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Welcome to the MHQP & HealthForce MN Quality Brownbag Room Monthly Noon Brownbag Fourth Thursday Every Month. September 24 th Access & Patient Flow Panel. Questions? Contact: Skip Valusek MHQP Education Chair [email protected] Slides are posted at:

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slide1

Welcome to the MHQP & HealthForce MN Quality Brownbag Room

Monthly Noon Brownbag Fourth Thursday Every Month

September 24th

Access & Patient Flow

Panel

Questions?

Contact: Skip Valusek

MHQP Education Chair

[email protected]

Slides are posted at:

http://www.healthforceminnesota.org/pages/Programs/courses.html

register your attendance
Hopefully you provided your name & organization when you signed in.

If so:

Just say Hi in the Chat Pod and we’ll capture your name and organization in the log.

If not:

identify yourself and organization in the Chat Pod to the

left of your screen.

If there are more than one attending on your sign-in, tell us how many by saying “Hi (tell us the number of attendees) “

Register your Attendance
poll who is attending this session
Rural / Outstate ?

Metropolitan area ?

Organization that has (or serves) both ?

Poll: Who is Attending this Session ?
poll who is attending organization type
Healthcare system

Hospital

Clinic or Clinic System

Long term care

Healthplan

Homecare / Hospice

A Quality Support Organization

Other ? (Identify other in Chat Pod)

Poll: Who is attending: Organization Type ?
poll what do you hope to gain by participating
I am a healthcare quality professional and am interested in additional education.

I am a healthcare professional interested in developing quality skills as a core competency.

I am a healthcare professional interested in learning more about healthcare quality.

Poll: What do you hope to gain by participating?
questions posed to the panel
A.   What innovative changes have you made that improved patient access and/or patient flow in your:

                -  clinic ?

                -  Emergency Dept ?

                -  hospital ?

                -  long-term care facility ?

B.  What do you consider to be your key measures of throughput/flow in your:

                -  clinic ?                 -  Emergency Dept ?

                -  hospital ?

                -  long-term care facility ?

C.  Have you tied "Lean"  to your access and flow ?

               If so,  in what way(s) ?

D.  What issue/problem have you not been able to solve and would like suggestions from the audience.

Questions posed to the Panel
panel member betty hydukovich rn
Quality Resource Specialist

Lake Region Healthcare Corporation

712 S. Cascade Street

Fergus Falls, MN  56537-1234

218-736-8068    Fax: 218-736-8757

[email protected]

Panel Member: Betty Hydukovich RN
the emergency department patient experience
Project Goals:

1. Reduce or mitigate patient wait time

2. Enhance communication to patient and family

3. Improve patient satisfaction

●Project Measures

1. Patient wait times

(measures access and throughput)

2. Patient Satisfaction scores

The Emergency Department Patient Experience
what innovative changes have you made that improved patient access and or patient flow
Assigned a “resource nurse” each shift

Re-defined roles for procedure nurses and unit clerk

Installed additional computers in patient rooms

Two additional work stations for nurses/doctors

Improved tracker board functioning

Dedicated “fast track” rooms on weekends when there are 2 ED physicians

What innovative changes have you made that improved patient access and/or patient flow ?
what do you consider to be your key measures of throughput flow
Decreased Wait Times

◦ From lobby / triage to room

◦ From room time to time seen by ED MD

◦ From time seen by ED MD to time seen by

hospitalist

◦ Disposition time – out the door

What do you consider to be your key measures of throughput/flow
have you tied lean to your access and flow if so in what way s
Rapid changes put into effect (Kaizen events)

Banish waste (reduced patient wait times, standardized staff roles, limited unnecessary movement, cut out repetitive documentation, etc.)

Implemented employee ideas to utilize talents and skills to their fullest

Have you tied "Lean"  to your access and flow? If so,  in what way(s) ?
what issue problem have you not been able to solve and would like suggestions from the audience
ANY suggestions would be helpful

◦ concerned about “sustaining the gain”

Thank you for allowing me to share this project with you!

Betty Hydukovich RN – Quality Resource Specialist

Lake Region Healthcare Corporation, Fergus Falls

What issue/problem have you not been able to solve and would like suggestions from the audience?
slide14
St. John’s ED

Lean Flow Project

Brownbag Panel

September 24th, 2009

Corin Hammitt

HealthEast

Process Improvement Consultant

651-232-0327

[email protected]

agenda
Agenda

St. John’s ED

Patient Throughput

Batching and Long ALOS

Triage & Rooming Patients

Rapid Treatment Design

st john s ed
St. John’s ED
  • Annual Volume = 38,000
  • 25 beds
    • 20 beds for all acuity levels
      • 1 trauma room
      • 3 resuscitation rooms
    • 5 bays for low acuity patients (4’s and 5’s only)
  • 23% of ED patients are admitted
    • ~50% of St. John’s Inpatients come through the ED
the situation st john s ed
The Situation: St. John’s ED

Emergency Room Capacity

SITUATION: The ED is full, LWBS = 4%, patient complaints are pouring in. We have to start ‘rounding’ on the waiting room patients to ensure them that they will be seen soon.

Admission Process (Patient Flow out of ED)

conventional solution
Conventional Solution

Emergency Room Capacity

SOLUTION: Expand the ED.

Currently have 25 beds

Expand to 36 beds

Meet the needs of the community. Right?

Admission Process (Patient Flow out of ED)

lean flow solution
Lean Flow Solution
  • Focus on the outflow of patients
    • In our case, the ED patient admission process
  • Don’t make the funnel larger- move patients out to bring new patients in
  • If a patient spends 30 fewer minutes in the ED and moves up to the unit, that releases capacity in the ED
    • No investment in expansion, staff, or physicians!
ed admit process pre lean flow
ED Admit Process: Pre-Lean Flow
  • Data:
  • 10-12 Handoffs
  • 9 roles involved, plus Ops Center
  • 4 Handoffs prior to making bed request = 20 minute delay!
  • Total Cycle Time = 70 minutes (avg)
  • Issues:
  • Patients waiting to be admitted to inpatient unit take up ED bed capacity- over 16 hours each day of unnecessary bed occupation
  • Impact:
  • ALOS for admitted patients = 4.8 hours in the ED
  • LWBS = 4%
ed admit process post lean flow
ED Admit Process: Post-Lean Flow
  • Data:
  • 3 Handoffs ; ACT RN is coordinator of the admission
  • 4 Roles Involved, plus the Ops Center
  • New Cycle Time = 30 minutes (avg)
  • Impact:
  • ALOS for admitted patients now 4.05 hours (as of Aug. 28, 2009)
  • August LWBS = 1.85%
  • 16 hours of ED capacity released each day
  • Opportunity to increase daily patient throughput and revenue
sources of long alos
Sources of Long ALOS

ALOS < 250 min

ALOS ≥ 250 min

  • Shift Change impact on Door to Bed and ALOS:
    • 1-2 hours prior to shift change (evenings and nights) Door to Bed is significantly longer
    • Long ALOS attributable to Shift Change (for those arrivals occurring at or 1-2 hours before shift change)
    • After further investigation, we found out that the provider shifts were set up in a way that inhibited handing off patients, thus providers would refrain from seeing new patients 2+ hours prior to end of shift.
  • Solution:
    • Change provider shift structure to promote hand off of patients between providers
    • Eliminate the batching of patients at shift change
slide26

Bottleneck

Q: Wait for ED Bed

Triage

(1 Server)

Patient is Roomed

(22 servers)

Cycle Times:

slide27

Triage

(1 Server)

Q: Wait for ED Bed

Patient is Roomed

(22 servers)

Triage

(1 Server)

Pull to Full

Cycle Times:

pull to full
Pull to Full

Pull to Full: Arrival to Patient Roomed

  • Pull to Full Eliminates Patient Waiting Waste
    • Empower the Triage RN to room the patient immediately if there are open rooms
    • Don’t wait for chart to go back to Charge RN
    • Eliminate the decision-making by only one person (gate-keeper)
    • If only one room is open, Triage RN will consult with Charge RN
slide30

Before

4/19/09

Rapid Treatment Area (T1-T5)

Rapid Tx

Rapid Tx

Computer/ Workstation

Rapid Tx

Rapid Tx

Rapid Tx

room utilization of rapid tx
Room Utilization of Rapid Tx
  • Rapid Treatment Area Overall Room Utilization = 34%
  • The rooms were not used to their full potential
    • Layout and motion waste meant that the rooms were not used equally
slide32

After

7/1/09

Rapid Treatment Area (T1-T5)

Rapid Tx

Rapid Tx

Rapid Tx

Rapid Tx

Computer/Workstation

Rapid Tx

Rapid Treatment Waiting Lounge

st john s ed dashboard
St. John’s ED Dashboard

Dashboard-Most data is available through electronic tracking board

This analysis is done monthly & posted in ED break room area

The ED Clinical Manager is trained on how to perform this analysis

measures details
Measures- Details

Arrivals, Admits and LWBS by Day of Week

ALOS Distribution

< 3 hours

3 -4 hours

4-5 hours

> 5 hours

measures details1
Measures- Details

ED Arrivals and LWBS by Hour of Day

Door to Bed (min.) by

Hour of Day

critical success factors
Critical Success Factors

Go to Gemba!

Measurement

Transparency

Frontline participation

Open-mindedness

Remove the barriers to solutions

Respect for one another

Don’t expect perfection

slide40

Welcome to the MHQP & HealthForce MN Quality Brownbag Room

Monthly Noon Brownbag Fourth Thursday Every Month

October 22nd

Patient Safety

Innovations

Panel

Questions?

Contact: Skip Valusek

MHQP Education Chair

[email protected]

Slides are posted at:

http://www.healthforceminnesota.org/pages/Programs/courses.html

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