Impact of quality improvement on epilepsy center outcome in a developing country
Abstract number :
3.377
Submission category :
13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year :
2017
Submission ID :
349577
Source :
www.aesnet.org
Presentation date :
12/4/2017 12:57:36 PM
Published date :
Nov 20, 2017, 11:02 AM
Authors :
Youssef Al-said, King Faisal Specialist Hospital and Research Center; Khalid Alqadi, King Faisal Specialist Hospital and Research Center; Saleh Baeesa, King Abdulaziz University; Edward Cupler, King Faisal Specialist Hospital and Research Center; Ibrahim
Rationale: Estimated number of patients with epilepsy in Saudi Arabia is around 200,000 people (prevalence of 6.5 per 1000), approximately 70,000 patients projected to have refractory epilepsy and required referral to epilepsy center for surgical evaluation.King Faisal Specialist Hospital and Research Center – Jeddah (KFSH&RC-J) is a leading epilepsy center in Saudi Arabia established in 2004, with around 5000 patients evaluated in the epilepsy monitoring unit (EMU) till December 2015, of which 430 epilepsy surgeries were performed.The goal of this study is to double the number of epilepsy surgery in one year, from 40 to 50 per year to target of 80 surgeries by improving the efficiency of the current resources. Methods: Lean principle and Plan-Do-Check-Act (PDCA) methodology were used to understand the process. The cycle time was defined as the time from the first outpatient clinic appointment to the day of surgery.A patient pathway flowchart was developed and the process cycle efficiency estimated.Brainstorming sessions identified many causes of delay that were placed into affinity diagrams and a fishbone analysis. After studying the variation related to delays, a nominal group technique was used to develop the final value stream map. Results: Employing the multi-voting technique, the long list of delays was narrowed to 4 items; long waiting time for MRI scanning, unavailable criteria for admission to the EMU, admission delays to the EMU and the lack of a multidisciplinary epilepsy clinic. The process cycle efficiency improved from 35% (figure.1) to 53% (figure.2) after implementation of the final mapping process.Pre-surgical waiting times decreased to a maximum of 13 months. This project resulted in 5 years savings of $6.8 million compared to medical management. Conclusions: A culture shift incorporating quality is possible in a major Saudi governmental institution.These results will allow KFSHRC-J epilepsy center to lead the change by using quality to increase productivity and decrease cost. Funding: none
Health Services