 2 Hot Spot

Continuous Pulse Oximetry is a valuable resource at San Francisco General Hospital, limited primarily to one medical/ surgical inpatient unit (4B). Overuse of continuos pulse oximetry can create unecessary bottle-necks in flow from the emergency room for newly admitted patients or out of the intensive care unit for patients ready to transition to the step-down unit. We aim to create a standardized order set with clear indications for continuous pulse oximetry use as well as automatic discontiuation within set-time frames shoulw providers not re-evaluate and renew the orders.

Reduce unnecessary blood cultures

Submitted by Lisa Winston on February 6, 2014 - 1:23pm Last revised by Web Producer on March 13, 2014 - 12:38pm.
Idea Status: 
Selected as Phase 2 Hot Spot

Cellulitis and community acquired pneumonia are common admitting diagnoses at SFGH. Blood cultures, even if obtained before antibiotics, are low yield and unlikely to change management in most cases where the patient is admitted to the floor. Similarly, patients admitted to the floor with cellulitis seldom have true positive blood cultures, particularly when the patient is afebrile.

Decrease Electrolyte Labs and Supplementation

Submitted by Lindsey Wu on February 5, 2014 - 10:34pm Last revised by Web Producer on March 13, 2014 - 12:38pm.
Idea Status: 
Selected as Phase 2 Hot Spot

When working nightfloat, I am often signed out a PM lytes check with instructions to "replete lytes to K>4, Mg>2". Hypokalemia is rarely clinically significant unless < 3, especially in the patient with no other cardiovascular issues. Where I went to medical school, the 'normal' range for potassium was wider - I believe 3.6-5 - and hence a lot less potassium repletion was seen unless K<3.5.

Oral repletion of electrolytes instead of IV

Submitted by David Margolius on February 5, 2014 - 1:06pm Last revised by Web Producer on March 13, 2014 - 12:38pm.
Idea Status: 
Selected as Phase 2 Hot Spot

Intravenous (IV) electrolyte repletion is often waste in our system. At UCSF and SFGH, we have a culture of over-checking, and over-repleting electrolytes. IV repletion is specifically bad for three reasons:

 

1) It is more expensive (but not more effective) than oral (PO) repletion.

2) It tethers patients to their beds and IV towers, increasing falls through the actual tubing and increasing delirium and worsening the care experience through the incessant beeping as each bag finishes or when the tubing kinks.

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