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Quality Forum 2013 Storyboard Winner - Aaron Miller

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How Kelowna General Hospital's bed reconfiguration project ensures the right patient is in the right bed

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Quality Forum 2013 Storyboard Winner - Aaron Miller

  1. 1. Kelowna General Hospital Bed Reconfiguration Project Ensuring the Right Patient is in the Right Bed Andrew Hughes - Health Service Director , Aaron Miller - Project Manager Tertiary Services, and Danielle Cameron – Nurse Manager ABSTRACT METHODS DISCUSSIONThe volume of healthcare services at Kelowna General Hospital (KGH) in Kelowna, British The project was divided into three stages: Data for Reconfiguration, Engagement and Design, The Bed Reconfiguration Project began as opportunity re-examine the bed allocation at KGH.Columbia, has rapidly expanded over the past several years. This is driven by population and Implementation Plan. The key feature of the project was the Engagement and Design stage. A similar initiative wasgrowth and shifting in demographics with approximately 18% of the population over the age conducted a few years earlier but did not succeed because staff and physicians were notof 65 years. These factors have impacted inpatient hospital bed utilization and patient flow. Stage 1: Data for Reconfiguration engaged in the process. By presenting the two options for reconfiguration prior to decision making allowed for engagement throughout the project including a forum to gather commentsKGH’s commitment to Patient and Family Centred Care is to improve the quality of the An analysis of baseline utilization, occupancy, and patient flow statistics of all of the major and feedback and eventually buy-in and support of the creation of the F-I-T Unit. Furthermore,patient’s hospital experience. This experience is impacted by the inpatient bed inpatient categories (medical, surgical, maternal/child, rehabilitation, psychiatry, and ALC) was basing decisions on data and Patient and Family Centred Care allowed for collaborativeconfiguration, service provision, and utilization. Through a hospital capital expansion, there conducted in order to examine utilization and bed days in comparison to bed allocation. In decision making by all stakeholders involved.was the opportunity to look at the bed allocation to address utilization and quality care to addition, working with the various medical, surgical, physician, union, and administrative leaders at the hospital, the inpatient bed priorities were developed for the patient populations served by Once the location of the F-I-T Unit was determined, the operational plan also included theensure that the Right Patient is in the Right Bed. screening criteria for patients to be admitted on the unit and how the care delivery model and KGH. Based on this analysis, there was a distinct need for an ALC type medical unit, and to convert an existing mixed medical/surgical unit into a surgical only unit. physical environment could support the patients in a Patient-Family Centred model. One of theThe goal of the Bed Reconfiguration Project was to better align patient populations within four-bed patient rooms was converted into a dining room lounge and the sun-room renovateddifferent inpatient units. Through a collaborative process involving detailed stakeholder into a rehabilitation/exercise space. These spaces support patient function and mobility byengagement with 14 separate departments and medical divisions, an appropriate bed Stage 2: Engagement and Design providing a destination that patients mobilize for meals or entertainment. This supportsallocation was determined including the need for an Alternative Level of Care (ALC) unit. maintenance and recovery of functional mobility. All patients admitted to the F-I-T Unit nowThis resulted in the medical/surgical inpatient beds reorganized and a medical ALC unit A Steering Committee was formed to use the historical bed utilization data (from Stage 1) and receive their meals in the dining room and the physiotherapists are active with rehabilitation tocreated. These changes created the environment and processes for the Right Patient in provide recommendations for the inpatient Bed Reconfiguration. Based on the data and Steering support a safe transition home.the Right Bed with the goal to improve access and flow and enhance the patient Committee direction, two different options for Bed Reconfiguration were created and presented toexperience. 14 different stakeholder groups across the hospital for feedback and endorsement. These stakeholder groups represented all of the nurses, physicians, and managers in the hospital. Stage 3: Implementation Plan BACKGROUND Using the endorsed option from Stage 2, an Implementation Plan was developed. This plan was completed in collaboration with a User Group of Nurse Managers, Human Resources, BusinessAt KGH, the allocation and locations of acute inpatient beds has been based on historical Consultants and Hospital Administration. The Implementation Plan outlined the key deliverablescare patterns with dedicated specialty beds for Psychiatry, Pediatrics, Obstetrics and and requirements for the successful reconfiguration of the inpatient beds.Rehabilitation and general inpatient beds for surgical and medical patients. As thepopulation has grown and is becoming increasing complex, the inpatient bed allocations Throughout each stage, the patient was the central focus with the overarching goal tohave not adapted to the changes. Complicating the inpatient care delivery is the increasein the number of Alternative Level of Care (ALC) patients in the hospital. These medical “Ensure that the Right Patient was in the Right Bed”patients, who no longer require acute care, are located across the hospital and contributeto approximately 16% of all total inpatient hospital days (54 inpatient days in 2010/11).This patient population negatively impacts opportunities for inpatient acute careadmissions. RESULTS Data for ReconfigurationIn May 2012, the Centennial Building, a new 360,000 ft2 addition to the KGH campusopened. As part of this new addition, two inpatient units - one medical and another surgical Given that the ALC population used approximately 54 beds per year at KGH in 2010/2011, it was F-I-T Dining Roomunit on the existing campus - had to relocated to accommodate the site’s new Cardiac determined that there was a significant need for a dedicated medical ALC inpatient unit. Based onSurgery Program. These inpatient unit relocations provided the opportunity to relook at the historical data, there was also an opportunity to change one of the mixed medical/surgical units tobed allocation and location of medical and surgical inpatient beds in the hospital to ensurethat the Right Patient was in the Right Bed. a surgical unit to improve bed utilization and aim to reduce the number of surgical cancellations due to lack of an inpatient bed. CONCLUSIONS Engagement and Design The Bed Reconfiguration Project began as an opportunity to impact bed utilization but through the engagement activities allowed for an integrated process to reconfigure the bed allocation at Two different options for bed reconfiguration were proposed. Both of these options included a KGH. With a goal to ensure that the Right Patient is in the Right Bed, the project developed medical ALC unit, but in different geographical locations at the site. These options were presented the F-I-T Unit and created dedicated medical and surgical inpatient units to optimize patient flow to 14 separate medical and nursing groups throughout the hospital over a period of one month in the hospital. and a preferred option – a 24-bed medical ALC Unit - was endorsed. The proposed location was in a recently vacated medical inpatient unit. As part of the Bed Reconfiguration project it was This project demonstrated that inclusive planning using a team approach with active stakeholder proposed that the unit be renovated to include a dining/lounge area and a rehabilitation/exercise engagement allowed for success within a Patient and Family Centred care model. Future work space to assist with the care of the patients. will investigate the impact of the F-I-T unit on site access and flow as well as the ALC patient experience. Implementation Plan Based on the preferred option, the User Group developed the Implementation Plan to operate the unit, including changes to staffing ratios and scheduling, operational budgets, renovations REFERENCES/ACKNOWLEDGEMENTS requirements, and equipment needs. The Implementation Plan also included the process to physically relocate all of the patients between the six different inpatient units that were involved in KGH Senior Leadership Team the relocation to open the 24-bed unit. KGH Medical Advisory Committee On September 5th 2012, the 24-bed F-I-T (Function-Independence-Transition) inpatient unit Project Working Group including: Loyd Busby, Lori Jakins, Sharon Wilkinson, Dan Goughnour, officially opened. This ALC inpatient medical unit delivers Patient and Family Centred Care that Wes Noppers, Dan Macafee, Jackie Vleeming, Danielle Cameron, Aaron Miller, and Andrew Kelowna General Hospital supports individuals to maximize their functional independence and overcome challenges in order to support transition to home from acute care. Hughes

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