2010 Award Winner

Redesign of Multi-Site Hospital Total Parenteral Nutrition (TPN) Processes

Category - Improving Efficiency

The Problem

Total Parenteral Nutrition (TPN) is the intravenous feeding of patients. Hamilton Health Sciences provides TPN to many of its neonatal, pediatric, and adult patients. In 2008-09, HHS produced 17,566 Total Parenteral Nutrition (TPN) solutions at two of its sites. Each of the two sites followed unique processes using different equipment leased from different vendors, resulting in potential care imbalances, inefficiencies and increased costs.

The Innovation

In 2009, the TPN vendor leases for both hardware and software expired. This created an opportunity for HHS to achieve one-time and ongoing cost savings by implementing a centralized and standardized process for the ordering, manufacturing, and delivery of TPN through a single HHS site. The potential benefits included knowledge translation across HHS of identified best practices, establishment and achievement benchmarks for quality, improved patient safety, better resource utilization and potential future revenue-generation opportunities. Quality improvement tools and methods were applied to guide the redesign of processes across sites and study the impact of changes upon identified outcome indicators. By July 2010, the new system was up and running.

The Results

The purchase of one TPN Compounder instead of two resulted in immediate one-time savings of $130,000. Centralizing production of TPN from two sites to one generated annualized operational cost savings of well over $200,000 per year. In addition, the new TPN technology included "guardrail" measurement and other quality assurance and patient safety checks. The new equipment safely increased HHS TPN production capacity by 50% within best practice production- to-delivery timelines. Finally, the new TPN Compounder included 5 additional "ports", which means that the number of TPN mixtures that require manual additives has been reduced from ten to five – thus also reducing the opportunities for errors.

Next Steps

Given increasing biotechnology costs and mounting pressures on healthcare providers to maximize value for money, HHS Pharmaceutical Services will build on the success of the TPN initiative and continue to look for opportunities to leverage the benefits of new technology and further process improvements.