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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Eliminate the requirement for non scrubbed staff in the OR to wear masks

Submitted by Paul Pratt on January 31, 2014 - 10:53am Last revised by Web Producer on March 13, 2014 - 12:38pm.
Idea Status: 
Selected as Phase 2 Hot Spot

OR staff not scrubbed into a case in the OR wear face masks.  It has no clinical evidence behind it, in fact it has been proven in studies that these masks do nothing to reduce SSI's.  They are a crutch.  A crutch that costs the hospital a lot of money every year.  Hospitals all across Australia, Europe and the UK do not require non scrubbed personnel to wear masks.  In an era where healthcare costs are so high it seems an obvious and easy one to contain.

Reduce Wasteful Telemetry Monitoring

Submitted by Nader Najafi on January 30, 2014 - 9:37pm Last revised by Web Producer on March 13, 2014 - 12:38pm.
Idea Status: 
Selected as Phase 2 Hot Spot

Overuse of telemetry monitoring is a target of the ABIM Foundation’s “Choosing Wisely” campaign, which recommends that hospitals develop a protocol to limit telemetry use. It is associated with ER overcrowding, over-testing and over-treatment of clinically irrelevant events, limited patient mobility and sleep due to frequent adjustment of equipment, and the cost of nurse and physician time responding to false alarms. A staggering statistic from the UCSF Medicine Service is that 44% of our patients are on telemetry until the moment they are discharged.

Reduction of Low-value Laboratory Testing for Inpatients

Submitted by Alvin Rajkomar on January 27, 2014 - 1:36pm Last revised by Web Producer on March 13, 2014 - 12:38pm.
Idea Status: 
Selected as Phase 2 Hot Spot

The ABIM Foundation’s Choosing Wisely campaign – under which more than 50 specialty societies have each identified five common practices that are often unnecessary – has received a significant amount of national attention. One of the Choosing Wisely recommendations by the Society of Hospital Medicine is to avoid "repetitive CBC and chemistry testing in the face of clinical and lab stability," which may be particularly relevant for patients hospitalized at UCSF.

Reducing Turnover Times in the Operating Room

Submitted by Lindsay Hampson on January 27, 2014 - 9:47am Last revised by Web Producer on March 13, 2014 - 12:38pm.
Idea Status: 
Selected as Phase 2 Hot Spot

The cost of running an operating room is significant - it is estimated that the cost of the use of a routine operating room at UCSF Health System is $69/minute. This means that any unused operating room time is a significant loss of money. On any given day, an operating room is used for multiple cases. Once one case finishes, a cleaning staff comes into the OR to clear away trash and the OR staff takes away supplies from the previous case and sets up supplies for the next case.

Update Attending Surgeon Operating Room Preference Lists

Submitted by Lindsay Hampson on January 27, 2014 - 9:30am Last revised by Web Producer on March 13, 2014 - 12:38pm.
Idea Status: 
Selected as Phase 2 Hot Spot

Costs of an operation are significant, and many of the costs incurred in the operating room are due to using expensive equipment, materials, sutures, and supplies. Each attending surgeon has an OR "preference list" for each specific case that they perform, which is a list of all of the supplies, equipment, and materials they need for that case. This list directs the operating room staff (OR scrub technician and OR nurse) in terms of what materials and supplies they need to gather and open for use in the operating room.

 

Reducing Unnecessary Respiratory Isolation through Point-of-Care TB Testing

Submitted by John Davis on January 24, 2014 - 4:23pm Last revised by Web Producer on March 13, 2014 - 12:38pm.
Idea Status: 
Selected as Phase 2 Hot Spot

>90% of patients placed in respiratory isolation because of concern for active TB are ultimately found not to have TB, but current evaluation algorithms based on smear microscopy require that patients remain in respiratory isolation for two or more days while multiple sputum samples are tested. We have recently shown in a non-interventional pilot study at SFGH that use of a novel rapid point of care assay, the Cepheid GeneXpert MTB/RIF test (Xpert), can evaluate a single sample in three hours or less with similar accuracy to the conventional microscopy-based algorithm.

Radiation and Past Imaging Information in Order

Submitted by Ellen Weber on January 24, 2014 - 2:12pm Last revised by Web Producer on March 13, 2014 - 12:38pm.
Idea Status: 
Selected as Phase 2 Hot Spot

Excessive imaging of patients increases health care costs and the risk for cancer. It also may create needless delays in disposition decisions. The idea: when a physician opens an order for a CT scan, prior CT's done in the last 3 years would be listed, allowing the physician to consider alternative means of testing or deciding not to image at this point at all. Additionally, the approximate amount of radiation and its risk for that study would be displayed. (Currently radiation information appears on the reading, but not in the order).

Judicious Use of Blood Bank Tests in the Newborn Nursery

Submitted by Michael Cabana on January 16, 2014 - 7:22pm Last revised by Web Producer on March 13, 2014 - 12:38pm.
Idea Status: 
Selected as Phase 2 Hot Spot

Background:

For many years the nurses and physicians at the UCSF newborn nursery (Parnassus Campus) have routinely been ordering a cord blood bank panel on ANY infant of a mother who was Rh-negative or O-positive.  This testing is due to concerns about jaundice due to ABO or Rh Incompatibility. 

Eye drops during surgery will be used post-op and for discharge as appropriate

Submitted by Elena Tinloy on January 16, 2014 - 4:59pm Last revised by Web Producer on March 13, 2014 - 12:38pm.
Idea Status: 
Selected as Phase 2 Hot Spot

During ophthalmology procedures, eye drops are used that are patient specific and required post-op.  However, they are not appropriately labeled for discharge and thus thrown away.  If these medications were ordered as discharge meds, thus would be appropriately labeled, they could be given to the patient post op and send home with them.  There would not be any wastage of the eye drops post op, they would be labeled for discharge and patient will not have to wait for discharge medications, nor go out via pharmacy to pick up medications.

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