Communication is essential to an effective “PULL” system - One of the ways that we support Pull is through Alert Paging

CC-Bed Alert: M/S near full-capacity LLM/High-level at full-capacity – 20 post-ops, 7 ED holds, 2 to EAU-N at 0900 – projected census to 99% within 3 hours – Brenda

Bed Alert Page

CC-Bed Alert: M/S near full-capacity LLM/High-level at full-capacity – 20 post-ops, 7 ED holds, 2 to EAU-N at 0900 – projected census to 99% within 3 hours – Brenda

Level 0 Level 1 Level 2 Level 3 Level 4

Projected Census

Level 4 Bed Alert

Level 4 Triggers – Site Occupancy >95% – >5 ED Holds (patients waiting for inpatient beds) – ED approaching or on diversion – PACU approaching or at full-capacity

Expected Actions: • case managers, physicians, & nursing staff work together to facilitate early

discharge • all pending/confirmed discharges are entered into E-board • physicians write complete order set at the time the order for discharge is written • newly admitted patients are transferred into assigned bed within 30 minutes of

clean bed assigned • PFCs report to ED/PACU to assist with transfer of assigned patients

Full-capacity

Definitions PACU Alert System – a collaborative approach that

proactively looks at perioperative demand and capacity to avoid putting the OR on hold using alpha-page notification of predetermined capacity measures that trigger specific action by a multi-disciplinary group of key staff

Steady flow Approaching full capacity OR Hold Overflow

Level 0 Level 1 Level 2 Level 3 Level 4

OR HOLD COMPARISON - PRIOR YEAR, SAME MONTH

905

723797

330

582 614

1311

1132

528

1009

614 608

70 54 15140197

572

0

120

240

360

480

600

720

840

960

1080

1200

1320

March April May June July August Sept Oct Nov Dec Jan Feb

Tota

l Min

utes

LAST YEAR 2005

The PACU Alert System – utilizes the bedboard to streamline communication and prevent OR HOLD for incredible results.

Life After the Magic!

Awesome results! Enhanced patient throughput

• Beds available for assignment earlier in the day • Significant reduction in bed turnaround time • Increase in Admissions • Increased ED Patient Satisfaction

Bed Availability LVH-CC Bed Availability - Discharges plus Bed TAT

by Hour of Day

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

20.0%

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Hour of Day

% o

f Dis

char

ges

durin

g H

our o

f Day

FY02 Effect FY03 Effect FY04 Effect

Take Away: GOC supported a shift in the capacity curve to earlier in the day; there are six more beds available at noon. LVH-M showed a similar capacity shift; yielding two more beds available at noon.

BedTurnaround Time - CC Site

0

30

60

90

120

150

180

210

240

Baselin

e -

FY

04-Sep

FY

04-Oct

FY

04-No

v

FY

04-Dec

FY

04-Jan

FY

04-Feb

FY

04-Mar

FY

04-Ap

r

FY

04-May

FY

04-Jun

FY

05-Jul

FY

05-Au

g

FY

05-Sep

FY

05-Oct

FY

05-No

v

FY

05-Dec

FY

05-Jan

FY

05-Feb

FY

05-Mar

FY

05-Ap

r

FY

05-May

FY

05-Jun

FY

06-Jul

Min

utes

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

Bed

s C

lean

ed

CC TAT CC Volume

77.9 to 86.6 (30% tile - 98% tile) Overall Rating

CC ED PG Improvements FY’04 1st Q - 4th Q FY’05

Arrival

70.5 to 82.2 (20% tile - 85% tile)

Nurses

81.1 to 88.2(35% tile - 93% tile)

Doctors & PAs

83.0 to 89.9 (55% tile - 97% tile)

Tests

82.6 to 85.9 (40% tile - 65% tile)

Family/Friends

82.7 to 88.5 (45% tile - 93% tile)

Personal/ Insur. Info.

83.2 to 88.7(35% tile - 85% tile)

Personal Issues

69.8 to 83.0 (20% tile - 93% tile) Patient & Families

74.7 to 87.0 (25% tile - 93% tile)

Overall Assessment

Capacity Throughput Council Maintain the gain ….

– Communication of key capacity metrics to senior management

– Bed Turnaround Time – Pull Times by nursing unit – Admission Volume – Transport Trip times – Transport Delay

– Monitor/audit of established processes to ensure compliance

– Functional leaders of each area will receive detailed TeleTracking report information

105.3% 95% 100% Transfer Center Acceptance Rate1

71.4% 60 84 Pull Average Times2

789.5% 300 38 OR Holds in Minutes - Cedar Crest2

39.4% 31 79 ED Time to Seen2

32.5% 25.0 76.9 ED Diversions in Hours2

93.7% 60 64 DBST Turn Around Time2

39.4% 20.00 7.89% Discharges Before 11:00 am1

Patient Flow/Demand

108% 4,380 4,734 ED Visits - Cedar Crest1

100% 4.6 4.6 LVH Length Of Stay2

124% 3,122 3,876 LVH Admissions1

Volume Indicator

Achievement Target Actual Measure – July 2005

LVH Capacity Dashboard

Lessons Learned

• Strong senior management support is necessary • Capacity initiatives must be hospital-wide not just a bed

management initiative or specific to the ED • Attention must be paid to redesigning process - technology cannot

fix bad processes • Technology can be successfully added to enhance process

improvements • Communication must be streamlined and occur real-time • A burning platform for change must built - with culture change an

organizational priority

Lehigh Valley Hospital - Built to Last

Questions ?

Lisa Romano RN, MSN Administrator, Patient Logistics/Patient Access Lehigh Valley Hospital Allentown PA 18105 Lisa.Romano@LVH.com