Moving the Needle on Hospital Throughput: Breaking Through the Status Quo. Session ID: 325

Transcription

1 Moving the Needle on Hospital Throughput: Breaking Through the Status Quo Session ID: 325

2 Objectives Objective 1: Demonstrate how two common strategies can be deployed to maximum benefit to support improvements in patient progression and throughput. Objective 2: Discuss the role of nursing leadership in leading the charge and building commitment to transforming throughput operations.

3 UAB Overview 1,157-bed academic medical center Only ACS-designated Level 1 Trauma and Burn Center in Alabama Comprehensive Transplant Program Only Magnet Designated Hospital in the State of Alabama 50,000 annual admissions 57 OR Suites with 130 surgeries a day 300 ED visits a day 4,400 deliveries a year with a 50 bed CCN and 85 bed RNICU Safety net hospital 35% of patients uninsured.

4 UAB Campus

5 Percent Occupancy % Occupancy Hospital Occupancy 89.00% 87.00% 85.00% 83.00% 81.00% Hospital Occupancy by Month UCL 87.11% CL 84.06% LCL 81.01% 79.00% 77.00% 75.00% Month 105% 101% 100% 98% 95% 90% 90% 87% 85% 89% 80% 6:00 7:00 8:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00 22:00 23:00 Current Census Time of Day Projected Census

6 2014 State of the Union 15% of Diversion Discharge 40% 60% Accepting Patients Orders Hospital Transfers 210 minutes Average Wait Time for Inpatient bed

7 Number of Patients Bed Supply and Demand The Daily Afternoon Bed Crunch Time of Day

8 UAB Nursing Organization CNO Psychiatric and Emergency Services Highlands Hospital Nursing Excellence Surgical Nursing Women's & Infants Services CV Services Medical Nursing Neurosciences & Rehab Services Throughput Care Transitions APPs Psych Highlands Nursing CNE Surgical Services Women's Services CV Nursing Units Medical Nursing Neuro Sciences NRCs Case Manageme nt NPs UED Highlands ED Magnet GI Med Infants Service Echo Lab Heme/Onc Stoke Program Center for Patient Flow Social Services PAs MET Staffing pool Nursing Education Transplant Telemetry BMT Spain Rehab Transfer Center EMMI CRNAs RMS Informatics Trauma CRU Palliative Care Drug and Alcohol Screening High Risk Fund Nursing Finance

9 Center for Patient Flow Structure CPF Supervisor Nursing degree, responsible for oversight of daily operations and management of staff Patient Placement Coordinators Nursing degree, responsible for oversight of shift. Handles any escalation due to OSH transfers or patient placement Patient Placement Specialist Non clinical, highly trained, responsible for transfer center calls, patient placement, and monitoring of patient delays Nursing Resource Coordinator Nursing degree, responsible for the House needs and acts as the 24/7 Administrator Stat Nurse ACLS, PALs, TNCC trained nurse, responsible for addressing clinical needs at the direction of the Nursing Resource Coordinator Lean Analyst: Provides data analysis and project management support for the Center for Patient Flow

10 What Gets Measured Gets Done Nursing Throughput Goals

11 Center for Patient Flow Operations Use Patient Flow Management System visual for all staff Centralized for all Portals of Entry Emergency Departments Direct Admissions Transfer Center Admits Operating Room & Procedural Area Admits Protocol Driven Placement based on: Service Level of Care Diagnosis/Procedure

12 ED ADMITS SURGERY ADMITS CARE COORDINATION DELAYS INTERNAL TRANSFERS CLINIC ADMITS CENTER FOR PATIENT FLOW SERVICE +LEVEL OF CARE DIAGNOSIS RESOURCES TRANSPORT OPERATIONS ENVIRONMENTAL SERVICES OPERATIONS OPERATIONAL DELAYS TRANSFERS

13 Center for Patient Flow Goals Access Provide opportunity for patient to have access to the excellent care UAB has to offer Efficient & Effective Placement Provide timely placement of patients into the care setting most beneficial for the patients Identification of Throughput Barriers Identify barriers to daily throughput and provide insight to gain solutions by partnering with Case Management.

14 Bed Huddle

15 Bed Huddle Standard Agenda 1. Review of Previous Day Throughput data Blocked room list Infection prevention 2. House-wide Overview Diversion status Special circumstances of the day Priority level of care changes 3. Diversion Census and Needs Breakdown by division discharges and bed needs 4. Plan of Care / Discharge Barriers 5. High Priority Unit Designation 6. Closing

16 Nursing Daily Dashboard

17 Measuring Our Progress October 2013 compared to January 2016 PENDING COMPLIANCE # OF POTENTIAL ORDERS TO ACTUALS CONFIRMED COMPLIANCE # OF ORDER NOTIFICATIONS BEFORE ACTUAL DISCHARGE 20% 70% 39% 75% AVERAGE PENDING TIME AVERAGE TIME FOR NOTIFICATION OF PLANNED DISCHARGE AVERAGE CONFIRMED TIME TIME FROM DISCHARGE ORDER TO PATIENT LEAVES FACILITY 13hrs 1 day 4.5 hrs 2.4 hrs

18 Placement Accuracy BED AGGREGATION PLAN

19 Community Reputation FY13 compared to FY15 Measure of Success Pre-Implementation Post-Implementation Diversion 60% 19% Declines Due to Capacity 249/ month 35/month Accepted Transfers 59% 76%

20 The difference between Ordinary and Extraordinary is that little EXTRA

21 The Secret Sauce Five Key Ingredients 1. Enterprise-wide leadership alignment around access and throughput as a strategic priority 2. Shift in culture around throughput and ownership of bed placement decisions 3. Rigorous use of data and technology to support decision-making and innovation 4. Focus on action 5. Celebration of success!

22 The Secret Sauce Enterprise-wide Alignment Enterprise-wise approach with concurrent access and throughput efforts in primary care and ambulatory clinics, perioperative services and inpatient areas Active engagement of nursing, administrative and physician leadership High visibility and participation of nursing and key support and ancillary department leaders Supported by performance goals linked to compensation

23 The Secret Sauce A Shift in Culture Heightened focus on throughput as a daily priority and accountability for leaders and staff across the enterprise throughput is everyone s job! Resolute commitment to centralizing responsibility, accountability and authority for decision making within the Center for Patient Flow Alignment of patient placement and nursing resource / staffing functions Involvement of physicians to reduce one-off decisions and end-runs

24 The Secret Sauce The Use of Data and Technology Optimization of patient flow system s functionality to support communication and decision-making both internally and externally (e.g., with post-acute providers, ambulance companies, insurers) Rigorous use of data to support transparency and realtime decision-making Use of daily score cards with agreed-upon metrics to clarify goals, monitor performance and troubleshoot

25 The Secret Sauce Focus on Action Unwavering commitment to hardwiring new processes into the daily work of managers and staff -- not approached as redesign project or pilot Bed huddle structured to support real-time problem solving and action Broad cross-functional attendance at bed huddle reduced finger-pointing and promoted collaboration and problemsolving Transparency and visibility promoted accountability for follow-up

26 The Secret Sauce Celebration of Success Bed huddle starts with acknowledgement of wins from prior day a heroic action, a great patient story, a metric that moved Real-time data sharing supported ability to identify and acknowledge progress more frequently than monthly management meetings Participation of leadership and visibility of effort made acknowledgement of success and progress meaningful to managers

27 Contact Information Terri L. Poe, DNP, RN, NE-BC Chief Nursing Officer University of Alabama Medical Center Post inspiring moments from the conference to the mobile app! #AONE2016