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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Automatic Paper Towel Dispensers

Submitted by Daniel Gordon on February 6, 2014 - 10:20am Last revised by Web Producer on March 13, 2014 - 12:43pm.
Idea Status: 
Review Complete

UCSF's hand towel dispensers should all be replaced with automatic units, especially in patient care areas. Hand hygiene is crucial in preventing health care associated infections. And proper drying is an essential part of hand hygiene. I did a brief review of literature and I found several studies, including one meta-study, that showed using automatic hand towel dispensers could improve hand hygiene and reduce potential for spreading infection. 

Radiology/EM " verbal time stamp" on verbal wet reads

Submitted by Neha Amin on February 6, 2014 - 10:00am Last revised by Web Producer on March 13, 2014 - 12:43pm.
Idea Status: 
Review Complete

As an EM resident, I often call the radiology resident for a verbal wet read as do many of my fellow co-resident. We are encouraged and expected to review our own films, but during period of high clinical activity or when the patient is unstable, it is not possible to get to a PACS computer to sit and review all chest x-rays and CT scans on our own while medically managing the patient. In the last few months, I've called for a read on a CXR. Sometimes, the resident or attending in radiology will pull up the last image, and give a wet read.

better communication between admitting services at SFGH and primary care providers

Submitted by Daniel Wlodarczyk on February 6, 2014 - 9:27am Last revised by Web Producer on March 13, 2014 - 12:43pm.
Idea Status: 
Review Complete

All services should adopt the formated email the the family practice inpatient service uses. It clearly identifies who is caring for the patient, the admitting problem and the estimated length of hospitalization and who to contact. It allows you to email the resident(s) and use the info to plan for the post hospital discharge visit. The FPIS will add any person to the list at your clinic like a specified RN or scheduling person. It is simple. You can email Jack Chase MD who helped create it.

Discharge Teaching Channel

Submitted by Ingrid Scozzafava on February 6, 2014 - 8:19am Last revised by Web Producer on March 13, 2014 - 12:43pm.
Idea Status: 
Review Complete

With the large expense of installing a large quantity of large screen tv's over the last several years, it would only make sense to use them to the fullest capacity. Designate one specific channel to Discharge teaching only, which can be designed to specific needs or departments. We can make patients aware of this option at time of admssion to reduce the time spend at discharge. Many patients are given a limited choice of channels which are watched for many hours a day, to pass the time.

Reduce or Eliminate Diversion Times - SFGH ER

Submitted by Hallam Gugelmann on February 6, 2014 - 6:15am Last revised by Web Producer on March 13, 2014 - 12:43pm.
Idea Status: 
Review Complete

Every day, SFGH ER goes on diversion, and all activity slows to a glacial pace. This is not unique to SFGH; it is a well-documented phenomenon that can be avoided by reducing or eliminating diversion times; see https://www.nasemso.org/Councils/DataManagers/documents/Effect-of-Ambulance-Diversion-Ban-on-ED.pdf

SFGH should implement a reduction-to-elimination plan for improving patient service by avoiding daily diversion.

Post average waiting times in the ED

Submitted by Dylan Carney on February 5, 2014 - 11:32pm Last revised by Web Producer on March 13, 2014 - 12:43pm.
Idea Status: 
Review Complete

Unexpectedly long waiting times contribute to patient anxiety and poor satisfaction, and lead many patients to leave without being seen or to begin their healthcare experience upset and frustrated. Posting average waiting times (either static or dynamic) in the ED waiting room can help patients manage their expectations (as well as self-titrate flow and arrival patterns). This could be expanded to include posting waiting times in other outpatient clinics and urgent care clinics, as well as average waiting times for certain procedures (i.e.

Respiratory Care Services: Patient-Driven Protocols (PDP)

Submitted by Jennifer Delaroderie on February 5, 2014 - 10:56pm Last revised by Web Producer on March 13, 2014 - 12:43pm.
Idea Status: 
Review Complete

UCSF Medical Center is the only hospital that I have worked at that does not employ Respiratory Care Patient-Driven Protocols. I was surprised to learn this as I know that UCSD Medical Center pioneered PDPs over 15 years ago. 

 

It is well documented in medical literature that Respiratory Care PDP use reduces costs and improves patient outcomes. It is also held that Respiratory Care PDP use elevates the profession of Respiratory Care and enhances job satisfaction. 

 

Thank you you for this opportunity.

 

Best,

Jennifer Delaroderie RCP

"Lytes Check" Option

Submitted by Paul PO-YI Su on February 5, 2014 - 8:25pm Last revised by Web Producer on March 13, 2014 - 12:43pm.
Idea Status: 
Review Complete

I find that a lot of times on the medicine and cardiology services, volume status is a large part of patient care.  Whenever we are removing volumes with diuretics, "lyte check" often follows - and often signed out to the overnight team to check.  

 

More often than not, really what is check is the K > 4 and Mg > 2, but often the lytes are ordered as a full BMP panel in the evening.

 

Code Sepsis Bundle - point of care Lactates

Submitted by Annou Davi on February 5, 2014 - 5:35pm Last revised by Web Producer on March 13, 2014 - 12:43pm.
Idea Status: 
Review Complete

With our Code Sepsis Alerts going housewide, obtaining appropriate lactate orders and samples can be challanging.  Currently, a blood gas lactate is part of the rule out sepsis protocol but there are several lactate options in APEX and often providers and nursing staff don't obtain the correct option.  This results in unnecessary wasted materials, repeated labs and delayed results and treatment.  Point of care lactate testing could help reduce waste and expidite appropriate diagnosis and treatment.  Perhaps a member of the code sepsis team could help with this?

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