Patient Flow - Adopting a Comprehensicve Performance Improvement Strategy

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  • 1. Patient Flow – Adopting a Comprehensive Performance Improvement Strategy Janet Davis, PT, MPH, FACHE
  • 2.  
  • 3. Recognized for Quality Care
    • Accreditations and Honors
    • Joint Commission
    • Nurse Magnet designation by American Nursing Credentialing Center since 2002
    • American College of Surgeons Commission on Cancer – Comprehensive Community Cancer Program
    • Top 10 “Best Places to Work” – by New Orleans CityBusiness
    • Affiliated with University of Texas M.D. Anderson Cancer Manager Program and Physician Network
  • 4. PATIENT FLOW FOCUS
    • Feb. 9-11: IHI Real Time Demand Capacity (RTDC) Workshop
    • March 11: Meeting with Sr. Execs regarding RTDC opportunity
  • 5.
    • April 16: Conference Call with San Antonio Medical Center
    • April 23: Decision to allocate .5 FTE to patient flow strategy implementation
    • April 28: Initiation of Morning Bed Huddles
    • May 4-5: Site visit to San Antonio Medical Center
  • 6. PATIENT FLOW ACTIVITIES
    • Daily bed huddles and executive summary
    • Weekly action plan meetings to address strategies in place at San Antonio Medical Center
    • TeleTracking ROI and Project Support
    • Assessment of best utilization of Observation Unit and status
  • 7.
    • “Wasted Capacity Rounds”
    • Implementation of on-call nurses under leadership of administrative reps (June 1)
    • Re-opening of SNF beds on 9 (June 3)
    • Census Management Plan/ED Surge
    • Metrics and data analysis
  • 8. Demonstrated Improvements
    • Reduction in PACU delays
    • Reduction in ED LWBS
    • Targeted efforts by Physician Advisors on movement of patients whose beds are needed on a given day
    • Improved coordination among Acute and Post Acute patient flow processes
  • 9.
    • Improved communication and collaboration among unit leaders, Care Managers, and ancillary departments regarding targeted bed needs
    • Patients on appropriate units & levels of care
    • More conversations about time of day patients will leave the building
  • 10. Strategies
    • Avoid inpatients on OBS – make room for admitted ED patients (based on criteria) awaiting beds on other units and rapid turnaround of OBS patients
    • Telemetry observation on Observation Unit – freeing up telemetry beds for inpatients
    • Pre and post procedure patients to Same Day Surgery
    • No PACU delays due to beds unavailable
  • 11.
    • Decrease ED delays for bed placement and LWBS
    • Increase unit leaders’ ownership of patient flow on their units, in partnership with Care Management
    • Increase communication with ancillaries re flow
    • Increase predictability of patient discharge days and times to optimize RTDC management of flow
  • 12. STRATEGIES
    • Flow Efficiency – Early Discharge
    • Flow efficiency metrics at the microprocess level
    • Reliable process for early prediction of day and time of discharge
    • Discharge appointments
    • Defined, reliable processes for communication of discharge data and time to all stakeholders
    • MD engagement in planning early for discharge and completing required documentation including provisional discharge orders
    • Optimize use of TeleTracking in supporting these flow strategies
    • Engage ancillaries in ensuring all tests/procedures required for patient discharge (including observation patients) are expedited
  • 13.
    • Care Management Strategies/ Program
    • Reduce % of hospital days related to long-stay patients
    • Increase % of observation patients discharged in 24 hours
    • Evaluate physician advisor role and staffing model, competencies
    • Evaluate care management/social services model (service line, hours of coverage, ED, skill mix, competencies )
    • Care Management medical director
    • Post Acute & Rehabilitation
    • Assess financial impact of Medicare Post Acute Care Transfer policy on EJGH strategies
    • Efficient post-acute consult process
    • Create “pull” by therapies, post acute units – patient finding
    • Early mobilization of patients
    • Physician and Administrative
    • Intensivists
    • Concurrent coding
    • Address end of life issues – paid palliative care
    • Hospitalists with defined expectations and accountability
  • 14.  
  • 15. Key Internal Drivers Average Length of Stay Oct 08 – Oct 10 Acute Care Admissions Excluded: SNF, PSY, GBH, RHB and Newborns
  • 16.  
  • 17.  
  • 18.  
  • 19. What about Lean?