Patient Flow - Adopting a Comprehensicve Performance Improvement Strategy


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Patient Flow - Adopting a Comprehensicve Performance Improvement Strategy

  1. 1. Patient Flow – Adopting a Comprehensive Performance Improvement Strategy Janet Davis, PT, MPH, FACHE
  2. 3. Recognized for Quality Care <ul><li>Accreditations and Honors </li></ul><ul><li>Joint Commission </li></ul><ul><li>Nurse Magnet designation by American Nursing Credentialing Center since 2002 </li></ul><ul><li>American College of Surgeons Commission on Cancer – Comprehensive Community Cancer Program </li></ul><ul><li>Top 10 “Best Places to Work” – by New Orleans CityBusiness </li></ul><ul><li>Affiliated with University of Texas M.D. Anderson Cancer Manager Program and Physician Network </li></ul>
  3. 4. PATIENT FLOW FOCUS <ul><li>Feb. 9-11: IHI Real Time Demand Capacity (RTDC) Workshop </li></ul><ul><li>March 11: Meeting with Sr. Execs regarding RTDC opportunity </li></ul>
  4. 5. <ul><li>April 16: Conference Call with San Antonio Medical Center </li></ul><ul><li>April 23: Decision to allocate .5 FTE to patient flow strategy implementation </li></ul><ul><li>April 28: Initiation of Morning Bed Huddles </li></ul><ul><li>May 4-5: Site visit to San Antonio Medical Center </li></ul>
  5. 6. PATIENT FLOW ACTIVITIES <ul><li>Daily bed huddles and executive summary </li></ul><ul><li>Weekly action plan meetings to address strategies in place at San Antonio Medical Center </li></ul><ul><li>TeleTracking ROI and Project Support </li></ul><ul><li>Assessment of best utilization of Observation Unit and status </li></ul>
  6. 7. <ul><li>“Wasted Capacity Rounds” </li></ul><ul><li>Implementation of on-call nurses under leadership of administrative reps (June 1) </li></ul><ul><li>Re-opening of SNF beds on 9 (June 3) </li></ul><ul><li>Census Management Plan/ED Surge </li></ul><ul><li>Metrics and data analysis </li></ul>
  7. 8. Demonstrated Improvements <ul><li>Reduction in PACU delays </li></ul><ul><li>Reduction in ED LWBS </li></ul><ul><li>Targeted efforts by Physician Advisors on movement of patients whose beds are needed on a given day </li></ul><ul><li>Improved coordination among Acute and Post Acute patient flow processes </li></ul>
  8. 9. <ul><li>Improved communication and collaboration among unit leaders, Care Managers, and ancillary departments regarding targeted bed needs </li></ul><ul><li>Patients on appropriate units & levels of care </li></ul><ul><li>More conversations about time of day patients will leave the building </li></ul>
  9. 10. Strategies <ul><li>Avoid inpatients on OBS – make room for admitted ED patients (based on criteria) awaiting beds on other units and rapid turnaround of OBS patients </li></ul><ul><li>Telemetry observation on Observation Unit – freeing up telemetry beds for inpatients </li></ul><ul><li>Pre and post procedure patients to Same Day Surgery </li></ul><ul><li>No PACU delays due to beds unavailable </li></ul>
  10. 11. <ul><li>Decrease ED delays for bed placement and LWBS </li></ul><ul><li>Increase unit leaders’ ownership of patient flow on their units, in partnership with Care Management </li></ul><ul><li>Increase communication with ancillaries re flow </li></ul><ul><li>Increase predictability of patient discharge days and times to optimize RTDC management of flow </li></ul>
  11. 12. STRATEGIES <ul><li>Flow Efficiency – Early Discharge </li></ul><ul><li>Flow efficiency metrics at the microprocess level </li></ul><ul><li>Reliable process for early prediction of day and time of discharge </li></ul><ul><li>Discharge appointments </li></ul><ul><li>Defined, reliable processes for communication of discharge data and time to all stakeholders </li></ul><ul><li>MD engagement in planning early for discharge and completing required documentation including provisional discharge orders </li></ul><ul><li>Optimize use of TeleTracking in supporting these flow strategies </li></ul><ul><li>Engage ancillaries in ensuring all tests/procedures required for patient discharge (including observation patients) are expedited </li></ul>
  12. 13. <ul><li>Care Management Strategies/ Program </li></ul><ul><li>Reduce % of hospital days related to long-stay patients </li></ul><ul><li>Increase % of observation patients discharged in 24 hours </li></ul><ul><li>Evaluate physician advisor role and staffing model, competencies </li></ul><ul><li>Evaluate care management/social services model (service line, hours of coverage, ED, skill mix, competencies ) </li></ul><ul><li>Care Management medical director </li></ul><ul><li>Post Acute & Rehabilitation </li></ul><ul><li>Assess financial impact of Medicare Post Acute Care Transfer policy on EJGH strategies </li></ul><ul><li>Efficient post-acute consult process </li></ul><ul><li>Create “pull” by therapies, post acute units – patient finding </li></ul><ul><li>Early mobilization of patients </li></ul><ul><li>Physician and Administrative </li></ul><ul><li>Intensivists </li></ul><ul><li>Concurrent coding </li></ul><ul><li>Address end of life issues – paid palliative care </li></ul><ul><li>Hospitalists with defined expectations and accountability </li></ul>
  13. 15. Key Internal Drivers Average Length of Stay Oct 08 – Oct 10 Acute Care Admissions Excluded: SNF, PSY, GBH, RHB and Newborns
  14. 19. What about Lean?