Hospital- Hospital---wide wide Patient Flo W… · Hospital-Hospital---wide wide Patient Flow. ... • 520-bed system with 4,400 employees ... • The process for assignment of beds

“Continuing Christ’s Ministry in our Franciscan Tradition”

HospitalHospitalHospitalHospital----wide wide wide wide Patient FlowPatient FlowPatient FlowPatient Flow

St. FrancisSt. FrancisSt. FrancisSt. FrancisA Division of the Sisters of St. Francis Health ServicesA Division of the Sisters of St. Francis Health ServicesA Division of the Sisters of St. Francis Health ServicesA Division of the Sisters of St. Francis Health Services

• A non-profit, full-service, tertiary care hospital.• 520-bed system with 4,400 employees (3,200 FTE’s).• Medical staff of 700 in 48 specialties and sub-specialties. • HealthGrades Award for Clinical ExcellenceTM in 2006,

2005 and 2004, ranking it among the top 5 percent of all hospitals in the country for overall clinical performance.

• Launched Lean Six Sigma program in 2006.• Recognized as one of the nation's 100 Top Hospitals® by

Solucient in 2007.• Named one of the nation's 100 Top Hospitals® by

Thomson Reuters for 2008.

Beech GroveIndianapolisMooresville

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Your PresentersYour PresentersYour PresentersYour Presenters

• Matthew Pierce, RN– Role: Manager, AIU Nursing

– Education: MSN, IUPUI

– Experience:• Lean Six Sigma Green Belt since 2007. Black Belt

candidate.

• Joseph Swartz– Role: Director, Business Transformation

– Education: MSM, Purdue U.

– Experience:• Six Sigma Black Belt since 2000.

• Continuous Improvement (CI) Guide for 16 years, 150+ CI projects.

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How We Got HereHow We Got HereHow We Got HereHow We Got Here

• ED 2006 Project.

• In 2007 started the ED 2010 Initiatives.

– Discovered that half of the patient flow issue

is outside the ED.

• In late 2007 we launched a Hospital-wide Patient Flow Initiative.


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BackgroundBackgroundBackgroundBackground

• Patient placement into inpatient beds can come from a variety of access points.

• Delays can be experienced at a number of points causing backlogs in various areas of the hospital.

• The process for assignment of beds varies by campus and time of day.

• There is no clear picture of what the overall bed status is at any given time in one spot.

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ED

Prompt Care

Surgery

Doctor’sOffice

Pts.

ICU, ACC, CCU

Med/Surg

Discharge

Home, Rehab,

ECF, Morgue

Hospital Key Process Flow DiagramHospital Key Process Flow DiagramHospital Key Process Flow DiagramHospital Key Process Flow Diagram

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Indy: 140

BG: 120

Indy: 190

BG: 175

Minutes604. ED Disposition to Departure

8583

Indy: 1,000

BG: 800

Indy: 425

BG: 385

Indy: 225

BG: 207

Before

86.882.6

Indy: 881

BG: 525

Indy: 365

BG: 335

Indy: 190

BG: 185

Current 11/09

%

Hr/mo.

Minutes

Minutes

Unit

2402. ED average LOS, admitted patients

88.285.0

5. Patient Satisfaction (Press Ganey)

1. Inpatient2. Emergency

1003. ED holding hours

1401. ED average LOS, all patients

GoalMetric

Major ObjectivesMajor ObjectivesMajor ObjectivesMajor Objectives


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Bed Placement Time StudyBed Placement Time StudyBed Placement Time StudyBed Placement Time Study Patient Tracking Sheet

1.) Time and date called for bed: ___________ 2.) Time Admitting called floor: _______________________ 3.) Time unit notified Admitting: _______________ 4.) Time Admitting calls ER with bed: __________________ 5.) Unit assigned to: _________________, Bed number: ___________ 6.) Time called to give report: __________________ 7.) Actual time report given: __________________ 8.) Admitting MD seeing pt in ED (y/n): ____, Time arrived: __________ 9.) Patient departure to unit time: __________________ 10.) Reasons for delays: � No beds � Bed not clean � Assigned bed occupied � No transporter � Ambulance delay � STAT order � Charge nurse not available � Pending test from ED � Not able to give report � Short staffed on unit � Unit shift change delay Give explanation for items checked or other delays:

___________________________________________________________ ___________________________________________________________

___________________________________________________________

Place Patient Label Here


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Admitting Timeline (Averages)Admitting Timeline (Averages)Admitting Timeline (Averages)Admitting Timeline (Averages)

DecisionTo Admit

Disposition to Admit

Room& StaffAvail.

UnitCalls

Admit-ting

Transport Pt

ED callsAdmit-

tingfor bed

ESArrives

To clean room

Ifdirty,notify

ES

Admit-ting calls unit

IDUnitRm

Admit-tingcalls ED

ED RNcalls

unit to give

report

Reportgiven

11m 27m 8m 46m 9m 29m

Delay reasons:• Report delays• ED chaotic• Unit short staffed• Wait on admit MD• Bed changed• Bed not clean

• Bed not ready• Pt refused to go to BG

?m

Delay reasons:• Transport delays• Ambulance transfers• Wait for orders• ED test delays

130 minutes, or 2 hours & 10 minutes

ED Admitting Process TATED Admitting Process TATED Admitting Process TATED Admitting Process TATBox PlotBox PlotBox PlotBox Plot

Data Source: Manual collection

Date Range: 11/09/07 – 11/17/07 or 1 week

N: 268 Admits from the ED department to a nursing unit.

Facility: Beech Grove & Indianapolis campuses.

File: BedTrackingStudyData.xls

ED Admitting Process TAT Box Plot

0:11

0:27

0:46

0:05

0:29

0:080:07

0:13

0:01

0:33

0:00

0:13

0:00

0:07

0:14

0:21

0:28

0:36

0:43

0:50

0:57

1:04

1:12

ED calls Admitting - to -

Admitting calls unit

to - Unit calls Admitting

back with a bed

to - Admitting calls ED to - ED RN calls unit for

report

to - Report complete to - Pt leaves ED

Process Step

Tu

rn A

rou

nd

Tim

e (

TA

T)

Q3

Max

Mean

Median

Min

Q1

Note: Upper scale is clipped at 1:12

I.e., the time from when Admitting called the ED until the ED RN calls the unit for report.

I.e., the time from when report is complete until the patient leaves the ED.

Getting a Bed Assigned

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DelaysDelaysDelaysDelays

Reasons For Delay Departure From BG & SC ED

0

334

67

11

14

171818

27

0

5

10

15

20

25

30

Bed not

clean

No beds Delay giving

report

Wait on MD Shift delay Amb. Delay No trans-

port

Short staff Bed occ. STAT

Order

Test in ED PCC not

avail.

Nu

mb

er O

f D

ela

ys

n=268

10% 7% 7% 6%

5%

4%

3% 2%

1% 1% 1%

Data Source: Manual collection

Date Range: 11/09/07 – 11/17/07 or 1 week

N: 268 Admits from the ED department to a nursing unit.

Facility: Beech Grove & Indianapolis campuses.

File: BedTrackingStudyData.xls


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Improvement RecommendationsImprovement RecommendationsImprovement RecommendationsImprovement Recommendations1. HWPF Committees.

2. ED to Med-Surg Unit SBAR Handoff.

3. Patient Placement Coordinator (Bed Czar).

4. Bed Management Team.

5. Bedding in Unit Hallways.

6. Admission Nurse Specialists.

7. Hospitality Centers (admitting & discharge).

8. iCARE.


1. HWPF 1. HWPF 1. HWPF 1. HWPF CommitteesCommitteesCommitteesCommittees

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HWPF CommitteesHWPF CommitteesHWPF CommitteesHWPF Committees

Source: Institute of Medicine (IOM)


2. Handoff 2. Handoff 2. Handoff 2. Handoff ReportReportReportReport

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Process Issues Process Issues Process Issues Process Issues ––––Handoff ReportHandoff ReportHandoff ReportHandoff Report

• Multiple phone calls.

• Dropped balls.

• ED gave incomplete information.

• Lost information in handoffs.

• Nurse availability.

• Variability in process.

• Follow-up with ED nurse difficult.

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Handoff ReportHandoff ReportHandoff ReportHandoff Report

• Form developed with input from staff nurses from both inpatient areas and ED.

S

Admission Status Order Present: Inpatient________ Observation________

Date:_______Patient Name:______________________Room#

Chief Complaint:____________________Admitting Dx______________________

Admitting Physician:_________________Consulting Physician:________________

Allergies:______________Isolation Type:____________Location:____________

B

Pertinent Hx: ________________________________________________________

____________________________________________________________________ Code B: yes no C: yes no Admitted from: Home ECF

Spouse/SO other with patient yes no Name:_______________Relationship__________

A

Vitals: Time________Temp________ HR________RR________BP________

O2 sat.________O2________Ht________Wt________stated Measured

Pain assmt: Pain Level________Last dose pain med________Time________

Meds Given: Antibiotics________________Antiemetics_________________

Level of consciousness:orientedcooperativeanxiousuncooperative confused

Restraints: yes no Incontinent: yes no Telemetry: yes no

Activity Level: up ad lib up with assist BRP bedrest

IV access: yes no Location:_______Type Fluids:___________IV started : ED EMS

Blood/Bld Products Given: yes no type_______________________

Lab Results:_____________________Radiology Results:_____________________

Any pending Admit orders needing completed: yes Accucheck_____________

Lines: NG/OG yes no Foley: yes no Ostomy: yes no

R

Report called/given to:_______________________________Time:____________

______________________ __________________________Date:______Time:___

Sending Nurse Signature Call Back/Contact Number

______________________ ______ ______ ___________________ _____ _____ Receiving Nurse Signature Date Time Receiving Nurse Signature Date Time

Emergency Department Admission Report

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ED to MedED to MedED to MedED to Med----SurgSurgSurgSurgUnit SBAR HandoffUnit SBAR HandoffUnit SBAR HandoffUnit SBAR Handoff

• High Level Process Map

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Lessons Learned Lessons Learned Lessons Learned Lessons Learned ––––Handoff ReportHandoff ReportHandoff ReportHandoff Report

• Pilot, get feedback, revise, … .

• Consider equipment placement issues.

• Inadequate education practices –weekends, nights, … .

• Be persistent.


3. Patient 3. Patient 3. Patient 3. Patient Placement Placement Placement Placement CoordinatorCoordinatorCoordinatorCoordinator

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Patient Placement CoordinatorPatient Placement CoordinatorPatient Placement CoordinatorPatient Placement Coordinator

• Started: August ’08 at Indy Campus.

• Key activities:

– Learned rules and logic of admitting by unit.

– Experienced common capacity issues.

– Runs daily bed meetings.

– Problem solves delays.

– Facilitates bed availability and patient placement.

• Replicated October ’09 at Beech Grove Campus.

• Next Steps:

– Predictive Admitting.

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Results Results Results Results –––– Patient Placement Patient Placement Patient Placement Patient Placement CoordCoordCoordCoord....

• During hours of Patient Placement Coordinator (PPC):

– 90 minute reduction in average time from ED

disposition to discharge.

– 71 minute reduction in average ED LOS.

• Pre-PPC, Mar-Jul ’08 vs. Post-PPC, Sep-Dec ’08.


4. Bed 4. Bed 4. Bed 4. Bed Management Management Management Management TeamTeamTeamTeam

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Process Issues Process Issues Process Issues Process Issues ––––Bed MgmtBed MgmtBed MgmtBed Mgmt

• Admitting Registration separate from Admitting Nurse.

• Inadequate bed tracking board.

• Multiple computer programs.

• ED admissions not planned for.

• Phone call to request a bed.

• Poor visibility of beds available hospital-wide.

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Purpose of Bed Mgmt TeamPurpose of Bed Mgmt TeamPurpose of Bed Mgmt TeamPurpose of Bed Mgmt Team

• Develop team, lead by Patient Placement Coordinator.

– To refine and streamline processes related to

patient admissions and placement.

– To problem solve delays in patient placement

process.

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BG BedBG BedBG BedBG Bed

TrackingTrackingTrackingTracking Rm Status Rm Status Rm Status Rm Status Rm Rm Status Rm Status Rm Status

BoardBoardBoardBoard 1 B/A 1 O 1 O 1 O 1 O 1 1 1 O

2 O 2 O 2 2 B/A 2 O 2 2 O 2 O

3 O 3 O 3 3 O 3 O 3 O 3 O 3 O

Status Codes: 4 O 4 O 4 O 4 B/A 4 O 4 O 4 O 4 O

Blank=Available 5 O 5 O 5 5 5 O 5 5 O 5

O=Occupied 6 6 O 7 O 7 7 7 7 O 7B/A=Assigned 7 O 7 O 8 8 8 8 8 O 8 OD/P=Pending 8 O 8 O 9 O 9 9 9 9 O 9 OT-unit=Transfer 9 O 9 O 10 10 O 10 O 10 10 O 10 ONIS=Not in Srv 10 O 10 O 11 11 11 O 11 11 B/A 11 O

11 O 11 O 14 14 14 14 14 O 14

12 O 12 O 15 15 15 O 15 15 15 O

13 O 13 O 61 61 O 20-1 O 20 20-1 O 20-1 O

14 O 14 62 63 B/A 20-2 22 20-2 O 20-2

15 O 15 O 64 64 22 O 24 O 22-1 O 22-1 O

16 O 65 65 O 24-1 O 26 O 22-2 O 22-2

17 O 67 67 O 24-2 28 24-1 24-1 O

18 68 68 O 26-1 B/A 24-2 24-2

69 69 26-2 26-1 26-1

70 70 28-1 O 26-2 26-2 O

74 71 28-2 28-1 O 28-1

75 74 53 B/A 28-2 28-2

Updated: 75 55 O 30-1 O 30-1

12/12/2009 57 O 30-2 O 30-2

21:05 Color Legend: 59 O 53 53-1 O

Ver 0.4 Available 62 55 O 53-2

Occupied O 64 O 57 O 55-1 O

Not in ServiceNIS 65 59 55-2 O

67 O 61 O 57-1

68 O 62 O 57-2

69 O 63 59-1

EEG study 70 O 64 B/A 59-2

High census 71 O 65 O 61 O

74 O 67 O 62 O

75 68 O 63 O

H1 69 O 64 O

H2 70 O 65 O

O 71 67 O

74 O 68 O

75 O 70

H1 71 O

H2 74

9T6T 8TICU ACC 2T 4T 5T

Electronic Bed

Boa

rdElectronic Bed

Boa

rdElectronic Bed

Boa

rdElectronic Bed

Boa

rd

Bed Capacity & Demand ToolBed Capacity & Demand ToolBed Capacity & Demand ToolBed Capacity & Demand ToolPurpose:

• 1) To help identify a daily plan to ensure our bed capacity meets our demand for

beds.

• 2) To learn how accurately we can plan and predict bed placement and to identify

where the most frequent delays and hang-ups to meeting demand are occurring.

Bed Capacity and Demand Tool - Beech Grove

Date:

Unit

Available

Beds

Potential

Discharges

by 2pm

No Orders

Discharges

by 2pm

With Orders

Estimated

Capacity

by 2pm

Actual plus

Potential ED

Admits

by 2pm

Scheduled

Directs +

Cath Lab +

Surgery

Admits

by 2pm

Planned

Transfers

by 2pm

Estimated

Demand

by 2pm `

Plan to Address Capacity and

Demand Variance

Actual

Discharges

by 2pm

Actual

Admits by

2pm Success

ICU

ACC

2T

4T

5T

6T

8T

9T

Capacity Demand ResultsPlan of Action

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Bed Capacity & Demand Tool Process:Bed Capacity & Demand Tool Process:Bed Capacity & Demand Tool Process:Bed Capacity & Demand Tool Process:

1. 7:30 am – Unit rep fills out “Capacity” section.

2. 8:30 am – Morning Bed Meeting: • Team completes “Demand” section.• Team completes “Plan of Action” section.

3. Unit rep communicates plan to unit staff.

4. At 2 pm Patient Placement Coordinator (PPC) makes rounds and completes “Results”

section.

5. At 5 pm, evening nurse supervisor meets with PPC.

6. Information reviewed monthly with senior leadership to understand the issues and remove roadblocks.


5. Bedding in 5. Bedding in 5. Bedding in 5. Bedding in Unit HallwaysUnit HallwaysUnit HallwaysUnit Hallways

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Bedding in Unit HallwaysBedding in Unit HallwaysBedding in Unit HallwaysBedding in Unit Hallways

• Included staff nurses from multiple inpatient areas.

• Reviewed literature re: bedding in hallways, and developed a St. Francis process.

• Designated two hallway beds in each Med-Surg unit.

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Hall Patient Exclusion Criteria• Patients requiring Critical Care.• Patients who require mechanical ventilation.• Patients requiring more than 4 liters of oxygen and neb

treatments.• Patients requiring suctioning, on Frazier water protocol or on

aspiration precautions.• Isolation patients.• Patients who are incontinent.• Restrained patients or those requiring a sitter.• Palliative Care or Hospice patients.• Patients with intractable vomiting.• Patients with active GI bleeds.• Patients with seizure precautions.• Patients with Alzheimer’s, delirium, agitation.• Critical care patient transfers will not be placed in hall beds.• Direct Admits.

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Lessons Learned Lessons Learned Lessons Learned Lessons Learned ––––Hallway BeddingHallway BeddingHallway BeddingHallway Bedding

• Strong initial pushback by staff.

– Got staff involved.

– Lots of education about latest research on

boarding in the ED and patient outcomes.

• Piloted with a mock patient, and discovered deficiencies.

– Re-evaluated the hallway bed locations based

on the pilot.

– Privacy concerns.

• It’s not a fix – it’s a stopgap.


6. Admission Nurse 6. Admission Nurse 6. Admission Nurse 6. Admission Nurse Specialists (ANS)Specialists (ANS)Specialists (ANS)Specialists (ANS)

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Admission Nurse SpecialistsAdmission Nurse SpecialistsAdmission Nurse SpecialistsAdmission Nurse Specialists

• Designed to provide an environment of patient-centered care:– Foster a more comprehensive, personal and

seamless patient admission process.

– Ensure high quality patient care with a more thorough admission history.

– Increase patient, nurse, and physician satisfaction.

– Promote Medicare compliance with mandatory quality measures and Present on Admission measures.

– Optimize reimbursement.

– Start patient and family education process.

• Side Benefits:– Improves patient throughput and flow.

Source: Borrowed from SAMH, with edits.

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What WeWhat WeWhat WeWhat We’’’’ve Piloted ve Piloted ve Piloted ve Piloted ––––ANS ANS ANS ANS

• Beech Grove:

– Started in September.

• Staffed 11a-11p, 5 days a week.

– November.

• Staffed 11a-7a, 5 days a week.

• Added 11a-11p, weekends.

• Indy:

– November.

• AIU provided their own staff 11a-11p, 5 days a week.

– January 2010.

• Staffed 11a-11p, 5 days a week.

• Staffed 11a-7:30p, weekends.

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Lessons Learned Lessons Learned Lessons Learned Lessons Learned ---- ANSANSANSANS

• Use a checklist.

• Added discharge capability, when they have time, which opens beds by expediting discharges.

• Expedites the admission process.


7. Hospitality 7. Hospitality 7. Hospitality 7. Hospitality Centers Centers Centers Centers (Admission & Discharge)(Admission & Discharge)(Admission & Discharge)(Admission & Discharge)

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Hospitality CentersHospitality CentersHospitality CentersHospitality Centers

• Opened Hospitality Center at Beech Grove campus (Admission and Discharge), only when needed.

• Opened Discharge Center at Indy campus open Monday through Friday, 10a-7p.

• Launched Discharge Teams at Indy campus in November ‘09.

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Lessons Learned Lessons Learned Lessons Learned Lessons Learned ---- HospitalityHospitalityHospitalityHospitality

• Nurses weren’t sending many patients to hospitality center, until center started doing all the discharge paperwork.

• Discharge teams are getting great reviews by patient and staff, especially when they perform the discharge in the patient’s room.


8. 8. 8. 8. iCAREiCAREiCAREiCARE

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iCAREiCAREiCAREiCARE for Critical Carefor Critical Carefor Critical Carefor Critical Care

• Started September ’08.

• Total Door to Arrival in Critical Care Time improvement from 4 hours 30 minutes to 3 hours 39 minutes.

• Improved Decision to Admit to Arrival in Critical Care from 2 hours 6 minutes to 52 minutes.

• Initially focused on improving quality and patient safety, but also improved flow.

ED determines to

admit patient

MD writes order

ED US calls CCC

for bed (sa-sp)

(sp-sa) referred to

BG for admit

CCC checks for

isolation and bed

availability, Check

IC in Affinity

Bed available?Type of Unit? Is bed clean?

CCC calls US or

charge RN to get

a bed assignment

and give info

BG/Peds

Indy

US calls BG

admitting for Beds

(all times)

NO

CCC call unit to

see if bed will

become available

(d/c, transfers out,

etc.)

YES

Bed Assigned.

Inpatient US calls

CCC with bed

number.

CCC orders a

STAT clean with

ES.

CCC calls ED with

bed number.

NO

YES

ED US puts bed

number on

tracking board

Get patient ready

for transport. (ED

RN faxes report

and confirms

receipt

ED RN or EDSA

transports patient

to unit

Patient received

by unit RN

US calls CCC or

admitting to advise

of patient arrival

CCC/Admitting

Affinity- Change

ED Dr. and

admitting

diagnosis

MCKESSON

shows patient

active

Consultant not

available to

write orders

Holding

Patients

MD doesn’t

write time on

orders

BG unaware

of patients

waiting

Report

Progress

Multiple

charts in

bin

Process

variation Where is

patient

admitted?

4:45-5:00

N/A for bed

request

Bed status not

communicated

to all

Leaving

messages

for CCC Charge RN has

pts. Unable to

place pt.

Inconsistent

unit

assignment

CCC assigning

beds w/out

consulting

Charge RN

Forget to

call with bed

#

Nurse

calling for

discharge

High ES

turnover

ES

unavailable.

2 breaks, 1

lunch Many

discharges

ES

staffing

levels

ES leaves

room before

finished

Room in

progress while

ES at lunch

Inconsistent

use of bed

tracking

CCC doesn’t

call with bed

#

RN has no

idea pt. has

bed

Communication

at assignment

Bed ready,

no orders

Inconsistent

PCC role

PCC has

patients

Patient waiting

for ride home

No verbal

communication

Call- RN

unavailable,

FAX busy

Nurses

delay

Units not

laid out the

same

Fax report not

visible to floor

US when rec’d

Rec’d another

CP while trying

to get patient

ready

No report

given

ED RN not

following up

on fax

NO EMTs to

transport

NO EDSAs

for AIU

transport

Low staffing

levels

RN is in

another

room

RN not

properly

notifiedPt. left in

room alone

Where is Pt.

chart?

US unaware

of pt. arrival

Pt. at

window

Volume

Floor staff doesn’t

know when pt.

activated

3 minute

delay

Cant order meds

or document

care if not active

Hold in ED

Lack of care

in ED

ED knowledge

of MAR/Meals

1-5pm mass

discharges

No beds, no

communication to

ER and consulting

MD

ED Inpatient Admitting Process

Admitting Process Admitting Process Admitting Process Admitting Process ---- BeforeBeforeBeforeBefore

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iCAREiCAREiCAREiCARE for Medfor Medfor Medfor Med----SurgSurgSurgSurg Process MapProcess MapProcess MapProcess Map

Decision to

admit

MD writes

order for

admission

Chart placed

at ED US

desk

AIU Charge

Nurse assigns

bed/nurse

ED Charge

Nurse calls

AIU Charge

Nurse

ED US

notifies ED

Charge Nurse

of admission

AIU Charge

Nurse notifies

ED Charge of

assignment

Pt transported

to AIU

ED RN calls

AIU RN to

review SBAR

and questions

ED RN tubes

SBAR form

to AIU for

RN review

STAT clean

sent to ES

ED RN

completes

SBA R report

form

ED US enters

bed request w/

assignment in

Affin ity

ED Charge

Nurse notifies

ED US and RN

of assignment

Bed

Ready

AIU charge

notifies ED

of clean bed

Yes

No

One step with one phone call

15 minute TAT goal

30 minute TAT goal

• Before: 2 hours 7 minutes.

• Goal: Total TAT < 60 minutes.


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ED LOS for All PatientsED LOS for All PatientsED LOS for All PatientsED LOS for All PatientsFor the Indianapolis CampusFor the Indianapolis CampusFor the Indianapolis CampusFor the Indianapolis Campus

Month

IN ED All Visits LOS (minutes)

Jan-10Sep-09May-09Jan-09Sep-08May-08Jan-08

250

225

200

175

150

S 13.0256

R-Sq 41.1%

R-Sq(adj) 38.5%

Regression

95% CI

95% PI

IN ED All Visits Monthly Average LOS in Minutes

Correlation Coefficient:

r = 0.64. The

downward trend is

statistically significant

(p=0.001), accounting

for 41% of the total

variation in LOS.

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ED LOS for Admitted PatientsED LOS for Admitted PatientsED LOS for Admitted PatientsED LOS for Admitted PatientsFor the Indianapolis CampusFor the Indianapolis CampusFor the Indianapolis CampusFor the Indianapolis Campus

Month

IN ED Admitted LOS (minutes)


500

450

400

350

300

S 24.0007

R-Sq 41.7%

R-Sq(adj) 39.1%

Regression

95% CI

95% PI

IN ED Admitted Patients Monthly Average LOS in Minutes


r = 0.65. The

downward trend is


(p=0.001), accounting

for 41.7% of the total

variation in LOS.

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ED Admitted ED Admitted ED Admitted ED Admitted DispoDispoDispoDispo to Departure TATto Departure TATto Departure TATto Departure TATFor the Indianapolis CampusFor the Indianapolis CampusFor the Indianapolis CampusFor the Indianapolis Campus

Month

Average Time in Minutes


250

200

150

100

S 19.1065

R-Sq 50.3%

R-Sq(adj) 48.0%

Regression

95% CI

95% PI

IN ED Admitted Disposition to Departure Monthly Average


r = 0.71. The

downward trend is


(p=0.000), and

accounts for 50.3% of

the total variation.

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ED LOS for All PatientsED LOS for All PatientsED LOS for All PatientsED LOS for All PatientsFor the Beech Grove CampusFor the Beech Grove CampusFor the Beech Grove CampusFor the Beech Grove Campus

Month

BG ED All Visits LOS (minutes)


240

230

220

210

200

190

180

170

160

S 10.4642

R-Sq 28.7%

R-Sq(adj) 25.5%

Regression

95% CI

95% PI

BG ED All Visits Monthly Average LOS in Minutes


r = 0.54. The

downward trend is


(p=0.007), but

accounts for only

28.7% of the total

variation in LOS.

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ED LOS for Admitted PatientsED LOS for Admitted PatientsED LOS for Admitted PatientsED LOS for Admitted PatientsFor the Beech Grove CampusFor the Beech Grove CampusFor the Beech Grove CampusFor the Beech Grove Campus

Month

BG ED Admitted LOS (minutes)


550

500

450

400

350

300

250

S 38.8652

R-Sq 13.5%

R-Sq(adj) 9.6%

Regression

95% CI

95% PI

BG ED Admitted Patients Monthly Average LOS in Minutes


r = 0.37. The

downward trend is

only marginally

significant (p=0.077),

accounting for only

13.5% of the total

variation in LOS.

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ED Admitted ED Admitted ED Admitted ED Admitted DispoDispoDispoDispo to Departure TATto Departure TATto Departure TATto Departure TATFor the Beech Grove CampusFor the Beech Grove CampusFor the Beech Grove CampusFor the Beech Grove Campus

Month

Average Time in Minutes


300

250

200

150

100

50

0

S 33.5966

R-Sq 24.5%

R-Sq(adj) 20.9%

Regression

95% CI

95% PI

BG ED Admitted Disposition to Departure Monthly Average (minutes)


r = 0.495. The

downward trend is


(p=0.016), and

accounts for 24.5% of

the variation.

HospitalHospitalHospitalHospital----wide Patient Flow (HWPF) Initiatives wide Patient Flow (HWPF) Initiatives wide Patient Flow (HWPF) Initiatives wide Patient Flow (HWPF) Initiatives RoadmapRoadmapRoadmapRoadmap

EDDoor to Doc

EDDx to Disposition

EDDoc to Diagnosis (Dx)

Disposition to Admit

ED-CPECTransfer

BedsideReg.

FrequentUsers

Program

RapidTriage (UM)

RN & MDReportCards

ED Compass

Bedding inHallways

Bed Mgmt Team

SBARHandoff

Pt PlacemtCoordinator

AdmissionNurses

Inpatient Stay

D/C & Aftercare

Discharge Home, ECF, etc.: 83%

Top 10Protocols

ED-ECFTransfer

PhysicianWorkflow

ChronicCare Mgmt

HWPFSteering

Committee

HospitalityCenters

HWPFTeam

PatientSatisfaction

End of LifeCare

EDSimulation

RadiologyTAT

PainMgmt

DischargeTeams

VentMgmt

AdmissionStatus

OverallInitiatives

CMSTeam

Curre

nt C

harte

red P

roje

cts

EDComm.Plan

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Questions?Questions?Questions?Questions?

Documents

Hospital- Hospital---wide wide Patient Flo W… · Hospital-Hospital---wide wide Patient Flow. ... • 520-bed system with 4,400 employees ... • The process for assignment of beds