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This study is an in-depth analysis using Lean Six Sigma tools to improve the workflow aspects specific to Transcatheter Aortic Valve Replacement (TAVR) procedures. TAVR involves several steps that must be executed to achieve optimal results. The analysis began with a comprehensive evaluation of each segment of the procedure. Timestamps were compared with national standards for each segment of the procedure. The analysis showed a total in-room time of 108.6 minutes compared to the standard of 110 minutes. The one area significantly worse than the standard was the in-room to first-stick time of 47 minutes versus the standard of 37 minutes. Using the Lean Six Sigma tools of spatial layout and movement tracing analysis helped identify inefficient intraoperative equipment and supplies placement. Repositioning resulted in a 30% reduction in average segment time, enabling the hospital to increase daily TAVR procedures by 50%. [ABSTRACT FROM AUTHOR]

High hospital readmission rates indicate inadequate facility performance, contributing to elevated healthcare costs resulting in an industry-wide effort to decrease the frequency. The objective of this paper is to perform a literature review to evaluate successful discharge practices and identify unutilized strategies which could be implemented within the organization to reduce the readmission rate. Findings suggest the variables most relevant to being discharged from an inpatient unit and maintaining psychiatric stability were associated with three areas. First, access to services that could assist with behavioral health and general life challenges, the need for social connection, and lastly, timely access to behavioral health services. The findings clearly show that the readmission rate is not only impacted by the facility's efforts but is tightly connected to the resources available to the patient upon discharge. [ABSTRACT FROM AUTHOR]

This paper addresses the non-urgent use of the Emergency Department (ED) and the impact it has on both healthcare organizations and patient care. Emergency Departments are a vital part of the healthcare system seeing on average 27 million patients per year. Of those 27 million, 18 million visits are considered nonurgent. As costs associated with healthcare continue to rise, identifying ways to cut down on these non-urgent visits will benefit both healthcare systems and patients alike. This project seeks to offer solutions that can help healthcare organizations mitigate these factors in order to reduce inappropriate use of the emergency department as well as better serve the needs of their community. Overall, the goal of this project is to understand the needs of the patients within their community, reduce spending and offer solutions that are sustainable for generations to come. [ABSTRACT FROM AUTHOR]

The healthcare industry has experienced several issues related to cybersecurity in recent years. Hospitals and health systems have been ground zero. This paper explores the issues in cybersecurity alignment in the healthcare industry. Outdated systems, information technology (IT) infrastructure, and medical devices may be catalysts for breaches by hackers. Acknowledgement of these risk factors allow healthcare system leaders an ability to plan and mitigate crucial system infrastructure against breaches. Researching different ways to solve this issue requires examination of mitigation tactics of different industries specifically ones that hold information on behalf of their constituents. Findings in this paper will add to the body of knowledge around cybersecurity in healthcare. [ABSTRACT FROM AUTHOR]

Construction of stand-alone UC's may not be possible for some healthcare organizations, leaving standing ERs as the choice for many patients. The shortage of primary care physicians partly fuels growth in Emergency Room (ER) utilization. Strategies such as triaging patients based on the severity of illness with proper triage systems, Point-of-Care (POC) testing, and the Fast-Track (FT) process can reduce wait times and improve patient satisfaction scores. Other innovative approaches include product, process, marketing, and organizational innovations that can strategically shift non-emergent patients from level 1 ERs to secondary type facilities such as level 3 and 4 ER's or UC clinics. Results will show that utilizing these strategies can effectively provide effective, safe, and efficient healthcare in the ER setting. There is a need for non-emergency center facilities to shift non-emergent visits from overcrowded ERs while developing strategies to reduce non-emergency utilization when secondary facilities are not an option. More Urgent Care (UC) facilities are needed to address the increased consumption of healthcare needs. [ABSTRACT FROM AUTHOR]

Hospital patient readmission has become one of the most critical quality outcome measurements alongside mortality and complication rates (Goldfield, 2010). Hospital patient readmissions are defined as "a hospital admission that occurs within a specific time frame after discharge from the first admission" (Upadhyay et al., 2019). Hospital performances often feature patient readmission because it is a good indicator of quality health care (Goldfield, 2010). Annually, the cost of readmissions to the health care system is estimated to be 17.4 billion for Medicare (Kripalani et al., 2014). Unfortunately, approximately 18% of Medicare patients are expected to be readmitted within 30 days (Donze et al., 2016). Robinsons & Hudali (2017) denote that increased readmission have been diversely identified, such as age, race, having a personal health care provider, major surgery, medical comorbidities, length of hospital stay, previous admissions in the last year, failure to transfer information to the outpatient setting, early discharge, and the number of medications at discharge. Therefore, to improve hospital patient readmission, the Centers for Medicare & Medicaid Services started to publicly report readmission rates in 2009 (Bhalla & Kalhut, 2010). While there are unavoidable readmissions, such as chemotherapy, some readmissions are preventable, and thus the rate of readmission is a cause for concern as it indicates healthcare waste that can be avoided (Zhang et al., 2020). [ABSTRACT FROM AUTHOR]

Emergency Departments (ED) are known for their high-stress environment as patient care can be unpredictable. Because of this environment, burnout among nurses is exceptionally high in the emergency department. Burnout rates continue to rise, and this is problematic for the profession. However, there is now research demonstrating how to combat burnout effectively. Burnout symptoms are identified as emotional exhaustion or compassion fatigue, stress, depersonalization, and lack of job satisfaction. The common causes of nurse burnout in the ED include workplace environment, stress performance, and lack of leadership support. When an ED nurse is experiencing the symptoms of burnout, it will have the potential to harm both the patients and the organization. This paper will focus on recognizing the symptoms of nurse burnout, its cause, searching for solutions to address this issue, and proposing a new workplace preventive program that focusing on alleviating the stressors of nurse burnout in the ED. [ABSTRACT FROM AUTHOR]

Emergency Medical Service (EMS) agencies in the United States have an outdated billing model which treats them more like taxis with base rates and a per mileage fee than healthcare providers. EMS is also not reimbursed in any way for its cost of readiness, the expenses have having EMS units prepared and available for 911 calls 24 hours a day. EMS services do have some unique revenue opportunities, some of which are not well known or considered throughout the industry. Further, the EMS reimbursement system is in need of major reforms. Revenue sources such as community paramedic programs, point of care labs and ultrasound, and specialty care transport should be considered by every EMS agency to see if they fit within their system. As an industry, EMS must come together to advocate for reforms that are vital to recognizing EMS as a member of the healthcare system, not simply a transportation method for patients. [ABSTRACT FROM AUTHOR]

Physician utilization of various high-end radiology procedures have been shown to increase costs, reduce quality, and expose patients to unwarranted radiation. Despite spending greater than 17% of GDP on healthcare, less than 60% of recommended care (preventative, acute, and chronic) is provided. In our current environment of vertically integrated ACO (Accountable Care Organization) structures and value-based purchasing concerns, healthcare facilities must seek to increase the value received through value chain transparency and analysis. This objective has been studied and attempted, but remains elusive in healthcare, due to the complexity and uniqueness of the healthcare market where physician dual agency must be deftly addressed and managed. Creating a mechanism to identify, educate, and modify utilization of physician directed resources (specifically highend radiology exams) through implementation of EBP (Evidence Based Protocols), CDS (Clinical Decision Support), and peer review has been shown to positively align physician ordering behaviors, organizational goals, regulatory standards, and increase value for all stakeholders. In review of public performance metrics, it was found that our hospital example has multiple opportunities to reduce cost, increase patient satisfaction, and improve outcomes through implementation of utilization committee focused on increasing value in radiology resource use. [ABSTRACT FROM AUTHOR]