Delivering on the Patient Promise. Reducing Hospital LOS
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- Cuthbert Palmer
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1 Delivering on the Patient Promise Reducing Hospital LOS
2 Outline Brief overview of WFBH Lessons Learned from Phase 1 Current State of Phase 2
3 Wake Forest Baptist Health Academic medical center located in Winston-Salem, NC Service area covers 24 county s in NW NC and SW VA Founded as North Carolina Baptist Hospital in 1923 Magnet Hospital 1,004 acute care, rehabilitation and psychiatric care beds 885 beds at Baptist Hospital and Brenner's Children's Hospital 94 beds at Lexington Medical Center 25 beds at Davie Hospital
4 2012 Stats Admissions: 38,601 Day Hospital Stays: 24,638 ED Visits: 104,325 Outpatient Visits: 905,879 Total Workforce: 13,625
5 Quality and Awards
6 Phase 1 Work Clinical Quality Goals set in Sept Aims with identified drivers and measures PI Team focused on Care Pathways and End of Life Care
7 Project Successes Leukemia Care Pathway Base MS-DRG: 281 Acute leukemia w/o maj OR proc Fiscal Year Hospital Cases LOS Outliers Mean LOS (Obs) StDev LOS (Obs) Mean LOS (Exp) LOS Index LOS Variance (Days) WAKEBAPTIST 151 (2) LOS Mean LOS StDev LOS Mean LOS LOS LOS Variance Fiscal Year Hospital Cases Outliers (Obs) (Obs) (Exp) Index (Days) WAKEBAPTIST 160 (5)
8 Project Success End of Life Care
9 Additional Project Work Discharge Optimization Mapped the patients stay from admission to discharge Discharge planning starts on admission Initially focused efforts on a few units Focus on discharge huddles Wanted to measure discharge process efficiency
10 Discharge Optimization Success
11 Any Impact on LOS???
12 Lessons from Phase 1 Were there other things that could have increased LOS? Are we focusing on the right drivers? How were projects executed? Change in behavior?
13 Lessons from Phase 1 Discharge Process Effectiveness Swift spread No focus on admissions Gaming the system to meet the target Messaging
14 Kicking Off Phase 2 Utilization and cost reduction efforts for FY14 Inpatient diagnostic tests and treatments Clinical practice variation LOS Vendor pricing
15 LOS Focus FY13-14 AIM FY14 DRIVERS FY14 MEASURES LOS: Decrease LOS by.30 days in 24 months (Mean Observed LOS; Includes early deaths; 18+ age, Excludes Normal Newborn/OB/PSYCH/RHB) High LOS Variance Case-Types Avoidable Days Discharge Process Effectiveness Number of care pathways developed for top 10 variance (by patient days) DRGs LOS for vent patient DRGs Number of avoidable days due to inability to obtain a post-acute bed placement Press Ganeyscore on speed of discharge questions Percent of patients discharged by 1pm
16 Current Status High LOS Variance Case Types Analysis to identify potential areas Heart Failure and Cervical & Thoracic Fusion Engaging leadership within areas to better understand opportunity and plan for implementation Vent Patient Pathway Interventions identified Work teams assigned and developing new processes
17 Current Status Avoidable Days Care coordination ownership Recently redefined avoidable day Reporting structure to capture avoidable days 84 reasons within 5 categories Recent meeting to discuss opportunity and implementation plan
18 Current Status Discharge Process Effectiveness 17% of units identified Physician/Nurse engagement plan Getting patients out and getting patients in
19 Timeline FY 14 Q1 (July Sept 2013) Utilization group launched in August LOS workgroup formed Analysis of drivers FY 14 Q2 (Oct Dec 2013) Defining project scope and implementation plans Kick-off meeting and planning for DC effectiveness FY 14 Q3 (Jan March 2014) Piloting of improvements across all drivers FY 14 Q4 (April June 2014) Target realization date and control phase
20 Questions?
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