The document discusses Insource Healthcare Solutions, a company focused on improving healthcare delivery and operations. It provides strategic solutions to healthcare clients, working with physicians and other medical professionals. The company aims to enhance quality, processes, and clinical excellence for each client.

1. We are focused on the way healthcare is
delivered…one client at a time.
CONFIDENTIAL: Copyright © 2012 Insource Healthcare Solutions, LLC

2.  A strategic healthcare
operations management
company that executes
customized solutions;
 A physician and business
partnership with nationally
acclaimed & board certified
resources & affiliates;
 Focused on improving quality,
operational, process design
and clinical excellence;
Copyright © 2012 Insource Healthcare Solutions, LLC

3.  ER DESIGN, PROCESS
IMPROVEMENT,
MANAGEMENT & RAPID
EVALUATION UNITS
 URGENT &
CONVENIENCE CARE
CENTER; PSO / MSO
OFFICE MANAGEMENT
 STRATEGIC BUSINESS /
Copyright © 2012 Insource Healthcare Solutions, LLC NET WORK

4.  The first High Performing Emergency Room (HiPER) Solution was created
and implemented in 2009. Since implementation, the process has been
reducing hospitals millions in unnecessary expansions and on average
$1,000,000 each year in captured revenues from unnecessary diversion
hours, elimination of most LWOTS (Left Without Treatment), along with
increased patient & staff satisfaction and numerous other quality
improvement metrics.
 Guaranteed to create a Door-To-Provider time of 15 minutes, the HiPER
solution is key to hospitals driving cost efficiency and patient satisfaction;
and key to preparing for the “Patient Protection and Affordable Health Act”.
Copyright © 2012 Insource Healthcare Solutions, LLC

5. Copyright © 2012 Insource Healthcare Solutions, LLC

6. Copyright © 2012 Insource Healthcare Solutions, LLC

7. Dealing with Emergency Department Over-Crowding and
Implementing “Rapid Evaluation Units”
Copyright © 2009 & 2010 INSOURCE HEALTHCARE SOLUTIONS

8.  Multiple attempts to improve have failed
 Only transient results
 Pressure and Pain intensifies
 Externalize causes of failure
 Become reactionary/creativity wanes
 Collegiality/Collaboration/Trust erode
 Finger pointing
 Administration reviews options

9. • Traditional  New Process
• Patient enters ED
 Patient enters ED
• Signs in triage log
• Waits in queue for triage
 Mini-registration
• Triaged  Patient to bed
• Waits in queue for registration
• Registered
• Patient to WR while chart goes
to main ED
• Charge nurse assesses acuity
and need for bed
• When patient matches acuity of
bed, patient to bed

10. Triage
ED Filters Main ED
Waiting Room
21 Beds
Registration
 Patients shuffled between
 WR and triage
 Triage and registration
 Registration and WR
 Then wait for nurse in ED to call

11. Triage
Main ED
No ED Filters 13 Beds
No Waiting
Waiting Room No LWBS
REU
Decreased Time Provider
4 Beds
DC Area
Registration 4 Beds
12 Chairs
 No filters patients go directly to ED bed
 Immediate nur sing assessment
 Immediate physician assessment
 Bedside registration
 Decision made on need for “stretcher time”
 Patients that do not need stretcher to Discharge Area
 Patients requiring longer work-ups or acute care to main ED

12. D/C Area
REU 10-15 Chairs
4 Beds
 The powerhouse that drives ED performance
 80% of ED patients processed here
 All decisions on “stretcher time”
 Accountability for and management of processes
 Formalizes discharge function (PPS)
 Identifies bottlenecks and simplifies remedies

13.  Immediate success
 Since inception:
 No patients in ED waiting room
 “0” LWBS
 Decreased time to provider 2.5 hrs under 11 mins.
 Other benefits
 Patients held in ED minimized
 Eliminated hectic and chaotic feel of ED
 ED volume increased 5% so far ($700,000)

14.  On the first day of implementation, average discharge
time of REU patients (50% of total daily volume) was
approximately down to 45 minutes!
 Since inception:
 No patients in ED waiting room
 The target remains: <1%” LWBS (down from 2.7%)
 Decreased time to provider 1.25 hrs to under 20 mins.
 Other Targeted Benefits:
 PatientSatisfaction has improved from the 60th%tile to the
90TH%tile as estimated by Press Gainey

15.  Riddle Hospital (Main Line Health), PA
 Claremont & Anderson Hospitals, OH
Copyright © 2009 Insource Healthcare Solutions, LLC

18. Traditional ED Approach to ED Volume
Total Capacity = 32,000
(Annualized 86 pts/day)
Fast Track Acute Care 18 Beds
Only
Utilized ~ 3 Beds 15 Beds 34,500
50% of time 4,500/yr 30,000/yr Patient
Capacity
3000/
2000 2000 2000
2
3000/ 3000/
2000 2000 2000
2 2
2000 2000 2000
2000 2000 2000
2000 2000 2000

21. Almost
80%
Spread

22. Traditional Capacity Model to Accommodate Peak
Daily Peak Capacity = 54,000
(Annualized 148 pts/day)
Fast Track Acute Care 29 Beds
Only Utilized
~ 50% of time 8 Beds 21 Beds 54,000
12,000/yr 42,000/yr 61% Increase Bed
3000/ 3000/ Capacity
2000 2000 2000
2 2
3000/ 3000/
2000 2000 2000
2 2
3000/ 3000/
2000 2000 2000
2 2
3000/ 3000/
2000 2000 2000
2 2
2000 2000 2000
2000 2000 2000
2000 2000 2000

24. New REU Concept for High Performance ED Stretchers
Daily Peak Capacity = 54,000
(Annualized 148 pts/day)
REU Acute Care 21 Beds
24 X 7
Utilization of 6 Beds 15 Beds 54,000
Resources 24,000/yr 30,000/yr 16% Increase in
Bed Capacity
4,000 4,000 2000 2000 2000
4,000 4,000 2000 2000 2000
4,000 4,000 2000 2000 2000
2000 2000 2000
2000 2000 2000

27. Mark E. Celmer, FACHE
President
Melissa Marsocci
Vice President for Operations
Hallie Schneeweiss, RN
Practice Consultant
701 Seneca Street, Suite 210
Buffalo, New York 14210
716-551-0684
Copyright © 2012 Insource Healthcare Solutions, LLC