Transcript Flowcharting - Vanderbilt University

Flowcharting
Paul King
V. 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.

C:\ABC\SAMPLES\PROCHART.AF3
Friday, February 25, 1994
8:50 PM
Step 3B: Hinge Adaptation
Tacoma facility procedure
Operate
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
Page 1
Transport
Store
Idle
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...

Flowchart: Hypertension Clinic # 1
Simplistic Representation of Hypertension Clinic #1
1
Sign-In
wait in
room
1
3
2
Wait
room
2
weight &
pulse & meds
wait
for MD
RN BP check
MD
interaction
wait
room
2
resched,
etc
4
Delay 1 2-10
Delay 2 2-20
Delay 3 5-20
Delay 4 5-20
Overall
waiting
time: 14-70
Actual
patient
interaction 7
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

Flowchart: Hypertension Clinic #2
Simplistic Representation of Hypertension Clinic #2
1
Sign-In
wait in
room
1
Delay 1 2-10
Delay 2 2-20
Delay 3 5-20
2
weight &
pulse & meds
& BP
wait
room
2
Overall
waiting
time: 9-50
3
wait in
room
MD
interaction
Actual patient
interaction 7
resched,
etc
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

Future Clinic Structure?
Ideal Hypertension Clinic?
1
Sign-In
Data
needed?
weight &
pulse & meds
& BP
MD
needed?
wait
room
2
MD
interaction
2
RN
Needed?
Wait
for RN
Update Meds
Time in-out 7-20
RN
Interaction
resched,
etc
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
Determine
educational
objectives
Input from
Constituencies
Determine Outcomes
Required to Achieve
Objectives
Evaluate/Assess
Determine How
Outcomes will be
Achieved
Formal Instruction
Student Activities
Determine How
Outcomes will be
Assessed
Establish Indicators
that Objectives are
Being Achieved
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 VANDERBILT
BREAST 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 COMPLETED
Flow of Pre -Registration
Physician
Appts
- Screening
- Dx
- Consult
Phone Call
No
Schedule Appt
Authorization
Needed?
Dx Procedures
Yes
Call Patient's
PCP
WORK COMPLETED
Flow of Registration
Postphone
Visit Until
Form is Signed
Call
Supervisor to
See Patient
No
Sign In &
Sit Down
Is Release of
Info Form
Needed?
Yes
Call Patient's
PCP
Yes
Patient Called
Back
Patient Signs
Form?
5-6 Pgs Printed
Separately in
Impact Printer
Yes
Info
changed
?
No
Yes
Co-Pay
?
Yes
Info Updated
in Computer
Collect money
Print Receipt
WORK COMPLETED
Process Flow for those Needing
Mammograms
Front Desk Alerts
Techs that
Paperwork is in Box
by Ringing Phone
Patient to
Dressing
Room
Images Taken
Patient Waits in
Dressing Room
While Film
Develops
Radiologist
Reviews Views
and Patient
Waits
Yes
Tech Picks Up
Paperwork after Ring
and Determines
Screening vs.
Diagnostic
Technologist
Checks Films
Machine
available for
mammogram?
No
Results Given
To Patient By
Radiologist
Yes
Results OK?
WAIT
No
Additional
Views
Needed?
Results OK?
No
Yes
yes
DISCHARGE
No
WORK COMPLETED
Process Flow for those Needing
Mammograms (continued)
Appt
Available?
No
Does Patient
Have Appt?
No
Reschedule
ASAP
Yes
Yes
Yes
To Ultrasound
Suite
Radiologist
Performs U/S
When He is
Available
Patient Put in
Room
Patient Seen
by MD
Yes
Ultrasound
Needed?
No
Patient Given
Results
Patient Need
to Be Seen?
No
DISCHARGE
WORK COMPLETED
Process Flow for those Not
Needing Mammograms
Put Patient in
Room
(Initial)
Clinician
Available?
Yes
Present info to
attending
H & P Done
BSE taught
Yes
Attending sees
patient
No
Room
Available?
WAIT
Review
Imaging
Chaperone/
Tech Needed
?
No
WAIT
No
Yes
WAIT
No
Chaperone
Available?
Yes
Exam,
questions, etc.
WORK COMPLETED
Process Flow for those Not
Needing Mammograms (continued)
No
Tests,
procedures
needed
?
Yes
Schedule to do test procedures
Call back follow up appt
(Nurse may not be
available during
day)
DISCHARGE
*
No
Results
available
?
Yes
Surgery
needed
?
No
Results given
& follow up (if
needed)
Yes
Possible Add'l Views
or U/S or Core Bx or
U/S Guided
Aspiration as
Needed by Clinician
Back to Clinic
Exam Room
H &P
Schedule
VPEC
Summary
Flowcharting works!.
 Flowcharting is a useful tool.
