Flowcharting

Paul KingV. U. School of Engineering

Paul KingV. U. School of Engineering

Overview

This Lecture will overview flowcharting of processes.

Elementary to detailed charting will be covered.

Why Flowchart???

Document the process. Allow study of roadblocks Allow display of timing & conditionals. Provide a communication tool.

Examples to follow:

Hinge Manufacture Hypertension Clinic #1 Hypertension Clinic #2 The ideal? ABET Diagram Breast Cancer Clinic.

8:50 PM

Friday, February 25, 1994

Page 1

C:\ABC\SAMPLES\PROCHART.AF3

Step 3B: Hinge Adaptation

Tacoma facility procedure

Reach for pin with left hand

Grasp pin at midpoint

Reach for spacer with right hand

Grasp spacer

Slide spacer onto pin until spacer is seated firmly

Hold subassembly

Carry to hinge assembly

Press footpedal of hinge opener

Wait for hinge to open

Slide pin into cavity of hinge assembly

Release footpedal

Operate Transport IdleStore

Hypertension Clinic - Flow Study #1 Patient enters, signs in, waits in waiting room until

called Patient goes to weigh-in room, weight & pulse rate

taken, medications reviewed (RN). Patient goes to new waiting room. Patient is sent to room, put on bed, lights out, 2

minute wait, BP taken (RN). Patient to waiting room Patient to clinic room ...

Hypertension Clinic - Flow Study #1, Continued Patient interviewed by MD or Resident/MD,

BP taken? Patient medications reviewed, lifestyle,

needs. Patient discharged & rescheduled and tests

ordered if necessary or admitted...

Sign-In weight & pulse & meds

wait in room

1

Wait room

2RN BP check

wait room

2

MD interaction

wait for MD

resched, etc

Simplistic Representation of Hypertension Clinic #1

1 2 3

4

Delay 1 2-10Delay 2 2-20Delay 3 5-20Delay 4 5-20

Overall waiting time: 14-70

Actual patient interaction 7

Flowchart: Hypertension Clinic # 1

Discussion

Using delay symbols for patient wait states stresses delays

Each delay is in fact a wait for event, simplified here.

Waiting times may be expressed as here, or as color bars for easy identification of outlier cases

Actual overall waiting times have ranged up to 100 minutes

Sign-In weight & pulse & meds

& BP

wait in room

1

wait room

2

MD interaction

resched, etc

Simplistic Representation of Hypertension Clinic #2

1 2 3

wait in room

Delay 1 2-10Delay 2 2-20Delay 3 5-20

Overall waiting time: 9-50

Actual patient interaction 7

Flowchart: Hypertension Clinic #2

Discussion

Using delay symbols for patient wait states stresses delays

Overall delay time has dropped. Delay 2 & 3 may be combined... Actual overall waiting times have decreased

Sign-Inweight &

pulse & meds & BP

MD interaction

resched, etc

Ideal Hypertension Clinic?

1

wait room

2

Data needed?

MD needed?

RN Needed?

Wait for RN

RN Interaction

Update Meds

2

Time in-out 7-20

Future Clinic Structure?

Discussion

While the chart is more complicated, the process is easier for most patients.

MD time is utilized for “needy” patients. RN time is used for less needy. Many patients will be status quo. This is approximately the dentist office

model..

The Two Loops of EC2000

Establish Indicatorsthat Objectives are

Being Achieved

Determine HowOutcomes will be

Assessed

Determine HowOutcomes will be

Achieved

Determine OutcomesRequired to Achieve

Objectives

Determine educational objectives

Evaluate/Assess

Input fromConstituencies

Formal InstructionStudent Activities

Discussion

Flowcharting in this fashion is far more powerful than the written text.

Flowcharts can be used to make a point of interactions between several factors.

Typical Undergraduate Flowcharting Project Breast center, 50 patients a day Categorize (normal v next step) Interview a subset Observe interactions and flow over three months Walk through the problem. Interview staff. Flowchart data, analyze data, recommend

changes.

PATIENT FLOW ANALYSIS OF VANDERBILTBREAST CENTER

Michelle E. Kandcer, B.S.Doris Quinn, PhD, Advisor

PROJECT DEFINITION

The goal of this project is to assess and to improve the patient flow process in Vanderbilt’s Breast Cancer Center. Patient responses will be of significant consideration.

OBJECTIVES

To create a flowchart in (Micrografx Flow-Charter 7.0) that will describe the current patient flow process.

To highlight weaknesses of the process.

To emphasize (on the flowchart) patients’ feelings regarding the process.

To make suggestions as to how to improve the current process.

SIGNIFICANCE

The American Cancer Society estimates that 178,700 women will be diagnosed with breast cancer this year alone and that 3,900 of these women will be from Tennessee. Furthermore, another 43,500 women will die because of this disease. *

Currently, more than 50 women per day utilize services provided by the Cancer Center.

WORK COMPLETEDFlow of Pre -Registration

Phone Call

PhysicianAppts

Dx Procedures

- Screening- Dx - Consult

Schedule ApptAuthorization

Needed?

Call Patient's PCP

Yes

No

WORK COMPLETEDFlow of Registration

Sign In &Sit Down

Patient Called Back

Infochanged

?

Co-Pay?

Collect money

Info Updated in Computer

No

Print Receipt

Call Patient's PCP

Patient Signs Form?

Postphone Visit Until

Form is Signed

5-6 Pgs Printed Separately in Impact Printer

Call Supervisor to See Patient

Is Release of Info Form Needed?

Yes

YesYes

No

YesYes

WORK COMPLETEDProcess Flow for those Needing Mammograms

Machine available for

mammogram?

WAIT

Patient to Dressing

Room

Images Taken

Patient Waits in Dressing Room

While Film Develops

Radiologist Reviews Views

and Patient Waits

Results Given To Patient By

Radiologist

Results OK?

Technologist Checks Films

Additional Views

Needed?

Yes

Results OK?No

Tech Picks Up Paperwork after Ring

and Determines Screening vs.

Diagnostic

Front Desk Alerts Techs that

Paperwork is in Box by Ringing Phone

Yes

No

DISCHARGE

No

Yes

No

yes

WORK COMPLETEDProcess Flow for those Needing Mammograms (continued)

DISCHARGE

To Ultrasound Suite

Radiologist Performs U/S When He is

Available

Patient Given Results

Ultrasound Needed?

Yes

Patient Need to Be Seen? No

Does Patient Have Appt?

Yes

Patient Put in Room

Patient Seen by MD

Yes

Appt Available?

Reschedule ASAP

Yes

NoNo

No

WORK COMPLETED Process Flow for those NotNeeding Mammograms

H & P DoneBSE taught

Review Imaging

Present info to attending

Attending sees patient

Chaperone/ Tech Needed

?

Exam, questions, etc.

(Initial) Clinician Available?

Yes

Yes

WAIT

Room Available?

Put Patient in Room

WAIT

Chaperone Available?

No

No Yes

WAIT

No

No

Yes

WORK COMPLETED Process Flow for those NotNeeding Mammograms (continued)

Tests, procedures

needed?

Schedule to do - test procedures

Results available

?

Call back - follow up appt

(Nurse may not be available during

day)

*

Surgeryneeded

?

H &P

Results given & follow up (if

needed)

Yes No

Yes

DISCHARGE

Yes

No

Schedule VPEC

Possible Add'l Views or U/S or Core Bx or

U/S Guided Aspiration as

Needed by Clinician

Back to Clinic Exam Room

No

Summary

Flowcharting works!. Flowcharting is a useful tool.