Time to Talk Throughput Webinar

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Time to Talk Throughput Webinar

  1. 1. Time to Improve Your ED Throughput - Part I5 Steps to Select the Right TechnologyMaureen Anderson, MD, Physician Executive 1
  2. 2. Today‟s Presenter Maureen Anderson, M.D. T-System Physician Executive Dr. Anderson is a practicing physician at William Beaumont Hospital in Troy, Michigan and a physician consultant for T- System. She provides input and strategy for new services and solutions designed to enhance the performance of emergency departments. She also works with clients to help them leverage our products to optimize clinical quality and efficiency.Smarter Emergency Care: everywhere, every
  3. 3. Low Throughput Has Negative Implications for EDs Patient Patient Revenue Safety Satisfaction Reduction • Longer waits increase • Time to provider most • Each LWS costs $300- morbidity important to patients $500 • EDs on diversion may • Each ambulance increase mortality for diverted costs >$3000k MI patients 75/100 dissatisfied Tell 465 potential patients patientsSmarter Emergency Care: everywhere, every
  4. 4. Current Trends Are Further Exacerbating The Issue • Healthcare Reform – More patients in the ED – MU is promoting EHR adoption which doesn‟t promise support of ED processes • ICD-10 – Requiring documentation of more specific information • ACO / Initiatives to keep patients in-network With the right strategy, EDs can provide evidence-based, efficient and compassionate careSmarter Emergency Care: everywhere, every
  5. 5. Significant Financial Incentives for Improving Throughput Metrics Results • 50,000 APV ED • Reduced LOS by 60 min • Avg LOS of 200 min – New LOS 140 min – 50,000 hours of increased ED • Physician group capacity – bill $100 per patient – 21,739 in potential new visits • Facility • Physician group increases revenue by – Bill $500 per ED visit – $2,173,900 – Bill $3,000 - $7,000 per inpatient admission • Facility increases revenue by – $8,696,000 for discharged patients – $13,041,000 for admitted patientsSmarter Emergency Care: everywhere, every
  6. 6. 5 Steps to Select the Right Technology1. Build your team2. Define your needs3. Look for key attributes4. Understand requirements5. Measure the ROI 6
  7. 7. 1. Build Your Team Who needs to be involved? Supportive and engaged Other key stakeholders leadership • CIO • HIM / coding – How will it fit enterprise system strategy – How will system support – Plan for support resources efficient coding and billing – How will it support key priorities • ED medical director such as MU, ICD-10, ACO – How will physician group • CFO productivity and – What financial savings and growth will result reimbursement be impacted – Adequate funding for training, • ED nurse director upgrades – Own and drive plan for ED • CNO / CMO workflow and management – How will it support quality initiatives and care coordination • Frontline providersSmarter Emergency Care: everywhere, every
  8. 8. Assess “Readiness” for a Change • As a facility/organization  Clear vision/direction/goals  Strong/committed/engaged leadership  Resources; financial/IT • As an ED  Leadership  Staff buy-in  Staffing levels  ED space/layoutSmarter Emergency Care: everywhere, every 8
  9. 9. Working Together Assess, re-assess, fine-tune and celebrate 1. Define desired outcomes and prioritize – Understand motivation and communicate benefits for each member 2. Define potential project barriers and plan to address – Technology proficiency and adoption – Conflicting projects – Travelling clinical staff / high turnover – Staffing levels 3. Define baselineSmarter Emergency Care: everywhere, every 9
  10. 10. 2. Define Your Needs Can Technology Help? • Dictation/Scribe cost • Illegible or incomplete records • Lost charts/lost revenue/undercoding • Prolonged los • Capacity; volume/space mismatch • IPD Bed Availability • Safety/cleanliness of the ED/Waiting Room • Inadequate staffing • Patient Satisfaction • Medication errors • Medicolegal risk/Quality issues • Meeting regulatory requirements • Communication across the continuum of care • Variability in clinical practice/documentationSmarter Emergency Care: everywhere, every 10
  11. 11. 3. Look for Key Attributes • Intuitive • Flexible • Robust, ED-appropriate content to minimize typing and clickingSmarter Emergency Care: everywhere, every
  12. 12. • Provides cues without causing alert fatigue • Supports communication between all team members • Features that support rather than impede workflowSmarter Emergency Care: everywhere, every 12
  13. 13. EDIS Functionality: ED Workflow Features Objectives • Registration • Maintain EMTALA compliance • Tracking • Allow for non-sequential, parallel processes • Task Management • Provide data and information to identify bottlenecks • CPOE & • Identify patients and procedures exceeding time thresholds e-prescribing • Provide visual queues for next steps in workflow • Discharge planning • Allow for seamless transition of care • Streamline and standardize order processSmarter Emergency Care: everywhere, every
  14. 14. EDIS Functionality: Clinical DocumentationFeatures• Triage, physician/nurse/ancillary• Clinical decision supportObjectives• Allow consistency and efficiency• Reduce or eliminate free text• Help providers make evidenced-based decisions faster and easily document their MDM and ED course• Present information sequentially and one a single planeSmarter Emergency Care: everywhere, every
  15. 15. EDIS Functionality: Data / Integration Features Objective • ADT / Lab / Radiology • Integrate with clinical and • Patient monitors business applications to reduce duplication of • Medications and allergies information in disparate systems • Reduce re-entry of information that already exists • Support current and future ED and hospital workflow and best practicesSmarter Emergency Care: everywhere, every
  16. 16. EDIS Functionality: Management & Reporting Features Objective • Patient load • Accurate, actionable reports to • Patient flow (Throughput) enhance • Staff productivity – Throughput – Patient safety and outcomes – Patient satisfaction – Staff efficiency – Staff satisfaction – Identify opportunities for improvementSmarter Emergency Care: everywhere, every
  17. 17. 4. Understand Requirements • Server needs or remote • In-house or HIS or other • On-site, remote, travel hosting • Trainer and end-user • Vendor staged or in-house training staging resources Hardware Training Interface work needs, staffing resources and and time line and time requirement expenditure requirements • Design time and resource • Site specific fields, reports availability Customization Content build time and requirements requirementsSmarter Emergency Care: everywhere, every 17
  18. 18. Potential Pitfalls in Selecting an EDIS Partner • “Product flexibility”-Total cost of ownership • “Staged deployments” • Vaporware • Make sure to actually try out the product to assess usability in your clinical environment. • Consult KLAS and other referencesSmarter Emergency Care: everywhere, every 18
  19. 19. 5. Measure the ROI Setting Baseline Performance Capturing Facility Metrics Patient Population Charting HIM • ED annual patient volume • Annual lost charts not billed Facility CPT Utilization Code • Revenue per discharged / admitted • Annual cost to find lost patient 99281 8% charts 99282 22% • LOS for discharged / admitted patients • Annual cost of paper / (min) dictation 99283 25% • % patients discharged / admitted • Annual cost of discharge 99284 17% instructions Radiology/Lab 99285 23% • Clerical FTEs required to 99291/99292 5% manage paper charts • Infusions down-coded to IV pushes per month • % of charts incomplete Payor Mix • Coder time to rework • Infusions not billed per month incomplete charts (minutes • Medicare (% of APV) • Denied radiology claims per week per chart) • Medicaid • # of patients with denied lab claims per • Nursing time for follow-up • Insurance week calls (minutes per call) • Workers • % of patients that require Compensation/Other • % of patients that require „Imaging Only‟, „Labs Only‟, „Imaging and Labs‟ nursing follow-up calls • Self Pay*Smarter Emergency Care: everywhere, every 19
  20. 20. Setting Baseline Performance Capturing Physician Metrics Physician Group Billing Metrics Operational • Cost of dictation Professional Fee Utilization Billing Level • Cost of paper documentation Level 1 0% • Annual cost to find lost charts so Level 2 1% they can be billed Level 3 29% • Clerical FTEs required to manage Level 4 31% paper charts Level 5 36% Critical Care 3%Smarter Emergency Care: everywhere, every 20
  21. 21. Calculate Expected ROIOne Hospital’s Results with T SystemEVAnticipated ROI (All Benefits) Payback period: 4.3 months 8X ROI Investment: $189K Year 1 Good breadth and distribution 3 Year ROI: 744%Top Benefits (Annual Value): Reduces TAT on radiology and lab results Benefits by Value Driver (facility benefit) = $651K 31% Improves infusion charge capture (facility 59% benefit) = $529K Improves support for facility charge levels (facility benefit) = $496K 5% 5% Optimize Revenue Capture Reduce Cost of Care Increase Operational Efficiencies Improve Quality of Care/ Patient Safety 21
  22. 22. Key Takeaways Addressing throughput issues requires a multipronged strategy Technology is not enough without the right team planning and processes that make the most of new automation capabilities Not all technology is equal – must support the unique workflow of the ED and gain adoptionSmarter Emergency Care: everywhere, every 22
  23. 23. Q&AJoin us for Time to Improve Your ED Throughput Part II:6 Effective Strategies Across the Patient ExperienceThursday, Oct. 11, 20129 a.m. PT, 10 a.m. MT, 11 a.m. CT, 12 p.m. ETClick here to register now
  24. 24. Time to Improve Your ED Throughput - Part II6 effective strategies across the patient experienceCheryl Ann Graf, ARNP, MSN, MBA – Client Relationship ExecutiveMaureen Anderson, MD – Physician Executive 24
  25. 25. Today’s Presenters Maureen Anderson, M.D. T-System Physician Executive Dr. Anderson is a practicing physician at William Beaumont Hospital in Troy, Michigan and a physician consultant for T-System. She provides input and strategy for new services and solutions designed to enhance the performance of emergency departments. She also works with clients to help them leverage our products to optimize clinical quality and efficiency. Cheryl Ann Graf, ARNP, MSN, MBA Client Relationship Executive Cheryl is a nurse practitioner that currently works in 4 client sites, and is a Client Relationship Executive for the T-System. She has worked at the T-System for 5 years and has 25 years of ED practice in WA.Smarter Emergency Care: everywhere, every
  26. 26. Low Throughput Has Negative Implications for EDs Patient Patient Revenue Safety Satisfaction Reduction • Longer waits increase • Time to provider most • Each LWS costs $300- morbidity important to patients $500 • EDs on diversion may • Each ambulance increase mortality for diverted costs >$3000k MI patients 75/100 dissatisfied Tell 465 potential patients patientsSmarter Emergency Care: everywhere, every
  27. 27. Current Trends Are Further Exacerbating The Issue • Healthcare Reform – More patients in the ED – MU is promoting EHR adoption which doesn‟t promise support of ED processes • ICD-10 – Requiring documentation of more information – (stat on negative impacts to productivity = throughput) • ACO / Initiatives to keep patients in-network With the right strategy, EDs can provide evidence-based, efficient and compassionate careSmarter Emergency Care: everywhere, every
  28. 28. Significant Financial Incentives for Improving Throughput Metrics Results • 50,000 APV ED • Reduced LOS by 60 min • Avg LOS of 200 min – New LOS 140 min – 50,000 hours of increased ED • Physician group capacity – bill $100 per patient – 21,739 in potential new visits • Facility • Physician group increases revenue by – Bill $500 per ED visit – $2,173,900 – Bill $3,000 - $7,000 per inpatient admission • Facility increases revenue by – $8,696,000 for discharged patients – $13,041,000 for admitted patientsSmarter Emergency Care: everywhere, every
  29. 29. Opportunities for Performance Improvementat Each Stage Registration MD Discharge / Call & Triage for Bed Pre ED Placement Patient Handoff Disposition EMS or Door to Doctor to Decision to or Walk-in Doctor Decision Dispo Discharge Room Utilization 29
  30. 30. Smarter Emergency Care: everywhere, every 30
  31. 31. #1 – Pre ED: Redirect Patients To Most Appropriate Settings • EMS pre-triage and transport to appropriate healthcare provider • Mobile units provide regional care • Provider at triage performs MSE and directs patient accordinglySmarter Emergency Care: everywhere, every
  32. 32. Using Technology to Direct Patients andProvide Pre-notification of Their Arrival
  33. 33. 33
  34. 34. #2 – Registration & Triage: Creating a No Wait ED • Patient pre-notification • Quick registration • Rapid triage • Provider at triage • Patients pulled to open beds • Vertical patients remain vertical • Order sets/protocolsSmarter Emergency Care: everywhere, every
  35. 35. Fast Track System at Grady Health System, Atlanta, Ga How they did it Outcomes • Patients with acute but non- • 2 hour reduction in Fast Track life-threatening conditions to throughput be treated more quickly and • 1/3 increased productivity then released • 50% decrease in avg time from • Sort patients by status and arrival to bed placement indicate services required • 19% decrease in avg time from • Mid-level or nurse more active bed placement to initial exam to make sure patients receive needed tests.Source: http://www.rwjf.org/qualityequality/product.jsp?id=29978Smarter Emergency Care: everywhere, every 35
  36. 36. #3 Door to Doctor: Rapid Medical Evaluation The What The Vision • Treatment process • Metrics can improve and you begins immediately can make the difference – Initial assessment – Ordering of labs, DI • Sites have reduced TTP from • Some cases have 10-80 minutes rapid discharge • Increased patient/family without using a bed satisfaction scores • Patients placed immediately in a bed • Increased revenues both and provider examination hospital and provider completed • Every dept must own the • ED culture change processSmarter Emergency Care: everywhere, every
  37. 37. RME: Case Studies This 99-bed, acute care facility decreased its TTP After reengineering its front-end process, this to 8 minutes and increased its Press Ganey ED experienced a 75% decrease in TTP from 100 Patient Satisfaction Percentile Ranking from the to 25 minutes. 25th to the 85th percentile. By creating an RME team consisting of a Through a number of modifications, including physician provider, triage nurse and an ED the addition of wireless bedside registration, Technician, this ED team found its TTP this ED reduced its TTP from 100 to less than 40 decreased more than 70%, its LWBS percentage minutes. reduced by 55%, and its diversion hours per month diminished by 75%.Smarter Emergency Care: everywhere, every
  38. 38. #4 – Doctor to Decision:Bedside Documentation/CPOE 38
  39. 39. #5 – Patient Hand-off: Active Management of Processes Reduce readmissions and improve efficiency at hand-off • Physician outreach process – Optimize for admitted and discharged patients • Case management process – identify and flag patients at highest risk of re-admission Transferred Admitted Medical Home Registration Triage Treatment Discharged (in-patient) Hand-off ED DischargeSmarter Emergency Care: everywhere, every 39
  40. 40. Workflow Automation Technology to ImproveHand-off and Reduce Avoidable Readmissions 40
  41. 41. #6 - Realigning Staffing to Peak Times 41
  42. 42. Throughput Technology to Calculate EDStatistics and Trends 42
  43. 43. 43
  44. 44. Key Takeaways Throughput can be addressed at every stage Addressing throughput issues requires a multipronged strategy Specialized technology can help identify bottlenecks and streamline processesSmarter Emergency Care: everywhere, every 44

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