Take These Actions to Immediately Improve Patient Throughput - PowerPoint PPT Presentation

Take These Actions to Immediately Improve Patient Throughput Webinar | October 2, 2017 | 10:00 AM CST Results Delivered. Performance Improved.

Presenters Bonnie Barndt-Maglio, RN, PhD Managing Director Prism Healthcare Partners Barbara Bryan, BSN, MBA Managing Director Prism Healthcare Partners 2

How significant of a problem is patient throughput? What are the real costs? Take These Actions to Immediately Improve Patient Throughput 3

Burning Platform: The Joint Commission Standards Highlights of Standards  Establishment of processes, measures and goals that support the flow of patients throughout the hospital  Plans for the care of admitted patients who are in temporary beds and in overflow locations  Plans for patients boarding in the ED, with specific procedures for the behavioral heath population  Criteria for decision-making to initiate ambulance diversion  Active review of patient flow processes, results and achievement of goals  Take action to improve patient flow processes when goals are not achieved 4

Effective Patient Throughput Creates Capacity Allowing for Additional Revenue or Savings Through Decreased Resource Use T otal Excess Day T otal Cost Savings 25% Cost Savings Excess Days Discharges Opportunity Opportunity 26,543 6,152 $1 1,944,350 $2,986,088 100% 33% 25% 20% 10% 50% $1 1.9M $3.9M $3.0M $2.4M $1.2M $6.0M 73 Beds 24 Beds 18 Beds 15 Beds 7 Beds 36 Beds 5

Questions to Address Newly-Defined Capacity Strategy 1: Backfill with additional volume  Where can we gain additional volume?  How much additional volume is available?  What type of volume is optimal?  Can new service lines be developed?  Can existing service lines be expanded?  Can we develop “Centers of Excellence”? Strategy 2: Maximize resources  Can we utilize swing beds?  Can we temporarily close or consolidate underutilized units?  Do we need to reallocate staff to areas where volume is high? 6

What are common misconceptions about patient flow and throughput? Take These Actions to Immediately Improve Patient Throughput 7

Common Misconception: Patient Flow is Easily Repaired  Everyone is involved – most importantly, patients and families! Communication Unit RN/ Environmental Charge RN Services Admitting/ RN Bed Financial Managers Communication Communication Reps Patients & Families Social RN Case Workers Managers Ancillary Physician/PA Services Communication 8

Common Misconception: Nursing and Case Manager Staff Can Fix the Problem  Common slip-ups regarding communication:  Care team members communicate to the patients and to one another separately  No discussion of ADD (Anticipated Date of Discharge) or clinical milestones  Discussion with families for discharge planning often occurs day before or day of discharge Coordinated Interdisciplinary Team Rounds Attending CRM Nurse/ Physical Attending/ Resident Social Therapy Hospitalist Worker Orthopedic Specialist Patient Social RN Case Staff RN Worker Manager Staff RN Physical Therapy Resident Patient 9

Common Misconception: Throughput Starts in the Emergency Department Rather than with Sound Inpatient Throughput Processes Patient Throughput Effective Discharge Effective Bed Management Processes Processes Discharge Discharge Bed Patient Planning Execution Turnover Placement Key Performance Metrics and Methods of Measurement Streamlined Communication and Structured Reporting 10

How do you start a successful throughput improvement project? What are the critical success factors? Take These Actions to Immediately Improve Patient Throughput 11

Project Infrastructure Components Methods for communication and feedback of project efforts A project timeline with key milestones for achievement of goals Establishment of goals, expectations and project ground rules Formation of committees and work groups with interdisciplinary membership A clear governance structure with a dedicated Executive sponsor 12

Critical Success Factors of a Patient Throughput Project A sound project infrastructure 1. Comprehensive examination of key patient flow processes 2. Meaningful performance metrics and methods of measurement 3. Maximization of tools and technology to enhance patient flow 4. processes Communication and reporting methods that cross all levels of the 5. organization 13

How do you engage all levels, from management to medical staff, in managing and improving throughput? Take These Actions to Immediately Improve Patient Throughput 14

Involve Management and Physicians in Governance Structure Oversight Committee Patient Flow Steering Committee Point of Entry and Bed Coordination of Care Team Discharge Process Team Access Team  Each team should have team leader and interdisciplinary membership, including physician representation in each group  Work teams develop solutions that are vetted through Patient Flow Steering Committee  Critical decisions are elevated to Oversight Committee (i.e. decisions that impact labor, physician or community relations, or other sensitive issues determined by Oversight Committee) 15

Clinical Performance Structure of Weekly Throughput Meetings • Shared Governance Hardwire Into Organization Model: Transparency, immediacy and accountability, both Pilots • Hospital leadership lateral and vertical weekly visibility, support and Weekly Work direction Team Meetings • Active participation Patient Flow of nursing Steering management, Committee ancillary support Weekly Meeting management, and providers Success relies on transparency and collaboration 16

Critical Success Factors for Committees and Work Teams Clear Communication Inputs Outputs Willingness To Hold Visible Senior Analytics Center for Examples All Stakeholders Management Sustainable Accountable Participation · Vendor Benchmark Information · Public Reported Information Performance · SME Intelligence Patient · Hospital Data Throughput Improvement Constructive & Balanced Prompt Conflict Prioritization Resolution Adequate Dedication of Resources & Time 17

How should hospital leaders track and manage clinical performance throughout the day, the week, the month? Take These Actions to Immediately Improve Patient Throughput 18

Performance Metrics and Measurement Methods  Determine very specific metrics to monitor that are directly related to initiatives and will accurately represent success/failure of pilots  Determine data sources and Measurable Simple validate data integrity  Create streamlined reporting process  Establish goals and baseline for each metric Timely Meaningful  Structure communication system to share information  Ensure compliance with monitoring  Hold everyone accountable 19

Sample Scorecard – Inpatient Throughput Department Indicator Baseline Target Jan Feb March Discharge within 2 hrs of order 15% 35% 19% 32% 57% Medical % of Discharges by 11am 19% 30% 18% 15% 28% Transfer Turnaround Time 15% 25% 28% 27% 27% Discharge within 2 hrs of order 15% 35% 24% 37% 40% Surgical % of Discharges by 11am 22% 30% 17% 24% 31% Transfer Turnaround Time 15% 25% 23% 45% 53% Discharge within 2 hrs of order 18% 50% 18% 28% 35% ICU Transfer Turnaround Time - OUT 23% 50% 23% 42% 61% Transfer Turnaround Time - IN 40% 80% 40% 21% 51% Bed Cleaning Turnaround Time 85 60 78 72 58 EVS STAT Bed Clean 62 45 50 45 42 Bed Direct Admit Denials 46 0 38 23 15 Management Occurences of No OR Add - Ons 9 0 7 5 4 20

Medical Unit – Discharge Orders by 11AM Baseline (2014) 39 40 400 31 31 January 30 43% of orders 300 Baseline 16 15 were placed 20 13 13 200 9 before 11AM 6 10 100 1 1 1 0 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 39 400 40 February 34 27 Baseline 47% of orders 300 24 30 were placed 14 200 20 12 11 11 before 11AM 5 4 100 10 1 1 0 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 42 36 36 400 40 March 46% of orders 300 Baseline 30 were placed 18 15 200 13 13 12 20 10 before 11AM 5 3 100 10 2 2 1 0 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 60 400 49 50 Baseline 300 49% of orders 30 April 40 27 21 30 200 were placed 15 14 13 13 20 8 before 11AM 6 100 1 1 10 0 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 Monthly Trend 50% Placed Before 42% % Orders 11AM 40% 30% Baseline January February March April 21

Discharge Orders before Noon by Physician  Discharge order times have improved but show opportunity for increased focus with targeted physicians 100% 86% 90% 80% 70% 65% 64% 60% 52% 50% 44% 38% 38% 40% 35% 29% 29% 30% 20% 20% 10% 0% Doctor Doctor 4 Doctor 6 Doctor 3 Doctor 1 Doctor 5 Doctor 8 Doctor Doctor 2 Doctor 7 Doctor 9 11 10 22