OUTPATIENT FACILITY BOARDS: PRACTICE MANAGEMENT ON ONE SCREEN. Isaac Dapkins MD: Bronx-Lebanon Hospital Center

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1 OUTPATIENT FACILITY BOARDS: PRACTICE MANAGEMENT ON ONE SCREEN Isaac Dapkins MD: Bronx-Lebanon Hospital Center

2 Agenda Bronx-Lebanon Hospital Center Objectives What is a Facility Board? Our Outpatient Facility Board Outcomes Lessons Learned Questions

3 Bronx-Lebanon Hospital Center Founded as two hospitals: Lebanon (1889) and Bronx (1909). Merged in Largest voluntary not-for-profit healthcare system in South/Central Bronx 579 acute care beds 32,000 acute care admits annually More than 90% occupancy rate 130,000 ED visits 1 million ambulatory care visits annually 330 long-term care beds

4 Our Practices Article 28, 330 grant funded FQHC 22 clinical programs at 9 different sites. All 9 sites are PCMH Level 3 (2011 Standards) More than 99% of referrals are internal (excludes only Cardiothoracic Surgery) All on Allscripts Sunrise Clinical Manager 6.1 and Enterprise Scheduler since 2008

5 Bronx-Lebanon Hospital Center

6 Bronx, NY High poverty Poorest congressional district in the US High disease prevalence DM, Obesity, Asthma, HIV Highly diverse Spanish speakers Recent immigrants

7 Objectives Triple Aim Reduce overall process time (Lower Cost) Identify bottlenecks in real time (Patient Experience) Improve discharge process (Outcomes/Pop Health) Triple Aim +1 Improve user experience

8 What is a Facility Board? Criteria Based List+ Colors Timers Views => Locations Developed for use in EDs Bronx-Lebanon uses them in ED and Inpatient units

9 An Outpatient Facility Board Outpatient Facility Board Step based views General locations Patients flow through locations Process driven

10 General Outpatient Workflow Check-In Vitals Clinician Check- Out

11 Our Old Workflow Highly variable processes ES, AM, Acute Care, Ambulatory Care Clinical documentation inconsistencies Highly variable outcomes Registration errors Bill-holds, denials or unbilled visits High walk-outs and low patient satisfaction

12 General Outpatient Workflow Check-In Vitals Clinician Check- Out

13 Our Current Workflow Structured processes All in one place Clinical documentation checking Manager view (with colors) Consistent outcomes Each visit closed out in timely fashion Fewer bill-holds, denials or unbilled visits Better patient flow

14 The Outpatient Facility Board

15 1. Expected Patients View Shows patients with appointments today.

16 2. Vitals View Shows patients who have been registered but need vitals. Columns give basic information and indicate wait time. Patients who do not answer when called can be marked as potential walk outs.

17 3. Clinician View Shows patients waiting to see providers or currently with providers Can be filtered further to show only the provider s patients Includes different wait time columns for provider activity

18 4. Check Out View Shows patients who have seen the provider and are ready for discharge process Columns indicate orders still on hold from this visit. Encounter form information populates here for easy access during discharge

19 5. All View All columns are visible from this view Shows all patients who are currently in the clinic

20 Outstanding View Shows all visits not closed out before the end of the day

21 Outcomes

22 Outcomes User satisfaction Appears to be a reduction in process time No patient satisfaction updates Currently implemented in 3 sites plan to roll out across network by December

23 Encounter Completion Time Go-Live

24 Discharge Type in the CCC

25 Patient Process Time Total Patient Process Time 2:23 2:24 2:09 1:56 1:55 1:40 1:26 1:12 1:30 1: :57 0:43 0:28 0:14 0:00 CCC H&W7

26 Patient Wait Time for Provider Patient Wait time for Provider 1:04 0:57 0:50 1:00 0:50 0:43 0:36 0:28 0:25 0: :21 0:14 0:07 0:00 CCC H&W7

27 Lessons Learned

28 Education Computer Based Training (Captivate) Monitor Outcomes by User 1-on-1 training as needed

29 Questions? Isaac Dapkins MD