UCSF Center for Healthcare Value - Caring Wisely 2.0

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

Review Complete Proposals

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Expedited appropriate transfers back to Laguna Honda

Submitted by Andrew Lai on February 11, 2014 - 12:08am Last revised by Web Producer on March 13, 2014 - 12:43pm.
Idea Status: 
Review Complete

On the medical service, there are numerous patients who are Laguna Honda residents who are medically stable to return to LH, but are kept hospitalized over weekends/holidays due to current LH policy of no transfers back during these periods.  I would imagine that this is due to reduced LH staffing during those times.

 

Scheduled Foley catheter removal to minimize un-necessary catheter re-insertion, to lower CAUTI rates

Submitted by Maurice Garcia on February 10, 2014 - 3:46pm Last revised by Web Producer on March 13, 2014 - 12:43pm.
Idea Status: 
Review Complete

[Submitted with Tina Quon, RN]

 

Background: To minimize CAUTI, we currently ask primary teams to assess, on a daily basis, need for ongoing indwelling urinary catheter use, and order removal when indicated.

 

Problem: Foley catheters are often removed late in the day, which often results in catheter replacement during or after night-shift transfer of care, despite actual need. 

 

A Smartphone based App for actual length, width and area measurements of decubitus ulcers and burns to assess dimensions and track response to treatment

Submitted by Maurice Garcia on February 10, 2014 - 3:31pm Last revised by Web Producer on March 13, 2014 - 12:43pm.
Idea Status: 
Review Complete

Background: Documentation of decubitus ulcer and dermatologic wound size at baseline and during treatment is important.

Problem: Use of paper rulers to measure wounds is inexact, and leaves no record or detail of the measurement. A more useful index of wound size is area- but no bedside device for this exists.

Consolidate the paging system

Submitted by Jing-Yu Pan on February 10, 2014 - 2:50pm Last revised by Web Producer on March 13, 2014 - 12:43pm.
Idea Status: 
Review Complete

Overall workflow and communication in the hospital could be significantly improved if the text paging system were more widely utilized.  One of the barriers to increased utilization of the text paging system may be the dual paging systems that are not well centralized - DPH employees who are on the DPH Central Paging system and UCSF residents/employees who are on the Pagerbox system.  If there is a way to better centralize this,perhaps more text paging may be used by all hospital staff to more efficiently communicate.  

Reducing Redundancy in Lab and Ultrasound Ordering

Submitted by Ana Delgado on February 10, 2014 - 2:47pm Last revised by Web Producer on March 13, 2014 - 12:43pm.
Idea Status: 
Review Complete

There are some lab tests, like Hemoglobin Electophoresis, that never change. Yet they are often ordered multiple times of the same patient. For example, we order one every pregnancy even though you are not going to acquire sickle cell trait between two pregnancies. Another example is screening for genetic carriers, like CF. That has been ordered more than once on the same patient. Perhaps the lab could simply indicate that the lab was not done because a result already exists and to resubmit if you really want to run the test.

 

Standing Orders for Lab Tests

Submitted by Eliseo Perez-Stable on February 10, 2014 - 11:33am Last revised by Web Producer on March 13, 2014 - 12:43pm.
Idea Status: 
Review Complete

Specialty clinics have designed a set of standing orders for lab tests for their patients. Although there may be some value in the initial evaluation of a referral, it is very wasteful to have repeat lab tests. For exampl, patients get fasting lipids every 4 months. Lab test orders should be based on what a patient presents with as a problem or anticipated from the previous visit and not left as routine standing.

Streamline Social Services - UM Referral Process at SFGH

Submitted by Jeffrey Critchfield on February 10, 2014 - 8:13am Last revised by Web Producer on March 13, 2014 - 12:43pm.
Idea Status: 
Review Complete

Patient FLow Issue at SFGH

 

Current State

Hospital to community health care facility transitions involve input from Social Services and Utilization Management staff.  The process is non-standard, non-reliable, inefficient and opaque to the providers who interface with the system.

 

Idea

Bring LEAN strategies to map the process to provide foundation for increased efficiencies in the referral process.

Providing an Integrated Approach for Back Pain Care

Submitted by Lisa Pascual on February 10, 2014 - 7:45am Last revised by Web Producer on March 13, 2014 - 12:43pm.
Idea Status: 
Review Complete

Low back pain is the fifth most common reason for all physician visits in the US.  While many patients have self-limited episodes of back pain, one third of these patients have persistent back pain lasting at least one year.  Hundreds of patient visits to SFGH are for back pain.  The good news is that the expertise to treat back pain exists at SFGH; there are there multiple venues to receive care.  However, when patients present with ongoing difficulties or require evaluation for other treatment modalities, the coordination of care between these venues is limited.   Significant wait times (

More Efficient Use of 4A at SFGH

Submitted by Rita Nguyen on February 9, 2014 - 9:46pm Last revised by Web Producer on March 13, 2014 - 12:43pm.
Idea Status: 
Review Complete

4A has a reputation among MDs as being incredibly difficult to refer patients to. There are idiosyncratic admission criteria that sometimes do not have clinical relevance (ie requesting pts on dialysis to get a repeat lab draw AFTER dialysis to ensure the potassium is ok, not allowing patients newly on O2 to be referred even if they've just recovered from ARDS 2/2 PNA in the ICU, only accepting patients on q8h antibiotics rather than q12h, etc).

Reducing Waste and Inefficiency in the SFGH Discharge Pharmacy

Submitted by Rita Nguyen on February 9, 2014 - 9:38pm Last revised by Web Producer on March 13, 2014 - 12:43pm.
Idea Status: 
Review Complete

SFGH's Discharge Pharmacy offers a unique and much needed service to inpatients: free meds on discharge. However, pts are often insured and can fill these meds at a local pharmacy rather than have the medications dispensed for free.

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