Real Time Demand Capacity Surge Planning

Transcription

1 This presenter has nothing to disclose. Real Time Demand Capacity Surge Planning Katharine Luther, RN, MPM April 6, 2016

2 Theoretical Frameworks P2 Queuing Theory Compression wave

3 Framework P3 Resar,, Roger Resar, M.D.; Kevin Nolan, M.A.; Deborah Kaczynski, M.S.; Kirk Jensen, M.D., M.B.A., F.A.C.E.P., Management to Improve Hospitalwide Patient Flow, Joint Commission Journal on Quality and Safety, May 2011 Volume 37 Number 5, pp r

4 Start Here 9:15a Return to Unit 1. Review assignment of specific tasks for discharges before 2PM 2. If Unit plan needed discuss w/ Charge RN & Unit Secretary and team RTDC Flow (Real Time Demand Capacity) 4-5PM before CM leaves: 1. Huddle with Charge RN 2. Review today s predicted d/c s who remains, what needs to be done 3. Start tomorrow s R sheet Day to Night Shift report Charge RN to Charge RN Update R Sheet If Needed Revised: 5/12/09 4 7:30p 7:00a: 1. Evening / Night shift to complete tasks for the following day (ie: teaching wound care w/ family, update changes in condition, communicate discharge w/ family) 2. Update R sheet (update pending/confirmed discharge list, add approximate time of dc 8:30-9:00AM - Hospital Wide Bed Meeting 1. Review demand/capacity # s from each unit 2. Plan for red units with mismatches 3. Review previous day s plans and successes 7AM-8:30 Unit Based Huddle 1. Review pending discharge list; identify needs 2. Assign responsibility for specific discharge tasks 3. Decide on whether the discharge will occur before 2PM Night to Day Shift report Charge RN to Charge RN Update R sheet if needed

5 RTDC P5 Unit Beds Empty Discharges D/C by 2:00 Yesterday Predicted/ Actual 4 South 3 North (Surg) 5 West 2 South ED OR

6 RTDC Discharge Prediction R Sheet

7 Unit Summary Worksheet for RTDC Capacity Demand Day/ Date Avail Beds Total Disc DCs By 2pm Total Admits Admits By 2pm PLAN S U C C E S S F U L 7

8 Example Results -- UPMC P8 Resar,, Roger Resar, M.D.; Kevin Nolan, M.A.; Deborah Kaczynski, M.S.; Kirk Jensen, M.D., M.B.A., F.A.C.E.P., Management to Improve Hospitalwide Patient Flow, Joint Commission Journal on Quality and Safety, May 2011 Volume 37 Number 5, pp r

9 All Teach All Learn P9 Real Time Demand Capacity Implementation Marianne Walston Director of Critical Care and Emergency Services Setara Healthcare Suffolk, Virginia

10 Surge Planning P10

11 Table Exercise: Surge Plan P11 Do you have a surge plan? Who manages it? How often is it implemented? How good is it? Do you debrief to learn after implementation?

12 Linda Kosnik, RN, MSN Chief Nursing Officer Overlook Hospital Summit, NJ 07902

13 Surge Plan Basic Concepts Categories Census Those indicators which describe what that unit counts to determine its workload Acuity Criteria which determine the level of stress specific to that population, procedures or specimens measurable in time. This category often measures turnaround time. Other Criteria specific to information systems and supplies. Staff Indicators specific to the status and matching of staff to demand and for the identification of staffing discrepancies. Census Acuity Other Staff

14 Basic Concepts Census Acuity Other Green Yellow Orange Red Status Green Reflects an optimally functioning system, a state of equilibrium, homeostasis. Staff describe it as, a good day. Yellow Reflects the state of early triggers which identifies and allows the system to initiate early interventions. Orange Reflects escalating demand without readily available capacity. In this state aggressive action required to avoid system overload and ultimate gridlock. Red Reflects a state of gridlock as a result of system overload. The system should respond by using its organizational Disaster Plan. Staff

15 Categories Basic Concepts Criteria=Indicators A criterion is a variable with a certain spectrum of valid values. For every criteria there must be Intervention(s). For every criteria there must be a call to action or it will not be a valuable criteria for the category. Census Acuity Other Staff Status Green Yellow Orange Red Intervention Intervention Intervention Intervention Intervention Intervention Intervention Intervention Intervention Intervention Intervention Intervention Interventi on Interventi on Interventi on Interventi on 15

16 EMERGENCY CENTER ACTIONS CAPACITY ASSESSMENT & COMMUNICATION Surge Plan -- Example P16 EC Level 4 EC Level 3 EC Level 2- ALERT EC Level 1-CODE PURPLE Definition: BEDS AVAILABLE Definition: APPROACHING TRIGGER LEVEL Definition: OVER CAPACITY (SURGE) Definition: DISASTER CAPACITY ** Requires Admin on-call alert All EC Level 2 elements and no direct admits of any kind except an EC EC: (Not busy/busy) EC: (Very busy) EC: (Severe) transfer from QMH. Normal operations Minimum of one (1) element below: Minimum of one (1) element below: Waiting Room > 25 patients Waiting Room > 60 patients Waiting Room > 80 patients Minimum of one (1) element below: Shock Room > 5 Shock Rooms > 10 Shock Rooms > 15 Waiting Room > 100 patients Minimum of one (1) element below: (unless holding >2 ICU with bed assignment > 30 min) (unless holding >3 ICU with bed assignment > 30 min), or Shock Rooms > 18 Holding <2 ICU with bed assignment, <4 floor admissions, Admitted patients waiting for inpatient bed Total (4-6 (unless holding 2 MICU EMTALA Transfers) (unless holding >4 ICU with bed assignment > 30 min), or <10 total admissions. (EMR= Request for floor admits) (EMR= Request for Hospitalization ) Admitted patients waiting for inpatient bed Total (unless holding 3 MICU EMTALA Transfers) Hospitalization ) (8-10 floor admits) (EMR= Request for Hospitalization ) Admitted patients waiting for inpatient bed Total >20 (>10 floor admits) (EMR= Request for Hospitalization ) House: Administrator Notified and Chief of Staff Notified: EC Diversion activated EC Diversion activated Trauma Diversion activated Stroke Diversion activated Capacity Leader uses Lync IM (Instant Messaging) to notify Direct admits from Harris Health facilities remain open as Psych Diversion activated nursing units of EC Level 3. Consider any additional long as no EC resources are utilized. STEMI Diversion activated notification message for clarity. If a resource is needed to be deployed or a unit needs a EC Level 1 and Diversions are each activated by Executive directive the Capacity Leader will call the unit(s) directly. Capacity Leader uses Lync IM (Instant Messaging) to Authorization (BT Admin Executive Team only) notify nursing units of EC Level 2. Consider any additional Paging Overhead: (Only as Last Resort) notification message for clarity. If a resource is needed to Capacity Leader uses Lync IM (Instant Messaging) to notify nursing EC Level 3 only when there are admitted patients waiting to be deployed or a unit needs a directive the Capacity units of EC Level 1. Consider any additional notification message alert the nursing units to pull to admit and rapidly discharge. Leader will call the unit(s) directly. for clarity. If a resource is needed to be deployed or a unit needs a directive the Capacity Leader will call the unit(s) directly. Paging Overhead: (Only as Last Resort) EC Level 2. The Capacity Leader will assess and call Paging Overhead: (Only as Last Resort) specific units identified to lend staff resources and/or EC Level 1 for all except Admitted patients waiting. The Capacity begin rapid pull to admit. Leader will assess and deploy resources. EC Level 1 and Code Purple for all + admitted patient waiting since this deems beds in the hallways. Code Purple Activation will be effective for a 4 hour period of time. At the conclusion of the 4 hours, the Capacity Leader, Administrator, Administrator on Call, Chief of Staff and ADON-EC will determine a Code Purple Notification of: Re-activation End Capacity Leader /AOD Capacity Assessment and Communication Emergency Center Nursing Units Physicians Support departments EC Actions: Responsibility: EC NCM -NCM shift huddle at beginning of shift -EC Teams in place with bedside reporting. -Nursing and physician care of emergency patients as per department policy. -EC patients discharged within 30 minutes of DC order -NCM evaluates capacity every 2 hours and electronically records status every 6 hours. -Stay a bed ahead. -Push to Full when beds available EC Actions: Responsibility: EC NCM - All EC Level 4 actions -NCM shift huddle every four hours. -Operationalize census alert and notify House Supervisor and Bed Management of status. -Utilize hall beds for patients waiting for transport -Request EC Physicians facilitate disposition of current patients -NCM evaluates capacity every 2 hours and electronically records status every 6 hours. -Consider and plan for RME process if surge continues -Identify any patient waiting for non-urgent transport (move to hall if possible) -Call House Supervisor to round on ED and nursing units to evaluate situation -Initiate RME (Rapid Medical Evaluation) process in MSE (applicable to after-hours operation 12 midnight to 6am via CDU MD coverage. EC Actions: Responsibility: EC NCM - All EC Level 4, EC Level 3 actions -NCM shift huddle every 2 hours -Operationalize Census Alert Role -NCM, House Supervisor and Bed Management huddle at board and prioritize patients -Request EC supply tech check for stock levels of essential supplies in TX rooms -Notify other departments of Level Alert status -Move patients awaiting admission to alternative holding areas -Assign EC CNL and EC Educator (business hours) to triage or direct patient care duties or critical care transport assist to inpatient admit. -Request hospital leadership round in ED waiting room for visibility and service recovery with patients. -EC Tech assigned to transport admissions to inpatient units -NCM notifies EM Systems every 2 hours of EC saturation status. -NCM notifies HFD Dispatch every 2 hours of EC saturation status. EC Actions: Responsibility: EC NCM -All EC Level 4, EC Level 3, and EC Level 2 actions -Consider and assess again for any patients who can be discharged from EC. Collaborate with physician on status for potential admit re-determinations. -PRN and Hourly updates to Capacity Leader who will then update Bed Management, Administration and/or Administrator on Call. -Update EMSystem every 2 hours while on EC Saturation/Divert status. Ben Taub Hospital Texas Medical Center 586 beds Level 1 Trauma Center 106,000 ED visits Claire Lauzon-Vallone, MBA, RN, CPHQ Administrative Director of Quality and Health Outcomes Harris Health, Houston TX

17 17 An Essential Element In Healthcare System Striving For High Reliability Paul B. Davenport RN, EMTP, BSN, MBA, CMTE Melanie K. Morris, MSN, RN, NREMT-P, CMTE

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19 Mission Control Center 19

20 What Does A Typical Transfer Feel Like 20 Multiple calls Information is segmented Human error designed system Dependent on phone communication, electronic methods.zero face to face (or line of sight) Variation on processes by section

21 What It Should Feel Like 21

22 Details 22

23 Mission Control=Mission Accomplished! If you build it, they will come Consistency in processes is key Seamless transfer process ensures customer loyalty Declined transfers: service recovery Thorough review monthly via Transfer Center software Trends: know who you said no to Focused marketing and outreach Patient follow-ups 23 Excellence in customer service for EVERY call

24 Summary 24 Designed for 100% reliability and unexpected event identification (HRO) Situational awareness (HRO) Actionable information (Information based organization) (HRO) One Call Does it All philosophy Seamless patient entry into the system Collaboration of key departmental operations Transfer acceptance and patient transportation model Centralized throughput command center Source of truth regarding all throughput information Overall goal: Right patient, right physician, right bed, and right mode of transport =optimal patient outcomes

25 Table Exercise: Surge Plan P25 Do you have a surge plan? Who manages it? How often is it implemented? How good is it? Do you debrief to learn after implementation?