The art of ed patient flow
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This is the "how to" manual for effective emergency department patient flow design
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The art of ed patient flow
- 1. The Art of ED Flow ©2014 Sean Carney, LLC. Sunday, February 23, 14
- 2. ED Flow Hubs Intake Throughput Outflow Surge Capacity Flow Catalysts Infrastructure Patient Satisfaction © 2014 Sean Carney, LLC Sunday, February 23, 14
- 3. ED Patient Intake Sunday, February 23, 14
- 4. ED Patient Intake Ambulatory • EMS Disrupt Triage • Kiosks/Greeters • • Protocols • • Consider mapping EMS triage through main triage. • • • Call ahead programs Eliminate or Flow Gate Rapid Entry Only Keep vertical/vertical Consider segmenting the unscheduled lower acuity • Protocols during delays • Implement Kiosks/Greeters • Consider Call ahead programs or mobile © 2014 Sean Carney, LLC Sunday, February 23, 14
- 5. ED Throughput Sunday, February 23, 14
- 6. ED Partner Relations • ED Sub-system management • Push/Pull concept • Bilateral flow monitoring • Shared targets • Imaging, lab, EVS, Transport, Pharmacy bed control, etc. © 2014 Sean Carney, LLC Sunday, February 23, 14
- 7. ED Cascading Communications • Agile ED Operations • Regular quick standup-No sitting!! No more than 10 min • Running the board • Everyone participates • What do you need from me to keep flow for every patient • Administration attends, listens and fixes, has no direct role © 2014 Sean Carney, LLC Sunday, February 23, 14
- 8. Cascading Communications ED Team • Cascades down from Agile Ops and continues through team • Decentralized • Running the board-target times • Regular team rounding-what are we waiting for? • Defining “done” at first patient interaction • Identifying potential admissions at first patient interaction © 2014 Sean Carney, LLC Sunday, February 23, 14
- 9. ED Leadership Cascading Communications • Facilitate Agile Ops and decentralized team communications • Running the board • Eliminate flow blocks • Initiate escalation and decompression plans • Responsible for Intake and Output targets © 2014 Sean Carney, LLC Sunday, February 23, 14
- 10. How to Eat The ED Elephant (please don’t really eat elephants) Sunday, February 23, 14
- 11. Make The ED Smaller • Break the ED and staff up into teams or functional areas • Areas mirror each other in clinical operations and size • Scalable based on studied ED patient demand • Team owned and incentivized © 2014 Sean Carney, LLC Sunday, February 23, 14
- 12. ED Tracks Or Pods • Scalable by hour and day of week • Breaths with predictable and non-predictable surge • Mirror in capability and capacity • Generalize ED beds, avoid specialty rooms. • Stop saving code rooms use for patients be walked out quickly when needed © 2014 Sean Carney, LLC Sunday, February 23, 14
- 13. ED Output • Optimized Discharge Flow • Identify “done” target • Think flow constraints • Pre-plan logistics • Optimized Admission Flow • Same as DC flow + early admission potential • ETA to Admit Units • Push and Pull Incentives © 2014 Sean Carney, LLC Sunday, February 23, 14
- 14. Flow Catalysts Sunday, February 23, 14
- 15. Flow Technology • Identify and implement technology via ROI that can enhance flow or reduce staff tasks • Real time flow monitoring systems • Automate, automate, automate • POC testing • Kiosks • Telemedicine • mobile applications • Smart rooms Sunday, February 23, 14 © 2014 Sean Carney, LLC
- 16. Flexibility in Flow • Flexibility • Designated ED flow coordinators • Scribes • Task Shifting and Sharing • Call Systems • Cross training © 2014 Sean Carney, LLC Sunday, February 23, 14
- 17. ED Infrastructure ED Planning Developing Cultural Sense of Urgency © 2014 Sean Carney, LLC Sunday, February 23, 14
- 18. ED Planning • Pertinent to Operational Flow • Functional Capacity • Daily ED team logistics • Defined roles and responsibilities © 2014 Sean Carney, LLC Sunday, February 23, 14
- 19. ED Team Design • Bonsai Teamscaping™ • Leverage data to allocate staff not “feel” • Strategic resource usage • Align functional capacity to demand by • • Day of week • • Hour of day Season ED flow should have consistent functional capacity based on demand need not on vacation, sick call, etc. © 2014 Sean Carney, LLC Sunday, February 23, 14
- 20. Designing An Urgency Culture • First before you go • Set Staff Up for Success • Design Flow • Staff led • Standardized • Scalable • and Simply to follow © 2014 Sean Carney, LLC Sunday, February 23, 14
- 21. ED Urgency Culture Shaping • Bonsai Teamscaping™ • Hiring analytics • Staff led collaborative flow design teams • Staff ownership of processes and targets Sunday, February 23, 14
- 22. Commander’s Intent Incentivize your people, give them the latitude to do the right thing. Lead by example so they will maintain operations when your not forcing it. © 2014 Sean Carney, LLC Sunday, February 23, 14
- 23. ED Surge Planning Sunday, February 23, 14
- 24. ED Decompression • ED focused standardized scalable plans based on LOS and/or volume to make ED • Temporarily bigger • Temporarily faster • Or both • Objective is to regain smooth flow • Example-Inside forward flow waiting areas to add capacity Sunday, February 23, 14
- 25. ED Escalation System • Facility wide standardized, documented escalation system based on ED LOS and/or volume • Provides common language across facility • Leadership line of sight to ED operations • Layered escalation system © 2014 Sean Carney, LLC Sunday, February 23, 14
- 26. Patient Satisfaction Sunday, February 23, 14
- 27. Patient Satisfaction • Patient Satisfaction Relates To LOS. Simple • Everything else is a workaround • Greeter/Rounders • Real time monitoring • Communication strategies • Service Recovery systems © 2014 Sean Carney, LLC Sunday, February 23, 14