LWOT Reduction Plan Success Story: Advocate Trinity Hospital
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1 LWOT Reduction Plan Success Story: Advocate Trinity Hospital Draft Submitted Jan. 6, 2011 Jacquelyn Whitten, DNP, RN Kimberly McIntyre, EdD(c), MSN, RN Julian M. Magdaleno, MS February 19, 2012
2 The Leaving Without Treatment (LWOT) Reduction Plan Success Story Busy 19-bed ED with an 8-bed Fast track area in an urban Emergency Department located on the southeast side of Chicago. Approximately 71% of Trinity s patient admissions come from the ED, which serviced nearly 40,000 patients in
3 The Leaving Without Treatment (LWOT) Reduction Plan Success Story 12.4% of patients arriving in the ED leave without being seen during high acuity times (11a-11p) daily peaked as high as 20%. Through "Process Improvements" the ED has reduced the percentage of LWOTs 1.1%.
4 Trinity s Emergency Department Past
5 Broken Processes Long turn around time for lab and radiology results Slow Fast Track Long wait times in ED waiting room Long disposition times Increased number of holders Delays in transportation Delays in triage process Delays in patient registration
6
7
8 Trinity s Emergency Department Present
9 Trinity s Best Practices ❿ Article: Metro Health, Spring 2011 State of Emergency: The Future of Emergency Departments ❿ Article: Nursing NOW newsletter, Vol. 1: Issue Emergency Department: A First Step on the Road to Success and STEMI Improvements Lead to Improved Team Work ❿ Radio: WVON broadcast March 16 th 2011 Trinity s Emergency Department, Dr. Anwer Hussain ❿ Award: Mission Lifeline STEMI Receiving Center Performance Achievement Award 2011 Bronze Level ❿ Article: Chicago Tribune, July 13, 2010 Health Overhaul May Mean Longer ER Waits and Crowding was also picked up by USA Today, CBS News, MSNBC, and NPR radio ❿ Award: Emergency Medicine Excellence Award 2010
10 Creating the Greeter position Scope Greeter promotes the patient centered care model by expediting patient flow and promoting patient satisfaction. Process Change Greeter notifies the triage nurse about any change in patients health complaint.
11 ED Unit Based Council Scope Develop a shared governance model which provided the ED team a voice to address concerns. Process Change Associates conduct regularly scheduled shared governance unit based meetings to proactively develop solutions to present to the leadership team.
12 New ED Physician Group Scope The new ED physician group had a vision around quality, safety, compassion, partnership, performance improvement and patient throughput Process Change Their contributions with performance improvement was evidenced by a decrease in LWOTs, LOS and improved turn around times.
13 High Census Alert Process Scope House-wide notification of increasing patient census. Process Change A collaborated effort with healthcare teams to coordinate patient flow.
14 Bed Huddles 9:30am, 3:30pm and 3:00am Scope Optimizing with all resources to expedite the coordinated plan of care in anticipation of the patient discharge. Process Change A collaborated group of healthcare professionals focused on the discharge plan of care.
15 Leader Patient Rounds Scope To demonstrate to patients and families the commitment to provide quality care, keeping patients and their families informed and promoting a patient centered care model. Process Change Leadership rounding with patients to ensure quality care and patient satisfaction.
16 Establishing Turn Around Times for Support Departments Scope Establishing standard turn around times for ancillary departments. Process Change Ancillary departments have established turn around times for results that are aligned with the performance improvement goals of the ED.
17 Utilizing the Tracking Board; Throughput Alerts Scope Visual representation of alerts needed to move the patient through the continuum of care. Process Change The healthcare team can respond timely to expedite the patient through the continuum of care.
18 Posting Metrics and Sending s Daily to Associates Scope Associate notification of the ED daily performance metrics. Process Change Associate ownership of ED throughput metrics
19 Reeducation on Patient Flow Scope Provides associate education regarding the expectations of moving the patient through the continuum of care. Process Change Associates were able to articulate their roles, expectations and utilize resources to move patients through the continuum of care.
20 ED Performance Metrics Average National Performance (50%) National Best Demonstrated Practice (10%) Trinity 2010 Trinity 2011 ED LOS Discharged Patients (mins.) Left without Being Seen 2.3% 0.79% 2.2% 1.1%
21 Trinity s Emergency Department Future
22 Sustain the Value and Delivery of Quality Care Hourly Rounding for Outcome Discharge Phone Calls Bedside Shift Report Inpatient Pull Team Hand off Process Automatic Initiation of Standing Order Sets in Triage Key Words at Key Times
23 Trinity s ED Future Improved workflow efficiency from door to doc and beyond More collaborative team assessment on the front end Expedite patients to where they need to be ASAP What do we want the future state in the ED to look like? Limited time in Triage Improve utilization of Fast Track Less shifting of the patient from person to person Focus on patient quality Reduction in LWOT s Scores Maintain high safety standards
24 Trinity s ED Recognitions Article: Metro Health, Spring 2011 State of Emergency: The Future of Emergency Departments Article: Nursing NOW newsletter, Vol. 1: Issue Emergency Department: A First Step on the Road to Success and STEMI Improvements Lead to Improved Team Work Radio: WVON broadcast March 16 th 2011 Trinity s Emergency Department, Dr. Anwer Hussain Award: Mission Lifeline STEMI Receiving Center Performance Achievement Award 2011 Bronze Level Article: Chicago Tribune, July 13, 2010 Health Overhaul May Mean Longer ER Waits and Crowding was also picked up by USA Today, CBS News, MSNBC, and NPR radio Award: Emergency Medicine Excellence Award 2010
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