BOX & Whiskers Vetted For Opportunities. Determine Length & Frequency Of Drill-Down & Target

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Kelley Williams
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1 Essentials PLUS

Quarterly SCOAP Report Received Tabular Data Reviewed For Opportunities BOX & Whiskers Vetted For Opportunities Bottom 25 th % ile NO Monitor Only YES Using the ARMUS Tables Function Create Targeted

5 Quarterly SCOAP Report Received Tabular Data Reviewed For Opportunities BOX & Whiskers Vetted For Opportunities Bottom 25 th % ile NO Monitor Only YES Using the ARMUS Tables Function Create Targeted Report Of Chosen Measures ENTER ARMUS Determine Length & Frequency Of Drill-Down & Target List Indicators Needing Drill-Down Pull MRN s From The Report That Fall Out Re-abstract Using These MRN s To Identify 1. Why Failed? 2. Who Failed? Scan or Print The MR Documentation That Caused The Measure Fall-Out Scan or Print The MR Documentation That Caused The Measure Fall-Out Add Enhanced Metafiles Of Measure Failure Documents To PP Slides Aggregate These Measure Failures For Quarterly Powerpoint Provide Targeted Practitioner With Hard Copies Of Documents Provide Physician Or Non-Physician Champions With Hard Copies Of Documents Make Hard Copy Packet, Including SCOAP Quarterly Report Present Quarterly To Appropriate Med Staff Committee

6 In doubt Pareto Shewhart Deming Ishikawa Chebyshev

7 Deming stated that there are seven essential tools for Quality Improvement activities. These are:

12 Opportunity Identifier/ Benchmark Compare Elective Rectal Q Q Q Procedures SCOAP Site #22 SCOAP Site #22 Total Procedures Benchmark N % N % code N % N % code 1.1 Median Age (years) Male % 08% 24 58% % 10 50% 1.3 Median BMI AvgComorbidity Index Operation Type Benchmark N % N % code N % N % code 2.3 LAR % % % % 2.4 APR % % % % 2.5 Total Colectomy % % % % 2.6 Colostomy Takedown % % % % 2.7 Proctectomy % % % % Indication/Diagnosis Benchmark N % N % code N % N % code 3.1 Diverticulitis % % % % 3.2 Cancer % % % % 3.3 Perforation % % % % 3.4 Polyps % % % % 3.5 Obstruction/mass % % % % 3.6 Prolapse % % % % 3.7 Ulcerative Colitis % % % % Normothermia Benchmark N % N % code N % N % code 4.1 Peri-op Temp >= 36 C % % % % X Euglycemia Benchmark N % N % code N % N % code Perioperative Blood 5.2 Glucose - Diabetics % 3 0% % % X Insulin Peri-op with 5.4 High BG >=200 mg % 0 N/A % 0 N/A Glucose Control w/i hr Diab BG <200 mg % 0 N/A % 0 N/A

13 Opportunity Identifier/ Benchmark Compare Procedures SCOAP Site # SCOAP Site # Total Procedures Benchmark N % N % code N % N % code Median Age (years) Male % 20 45% Median BMI AvgComorbidity Index Operation Type Benchmark N % N % code N % N % code Right Hemicolectomy % % % Left Hemicolectomy % % % LAR % % % Total Colectomy % % % Colostomy Takedown % % % Indication/Diagnosis Benchmark N % N % code N % N % code Diverticulitis % 2% % % Cancer % % % Perforation % % % Polyps % % % Obstruction/mass % % % Prolapse % % % Ulcerative Colitis % % % Normothermia Benchmark N % N % code N % N % code Periop Temp >= 36 C % (A) % % Euglycemia Benchmark N % N % code N % N % code Perioperative Blood Glucose - Diabetics % 8 50 (R) % 2 0% X Insulin Peri-op with High BG >=200 mg % 1 0 (R) % 0 N/A Glucose Control w/i 48hr Diab BG <200 mg % (G) % 2 50% X

14 COLORECTAL PROCEDURES MARCH 2011 Descriptive Info Glucose Control Transfusion Free Beta Blockers NG/G-Tube DC Date MRN Doc APR L R LAR Abd Colon Glucose Insulin Lowest B B B B BB G-Tube NG Tube Stoma Total DM BS Trxn EBL Hemi Hemi Proct Cancer Cotrolled Periop Hg W/I 24 Intraop Compliance PACU PACU 3/1/2011 #### 1404 No No No Yes No No No No Yes FALSE No No NA cc No No FALSE No No 3/9/2011 #### 1453 No No No No No No No No No FALSE No No NA cc No No FALSE No No 3/9/2011 #### 1552 No No No Yes No No No Yes Yes 207 TRUE Yes Yes >250cc No No FALSE No No 3/9/2011 #### 1010 No No Yes No No No No Yes No 83 FALSE No No NA cc No No FALSE No No 3/13/2011 #### 1404 No No No Yes Yes No No Yes No FALSE No No NA cc No No FALSE No No 3/14/2011 #### 1404 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 3/16/2011 #### 1248 No No Yes No No No No No No FALSE No No NA cc No No FALSE No No 3/21/2011 #### 1023 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 3/23/2011 #### 1404 No No Yes No No No No No No 106 FALSE No Yes cc No No FALSE No No 3/26/2011 #### 1552 No No Yes No No No No Yes No FALSE No No NA cc No No FALSE No No # Cases APR L R LAR Abd EBL Colon Glucose Mean Txn B B BB G-Tube NG Tube Stoma Total DM BS Insul? Trxn Cases Hemi Hemi Proct Cancer Cotrolled Hg W/I 24 Compliance PACU PACU > 250 ml Rates 0% 0% 40% 50% 10% 0% 0% 40% 20% 10% 100% 100% 80% 1 10% 0% 100% 0% 0% 9 1 COLORECTAL PROCEDURES February 2011 Descriptive Info Glucose Control Transfusion Free Beta Blockers NG/G-Tube DC Date MRN Doc APR L R LAR Abd Colon Glucose Insulin Lowest B B B B BB G-Tube NG Tube Stoma Total DM BS Trxn EBL Hemi Hemi Proct Cancer Cotrolled Periop Hg W/I 24 Intraop Compliance PACU PACU 2/4/2011 #### 1453 No Yes Yes No No No No No Yes 283 TRUE Yes No NA cc No No FALSE No No 2/6/2011 #### 1023 No No No No Yes No No Yes No 87 FALSE No No NA cc No No FALSE No No 2/9/2011 #### 1052 No No No Yes No No No No No FALSE No No NA >250cc No Yes FALSE No No 2/10/2011 #### 1023 No No No No Yes No No No No FALSE No Yes cc No No FALSE No No 2/11/2011 #### 1023 No No Yes No No No No Yes No 84 FALSE No No NA cc No No FALSE No No 2/15/2011 #### 1404 No No No No Yes No No No No 85 FALSE No No NA cc Yes No FALSE No No 2/15/2011 #### 1010 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 2/16/2011 #### 1453 No No No No Yes No No Yes Yes FALSE No No NA cc No No FALSE No Yes 2/16/2011 #### 1404 No No No No Yes No No Yes Yes 175 FALSE No No NA cc No No FALSE No Yes 2/16/2011 #### 1023 No No Yes No No No No No No 125 FALSE No No NA cc No No FALSE No No 2/18/2011 #### 1023 No No No No Yes No No No No 138 FALSE No No NA cc No No FALSE No No # Cases APR L Hemi R Hemi LAR Abd Proct Stoma Total Colon Cancer DM BS Glucose Cotrolled Insul? Trxn Mean Txn Hg EBL Cases > 250 ml. B B W/I 24 BB Compliance Rates 0% 9% 27% 18% 55% 0% 0% 36% 27% 9% 100% 100% 91% 1 9% 9% 0% 0% 18% 10 1 COLORECTAL PROCEDURES JANUARY 2011 Descriptive Info Glucose Control Transfusion Free Beta Blockers NG/G-Tube DC Date MRN Doc APR L R BB BB G-Tube LAR Abd Colon Glucose Insulin Lowest B B BB GTube NG Tube Stoma Total DM BS Trxn EBL Hemi Hemi Proct Cancer Cotrolled Periop Hg W/I 24 Intraop Compliance PACU PACU 1/10/2011 #### 1023 No No No No Yes No No Yes No FALSE No No NA <50 cc No No FALSE No No 1/11/2011 #### 1453 No No Yes No No No No No No FALSE No No 9.6 >250cc No No FALSE No No 1/11/2011 #### 1404 No No No No Yes No No Yes Yes 171 FALSE Yes No NA cc No No FALSE No No 1/13/2011 #### 1453 Yes No No No No No No No No FALSE No No NA cc No No FALSE No No 1/15/2011 #### 1552 No No No No Yes No No No No FALSE No No NA cc No No FALSE No No 1/16/2011 #### 1552 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 1/16/2011 #### 1404 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 1/16/2011 #### 1404 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 1/16/2011 #### 1049 No No No Yes No No No No No 126 FALSE No No NA cc No Yes FALSE No No 1/17/2011 #### 1404 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 1/20/2011 #### 1049 No No No Yes No No No Yes No 127 FALSE No No NA cc Yes No FALSE No Yes 1/27/2011 #### 1453 No No No No No No No No No FALSE No No NA cc Yes No FALSE No No 1/27/2011 #### 1453 No No No Yes No Yes No No Yes 113 FALSE No No NA cc No No FALSE No No 1/27/2011 #### 1404 No No No No Yes No No No No FALSE No No NA cc No No FALSE No No 1/30/2011 #### 1404 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 1/30/2011 #### 1404 No No No No Yes No No Yes No FALSE No No NA cc No No FALSE No No G-Tube PACU NG Tube PACU

15 Quality Improvement Council April 17, 2011 Diabetic Cases 50% 25% 31% 27% 20% 21% 20% 14% 7% 10% 13% 0% 0% Apr 10 May 10 Jun 10 Jul 10 Aug 10 Sep 10 Oct 10 Nov 10 Dec 10 Jan 11 Feb 11 Mar 11 Rate 20% 0% 31% 21% 14% 7% 0% 10% 0% 13% 27% 20% Volume Opportunity Identifier/ Process Performance 50% DM and Non-DM Cases W Periop BS >200 25% 10% 8% 10% 9% 10% 0% Apr 10 May 10 Jun 10 Jul 10 Aug 10 Sep 10 Oct 10 Nov 10 Dec 10 Jan 11 Feb 11 Mar 11 Rate 10% 0% 8% 0% 0% 0% 0% 0% 10% 0% 9% 10% Volume % Cases W BS >200 And/Or DM Getting Periop Insulin 50% 100% 100% 100% 100% 100% 100% 50% 0% Apr 10 May 10 Jun 10 Jul 10 Aug 10 Sep 10 Oct 10 Nov 10 Dec 10 Jan 11 Feb 11 Mar 11 Rate 100% 0% 0% 100% 0% 0% 0% 100% 50% 100% 100% 100% Volume

17 Opportunity Identifier/ Hospital Compare Box and &Whisker Hi Level Draft 110% 90% 2nd %ile 2nd %ile 2nd %ile 2nd %ile 2nd %ile 2nd %ile 3rd %ile 3rd %ile 3rd %ile 3rd %ile 3rd %ile 3rd %ile liance % Compl 70% 2nd %ile 2nd %ile 2nd %ile 2nd %ile 3rd %ile 3rd %ile 3rd %ile 3rd %ile 50% 30% Diabetic BS > 200 Periop Anticoag 1Anticoag 2Anticoag 3 Anticoag 4 BB 1 BB 2 Anast Test Control Insulin

18 COLORECTAL PROCEDURES MARCH 2011 Descriptive Info Glucose Control Transfusion Free Beta Blockers NG/G-Tube DC Date MRN Doc APR L R LAR Abd Colon Glucose Insulin Lowest B B B B BB G-Tube NG Tube Stoma Total DM BS Trxn EBL Hemi Hemi Proct Cancer Cotrolled Periop Hg W/I 24 Intraop Compliance PACU PACU 3/1/2011 #### 1404 No No No Yes No No No No Yes FALSE No No NA cc No No FALSE No No 3/9/2011 #### 1453 No No No No No No No No No FALSE No No NA cc No No FALSE No No 3/9/2011 #### 1552 No No No Yes No No No Yes Yes 207 TRUE Yes Yes >250cc No No FALSE No No 3/9/2011 #### 1010 No No Yes No No No No Yes No 83 FALSE No No NA cc No No FALSE No No 3/13/2011 #### 1404 No No No Yes Yes No No Yes No FALSE No No NA cc No No FALSE No No 3/14/2011 #### 1404 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 3/16/2011 #### 1248 No No Yes No No No No No No FALSE No No NA cc No No FALSE No No 3/21/2011 #### 1023 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 3/23/2011 #### 1404 No No Yes No No No No No No 106 FALSE No Yes cc No No FALSE No No 3/26/2011 #### 1552 No No Yes No No No No Yes No FALSE No No NA cc No No FALSE No No # Cases APR L R LAR Abd EBL Colon Glucose Mean Txn B B BB G-Tube NG Tube Stoma Total DM BS Insul? Trxn Cases Hemi Hemi Proct Cancer Cotrolled Hg W/I 24 Compliance PACU PACU > 250 ml Rates 0% 0% 40% 50% 10% 0% 0% 40% 20% 10% 100% 100% 80% 1 10% 0% 100% 0% 0% 9 1 COLORECTAL PROCEDURES February 2011 Descriptive Info Glucose Control Transfusion Free Beta Blockers NG/G-Tube DC Date MRN Doc APR L R LAR Abd Colon Glucose Insulin Lowest B B B B BB G-Tube NG Tube Stoma Total DM BS Trxn EBL Hemi Hemi Proct Cancer Cotrolled Periop Hg W/I 24 Intraop Compliance PACU PACU 2/4/2011 #### 1453 No Yes Yes No No No No No Yes 283 TRUE Yes No NA cc No No FALSE No No 2/6/2011 #### 1023 No No No No Yes No No Yes No 87 FALSE No No NA cc No No FALSE No No 2/9/2011 #### 1052 No No No Yes No No No No No FALSE No No NA >250cc No Yes FALSE No No 2/10/2011 #### 1023 No No No No Yes No No No No FALSE No Yes cc No No FALSE No No 2/11/2011 #### 1023 No No Yes No No No No Yes No 84 FALSE No No NA cc No No FALSE No No 2/15/2011 #### 1404 No No No No Yes No No No No 85 FALSE No No NA cc Yes No FALSE No No 2/15/2011 #### 1010 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 2/16/2011 #### 1453 No No No No Yes No No Yes Yes FALSE No No NA cc No No FALSE No Yes 2/16/2011 #### 1404 No No No No Yes No No Yes Yes 175 FALSE No No NA cc No No FALSE No Yes 2/16/2011 #### 1023 No No Yes No No No No No No 125 FALSE No No NA cc No No FALSE No No 2/18/2011 #### 1023 No No No No Yes No No No No 138 FALSE No No NA cc No No FALSE No No # Cases APR L Hemi R Hemi LAR Abd Proct Stoma Total Colon Cancer DM BS Glucose Cotrolled Insul? Trxn Mean Txn Hg EBL Cases > 250 ml. B B W/I 24 BB Compliance Rates 0% 9% 27% 18% 55% 0% 0% 36% 27% 9% 100% 100% 91% 1 9% 9% 0% 0% 18% 10 1 COLORECTAL PROCEDURES JANUARY 2011 Descriptive Info Glucose Control Transfusion Free Beta Blockers NG/G-Tube DC Date MRN Doc APR L R BB BB G-Tube LAR Abd Colon Glucose Insulin Lowest B B BB GTube NG Tube Stoma Total DM BS Trxn EBL Hemi Hemi Proct Cancer Cotrolled Periop Hg W/I 24 Intraop Compliance PACU PACU 1/10/2011 #### 1023 No No No No Yes No No Yes No FALSE No No NA <50 cc No No FALSE No No 1/11/2011 #### 1453 No No Yes No No No No No No FALSE No No 9.6 >250cc No No FALSE No No 1/11/2011 #### 1404 No No No No Yes No No Yes Yes 171 FALSE Yes No NA cc No No FALSE No No 1/13/2011 #### 1453 Yes No No No No No No No No FALSE No No NA cc No No FALSE No No 1/15/2011 #### 1552 No No No No Yes No No No No FALSE No No NA cc No No FALSE No No 1/16/2011 #### 1552 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 1/16/2011 #### 1404 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 1/16/2011 #### 1404 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 1/16/2011 #### 1049 No No No Yes No No No No No 126 FALSE No No NA cc No Yes FALSE No No 1/17/2011 #### 1404 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 1/20/2011 #### 1049 No No No Yes No No No Yes No 127 FALSE No No NA cc Yes No FALSE No Yes 1/27/2011 #### 1453 No No No No No No No No No FALSE No No NA cc Yes No FALSE No No 1/27/2011 #### 1453 No No No Yes No Yes No No Yes 113 FALSE No No NA cc No No FALSE No No 1/27/2011 #### 1404 No No No No Yes No No No No FALSE No No NA cc No No FALSE No No 1/30/2011 #### 1404 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 1/30/2011 #### 1404 No No No No Yes No No Yes No FALSE No No NA cc No No FALSE No No G-Tube PACU NG Tube PACU

20 very powerful tools which display data in an order which it occurs plot data over time or sequence display the performance of a process as it works give visual clues when items in the process are OUT OF WHACK Makes data easy to see display patterns for analysis show you things not ordinarily seen

21 # L A R C O M P L I C A T I O N S Plot the data values in the sequence which they occur Draw lines to connect the points on the graph Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

22 C l l t A Li Of Calculate A Line Of Central Tendency If Appropriate

23 Central Tendency Tools The Mean is simply the arithmetic ti average of your values The Median is a number in a series where half the numbers in that series are greater than or equal to it, and half the numbers in that series are less than or equal to it The Mode is the value of X which occurs most frequently in a data set. The Midrange is the number exactly between the highest and lowest values in a data set. A Standard Deviation is the positive square root of the variance in a data set.

24 ER Arrival To Admit In Minutes Minutes Patient

25 The RULES are the reason why analysts use The RULES are the reason why analysts use Run/Control charts so extensively and why they are considered so valuable.

26 Rule #1 SHIFTS When 7 or more consecutive data points appear above or below the Line Of Central Tendency, this is called a shift, and should be scrutinized as important Variation!

27 Rule #2 TRENDS When 7 or more consecutive data points progress in ascending or descending fashion, each point higher than the previous point in ascending fashion, or each point lower than the previous point in descending fashion, this is a trend, and should be scrutinized as important Variation!

28 Rule #3 PATTERNS When 7 or more sets or subsets of data points repeat themselves, alternating above and below the Line of Central Tendency, this is called a pattern, and should be scrutinized as important Variation

29 CONTROL CHARTS 30 Rule #4 - OUTSIDE LIMITS When a single point falls outside upper or lower control limit on a control limited chart (based on Standard Deviations), look for important Causation surrounding that point UCL LCT 5 LCL SDV

30 CONTROL CHARTS Rule #5 - ONE SIGMA If at least 4 out of 5 consecutive points fall on the same side of the line of central tendency AND are more than one standard deviation from the line of central tendency, important Variation is indicated STDV LCT 8 6-1STDV

31 Control Charts have a general form UCL Variable LCT LCL

32 There are a lot of different types of Control Charts. Each one is designed to give you a different perspective on the data you are looking at.

33 p Chart

34 X-R Chart (X bar R)

35 Other Control Chart Types ~ X-R Called a Median Range Chart Uses the median instead of the subgroup mean for the LCT. Includes a Range Graph over time along with the Variables graph. X-S X bar S Control Chart - Uses standard deviation instead of range display in X bar R Chart

37 COLORECTAL PROCEDURES MARCH 2011 Descriptive Info Glucose Control Transfusion Free Beta Blockers NG/G-Tube DC Date MRN Doc APR L R LAR Abd Colon Glucose Insulin Lowest B B B B BB G-Tube NG Tube Stoma Total DM BS Trxn EBL Hemi Hemi Proct Cancer Cotrolled Periop Hg W/I 24 Intraop Compliance PACU PACU 3/1/2011 #### 1404 No No No Yes No No No No Yes FALSE No No NA cc No No FALSE No No 3/9/2011 #### 1453 No No No No No No No No No FALSE No No NA cc No No FALSE No No 3/9/2011 #### 1552 No No No Yes No No No Yes Yes 207 TRUE Yes Yes >250cc No No FALSE No No 3/9/2011 #### 1010 No No Yes No No No No Yes No 83 FALSE No No NA cc No No FALSE No No 3/13/2011 #### 1404 No No No Yes Yes No No Yes No FALSE No No NA cc No No FALSE No No 3/14/2011 #### 1404 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 3/16/2011 #### 1248 No No Yes No No No No No No FALSE No No NA cc No No FALSE No No 3/21/2011 #### 1023 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 3/23/2011 #### 1404 No No Yes No No No No No No 106 FALSE No Yes cc No No FALSE No No 3/26/2011 #### 1552 No No Yes No No No No Yes No FALSE No No NA cc No No FALSE No No # Cases APR L R LAR Abd EBL Colon Glucose Mean Txn B B BB G-Tube NG Tube Stoma Total DM BS Insul? Trxn Cases Hemi Hemi Proct Cancer Cotrolled Hg W/I 24 Compliance PACU PACU > 250 ml Rates 0% 0% 40% 50% 10% 0% 0% 40% 20% 10% 100% 100% 80% 1 10% 0% 100% 0% 0% 9 1 COLORECTAL PROCEDURES February 2011 Descriptive Info Glucose Control Transfusion Free Beta Blockers NG/G-Tube DC Date MRN Doc APR L R LAR Abd Colon Glucose Insulin Lowest B B B B BB G-Tube NG Tube Stoma Total DM BS Trxn EBL Hemi Hemi Proct Cancer Cotrolled Periop Hg W/I 24 Intraop Compliance PACU PACU 2/4/2011 #### 1453 No Yes Yes No No No No No Yes 283 TRUE Yes No NA cc No No FALSE No No 2/6/2011 #### 1023 No No No No Yes No No Yes No 87 FALSE No No NA cc No No FALSE No No 2/9/2011 #### 1052 No No No Yes No No No No No FALSE No No NA >250cc No Yes FALSE No No 2/10/2011 #### 1023 No No No No Yes No No No No FALSE No Yes cc No No FALSE No No 2/11/2011 #### 1023 No No Yes No No No No Yes No 84 FALSE No No NA cc No No FALSE No No 2/15/2011 #### 1404 No No No No Yes No No No No 85 FALSE No No NA cc Yes No FALSE No No 2/15/2011 #### 1010 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 2/16/2011 #### 1453 No No No No Yes No No Yes Yes FALSE No No NA cc No No FALSE No Yes 2/16/2011 #### 1404 No No No No Yes No No Yes Yes 175 FALSE No No NA cc No No FALSE No Yes 2/16/2011 #### 1023 No No Yes No No No No No No 125 FALSE No No NA cc No No FALSE No No 2/18/2011 #### 1023 No No No No Yes No No No No 138 FALSE No No NA cc No No FALSE No No # Cases APR L Hemi R Hemi LAR Abd Proct Stoma Total Colon Cancer DM BS Glucose Cotrolled Insul? Trxn Mean Txn Hg EBL Cases > 250 ml. B B W/I 24 BB Compliance Rates 0% 9% 27% 18% 55% 0% 0% 36% 27% 9% 100% 100% 91% 1 9% 9% 0% 0% 18% 10 1 COLORECTAL PROCEDURES JANUARY 2011 Descriptive Info Glucose Control Transfusion Free Beta Blockers NG/G-Tube DC Date MRN Doc APR L R BB BB G-Tube LAR Abd Colon Glucose Insulin Lowest B B BB GTube NG Tube Stoma Total DM BS Trxn EBL Hemi Hemi Proct Cancer Cotrolled Periop Hg W/I 24 Intraop Compliance PACU PACU 1/10/2011 #### 1023 No No No No Yes No No Yes No FALSE No No NA <50 cc No No FALSE No No 1/11/2011 #### 1453 No No Yes No No No No No No FALSE No No 9.6 >250cc No No FALSE No No 1/11/2011 #### 1404 No No No No Yes No No Yes Yes 171 FALSE Yes No NA cc No No FALSE No No 1/13/2011 #### 1453 Yes No No No No No No No No FALSE No No NA cc No No FALSE No No 1/15/2011 #### 1552 No No No No Yes No No No No FALSE No No NA cc No No FALSE No No 1/16/2011 #### 1552 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 1/16/2011 #### 1404 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 1/16/2011 #### 1404 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 1/16/2011 #### 1049 No No No Yes No No No No No 126 FALSE No No NA cc No Yes FALSE No No 1/17/2011 #### 1404 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 1/20/2011 #### 1049 No No No Yes No No No Yes No 127 FALSE No No NA cc Yes No FALSE No Yes 1/27/2011 #### 1453 No No No No No No No No No FALSE No No NA cc Yes No FALSE No No 1/27/2011 #### 1453 No No No Yes No Yes No No Yes 113 FALSE No No NA cc No No FALSE No No 1/27/2011 #### 1404 No No No No Yes No No No No FALSE No No NA cc No No FALSE No No 1/30/2011 #### 1404 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 1/30/2011 #### 1404 No No No No Yes No No Yes No FALSE No No NA cc No No FALSE No No G-Tube PACU NG Tube PACU

38 Quality Improvement Council April 17, 2011 Diabetic Cases 50% 25% 31% 27% 20% 21% 20% 14% 7% 10% 13% 0% 0% Apr 10 May 10 Jun 10 Jul 10 Aug 10 Sep 10 Oct 10 Nov 10 Dec 10 Jan 11 Feb 11 Mar 11 Rate 20% 0% 31% 21% 14% 7% 0% 10% 0% 13% 27% 20% Volume Opportunity Identifier/ Process Performance 50% DM and Non-DM Cases W Periop BS >200 25% 10% 8% 10% 9% 10% 0% Apr 10 May 10 Jun 10 Jul 10 Aug 10 Sep 10 Oct 10 Nov 10 Dec 10 Jan 11 Feb 11 Mar 11 Rate 10% 0% 8% 0% 0% 0% 0% 0% 10% 0% 9% 10% Volume % Cases W BS >200 And/Or DM Getting Periop Insulin 50% 100% 100% 100% 100% 100% 100% 50% 0% Apr 10 May 10 Jun 10 Jul 10 Aug 10 Sep 10 Oct 10 Nov 10 Dec 10 Jan 11 Feb 11 Mar 11 Rate 100% 0% 0% 100% 0% 0% 0% 100% 50% 100% 100% 100% Volume

39 Opportunity Identifier/ Process Performance 100% 75% 50% 25% 0% 0% 0 Apr 10 Pts. On Beta Blockers W/I 24 hrs Pre-op 1 46% 23% 29% 29% 30% 20% 20% 29% 13% 9% May 10 Jun 10 Jul 10 Aug 10 Sep 10 Oct 10 Nov 10 Dec 10 Jan 11 Feb 11 Mar 11 Rate 0% 23% 46% 29% 29% 20% 30% 20% 29% 13% 9% 0% Volume % 100% 75% 50% 25% 0% Perioperative Beta Blocker Compliance 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Apr 10 May 10 0% 0% Jun 10 Jul 10 Aug 10 Sep 10 Oct 10 Nov 10 Dec 10 Jan 11 Feb 11 Mar 11 Rate 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 0% 100% Volume

41 Detail/Individual Performance Paretos are getting a lot of attention lately! So what is a pareto?

42 A Pareto Chart is simply a Combination Bar/Line Graph, which h utilizes two Y axes. Related Measurements are then ranked in decreasing order of occurrence. This decreasing order of occurrence is reflected on a second Y axis as a percentage of the overall total ::::::::::::::from:::::::::::::::: Say 0% what!!!??? to 100% of the total

43 Maybe You ve Seen One! % % 80% 70% 60% 32 50% % 30% 20% 10% 0 After Midnight After Dinner Before Bkfst Between B&L Between LD 0%

44 The basic configuration of a Pareto tells you!!!!! Where to place your emphasis Where you will get the most bang for your buck

45 This special tool is attributed to -Vilfredo Pareto- Was an Italian economist studying Eastern European Poverty in the early 1900 s.

46 Vilfredo s Startling (???) The quality tools attributed to Observations Vilfredo, i.e. the Pareto Effect, Regarding the Pareto Principle and Pareto The Distribution Diagrams, Of Wealth In all stemmed from... Early 20th Century Europe!!!

47 His thesis Pareto s Principle, then, is a simple The restatement overall wealth of in his Europe discovery. at the That time... is concentrated t in the hands In the Universe there of only is a an few, unequal while poverty distribution pervasive of things. over the masses.

48 Joseph M. Juran (A Quality Analyst of the 1940 s) (Not to be confused with Duran Duran) Was a contemporary of Deming As a Quality Analyst he Was working on Quality Loss Distributions o Realized that there might be a connection to Pareto s work o Saw the light & Resurrected Pareto s Work on Poverty

49 In the blinding light of epiphany he connected Pareto s Principle to Process Improvement

50 The 80/20 rule was born! BINGO GO!

51 80% of the money in Europe is controlled by 20% of the population (Pareto s Thesis) Then, it could make sense that... 80% of identified problems relate to only 20% of problem sources!

52 His Principle demonstrates the fact that 80% of problems usually stem from only 20% of the causes!

53 Physician Name # Complications % of Total Complications Pareto Percent Dr. Spandex 50 Dr Strangelove 40 Dr. Seuss 53 Dr. Quinn 9 Dr. Spock 18 Dr. Golitely 7 Dr. Pepper 1

54 Physician Name # Crystal Complications % of Total Crystal Complications Pareto Percent Dr. Seuss 53 Dr Spandex 50 Dr. Strangelove 40 Dr. Spock 18 Dr. Quinn 9 Dr. Golitely 7 Dr. Pepper 1 178

55 Physician Name # Complications % of Total Complications Pareto Percent Dr. Seuss 53 Dr Spandex 50 Dr. Strangelove 40 Dr. Spock 18 Dr. Quinn 9 Dr. Golitely 7 Dr. Pepper 1

56 Physician Name # Crystal Complications % of Total Crystal Complications Pareto Percent Dr. Seuss 53 Dr Spandex 50 30% 28% Dr. Strangelove 40 22% Dr. Spock 18 Dr. Quinn 9 Dr. Golitely 7 10% 5% 4% Dr. Pepper 1 1%

57 Physician Name # Crystal Complications Dr. Seuss 53 Dr Spandex 50 % of Total Crystal Complications 30% 28% Pareto Percent 30% 30% 58% + 28% = Dr. Strangelove 40 22% 58% 80% + 22% = Dr. Spock 18 Dr. Quinn 9 Dr. Golitely 7 10% 5% 4% 80% 90% + 10% = 90% 95% + 5% = 99% 95% + 4% = Dr. Pepper 1 1% 99% 100% + 1% = Now get the Pareto %

58 Table s Done! Now Do The Chart.

59 Draw and label the x and 2 y axes Plot your value data points % % 80 50% 40 25% 0 Dr.1 Dr.2 Dr.3 Dr.4 Dr.5 Dr.6 Dr.7 0%

60 Convert them to columns % % 80 50% 40 25% 0 Dr.1 Dr.2 Dr.3 Dr.4 Dr.5 Dr.6 Dr.7 0%

61 Plot your Pareto % data as dots against your Second Y axis Don t forget % % 80 50% 40 25% 0 Dr.1 Dr.2 Dr.3 Dr.4 Dr.5 Dr.6 Dr.7 0%

62 Connect the dots! % % 80 50% 40 25% 0 Dr.1 Dr.2 Dr.3 Dr.4 Dr.5 Dr.6 Dr.7 0%

63 Apply the 80/20 Rule Vital Few 100% 75% 80 Trivial Many 50% 40 25% 0 Dr.1 Dr.2 Dr.3 Dr.4 Dr.5 Dr.6 Dr.7 0%

64 By using Paretos you can By using Paretos you can Zero appropriately In on those choose Surgeons which who target individual surgeons do not procedures order Beta need Blockers who have the most complications. secondary when appropriate. reviews.

66 COLORECTAL PROCEDURES MARCH 2011 Descriptive Info Glucose Control Transfusion Free Beta Blockers NG/G-Tube DC Date MRN Doc APR L R LAR Abd Colon Glucose Insulin Lowest B B B B BB G-Tube NG Tube Stoma Total DM BS Trxn EBL Hemi Hemi Proct Cancer Cotrolled Periop Hg W/I 24 Intraop Compliance PACU PACU 3/1/2011 #### 1404 No No No Yes No No No No Yes FALSE No No NA cc No No FALSE No No 3/9/2011 #### 1453 No No No No No No No No No FALSE No No NA cc No No FALSE No No 3/9/2011 #### 1552 No No No Yes No No No Yes Yes 207 TRUE Yes Yes >250cc No No FALSE No No 3/9/2011 #### 1010 No No Yes No No No No Yes No 83 FALSE No No NA cc No No FALSE No No 3/13/2011 #### 1404 No No No Yes Yes No No Yes No FALSE No No NA cc No No FALSE No No 3/14/2011 #### 1404 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 3/16/2011 #### 1248 No No Yes No No No No No No FALSE No No NA cc No No FALSE No No 3/21/2011 #### 1023 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 3/23/2011 #### 1404 No No Yes No No No No No No 106 FALSE No Yes cc No No FALSE No No 3/26/2011 #### 1552 No No Yes No No No No Yes No FALSE No No NA cc No No FALSE No No # Cases APR L R LAR Abd EBL Colon Glucose Mean Txn B B BB G-Tube NG Tube Stoma Total DM BS Insul? Trxn Cases Hemi Hemi Proct Cancer Cotrolled Hg W/I 24 Compliance PACU PACU > 250 ml Rates 0% 0% 40% 50% 10% 0% 0% 40% 20% 10% 100% 100% 80% 1 10% 0% 100% 0% 0% 9 1 COLORECTAL PROCEDURES February 2011 Descriptive Info Glucose Control Transfusion Free Beta Blockers NG/G-Tube DC Date MRN Doc APR L R LAR Abd Colon Glucose Insulin Lowest B B B B BB G-Tube NG Tube Stoma Total DM BS Trxn EBL Hemi Hemi Proct Cancer Cotrolled Periop Hg W/I 24 Intraop Compliance PACU PACU 2/4/2011 #### 1453 No Yes Yes No No No No No Yes 283 TRUE Yes No NA cc No No FALSE No No 2/6/2011 #### 1023 No No No No Yes No No Yes No 87 FALSE No No NA cc No No FALSE No No 2/9/2011 #### 1052 No No No Yes No No No No No FALSE No No NA >250cc No Yes FALSE No No 2/10/2011 #### 1023 No No No No Yes No No No No FALSE No Yes cc No No FALSE No No 2/11/2011 #### 1023 No No Yes No No No No Yes No 84 FALSE No No NA cc No No FALSE No No 2/15/2011 #### 1404 No No No No Yes No No No No 85 FALSE No No NA cc Yes No FALSE No No 2/15/2011 #### 1010 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 2/16/2011 #### 1453 No No No No Yes No No Yes Yes FALSE No No NA cc No No FALSE No Yes 2/16/2011 #### 1404 No No No No Yes No No Yes Yes 175 FALSE No No NA cc No No FALSE No Yes 2/16/2011 #### 1023 No No Yes No No No No No No 125 FALSE No No NA cc No No FALSE No No 2/18/2011 #### 1023 No No No No Yes No No No No 138 FALSE No No NA cc No No FALSE No No # Cases APR L Hemi R Hemi LAR Abd Proct Stoma Total Colon Cancer DM BS Glucose Cotrolled Insul? Trxn Mean Txn Hg EBL Cases > 250 ml. B B W/I 24 BB Compliance Rates 0% 9% 27% 18% 55% 0% 0% 36% 27% 9% 100% 100% 91% 1 9% 9% 0% 0% 18% 10 1 COLORECTAL PROCEDURES JANUARY 2011 Descriptive Info Glucose Control Transfusion Free Beta Blockers NG/G-Tube DC Date MRN Doc APR L R BB BB G-Tube LAR Abd Colon Glucose Insulin Lowest B B BB GTube NG Tube Stoma Total DM BS Trxn EBL Hemi Hemi Proct Cancer Cotrolled Periop Hg W/I 24 Intraop Compliance PACU PACU 1/10/2011 #### 1023 No No No No Yes No No Yes No FALSE No No NA <50 cc No No FALSE No No 1/11/2011 #### 1453 No No Yes No No No No No No FALSE No No 9.6 >250cc No No FALSE No No 1/11/2011 #### 1404 No No No No Yes No No Yes Yes 171 FALSE Yes No NA cc No No FALSE No No 1/13/2011 #### 1453 Yes No No No No No No No No FALSE No No NA cc No No FALSE No No 1/15/2011 #### 1552 No No No No Yes No No No No FALSE No No NA cc No No FALSE No No 1/16/2011 #### 1552 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 1/16/2011 #### 1404 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 1/16/2011 #### 1404 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 1/16/2011 #### 1049 No No No Yes No No No No No 126 FALSE No No NA cc No Yes FALSE No No 1/17/2011 #### 1404 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 1/20/2011 #### 1049 No No No Yes No No No Yes No 127 FALSE No No NA cc Yes No FALSE No Yes 1/27/2011 #### 1453 No No No No No No No No No FALSE No No NA cc Yes No FALSE No No 1/27/2011 #### 1453 No No No Yes No Yes No No Yes 113 FALSE No No NA cc No No FALSE No No 1/27/2011 #### 1404 No No No No Yes No No No No FALSE No No NA cc No No FALSE No No 1/30/2011 #### 1404 No No No Yes No No No No No FALSE No No NA cc No No FALSE No No 1/30/2011 #### 1404 No No No No Yes No No Yes No FALSE No No NA cc No No FALSE No No G-Tube PACU NG Tube PACU

67 Beta Blocker Non-Compliance By Surgeon 6 120% N u m b e r % 63% 74% 84% 89% 95% 100% 100% 80% 60% 2 26% 40% 1 20% % Surgeon

3. EXCEL FORMULAS & TABLES

Fall 2017 CS130 - Excel Formulas & Tables 1 3. EXCEL FORMULAS & TABLES Fall 2017 Fall 2017 CS130 - Excel Formulas & Tables 2 Cell References Absolute reference - refer to cells by their fixed position.