Performance Improvement & Analytics. Broward Health - Coral Springs Medical Center Case Study

Transcription

1 Performance Improvement & Analytics Broward Health - Coral Springs Medical Center Case Study

2 Coral Springs Medical Center 2

3 Coral Springs Background Challenge with the availability of inpatient beds Increased volume followed construction of a new ED, leading to a 5% volume increase in the number of admitted patients Analysis of inpatient units showed the hospital was not getting patients discharged in a timely manner total discharges from Jul 2009 through Jun % discharges before 11:00 AM (best practice is 40%) Mean discharge time: 4:00 PM Emergency Department volumes begin to build at 9:00 AM Many patients wait several hours to be transferred to a inpatient bed Delayed discharges in inpatient units are the biggest inhibitor to efficient ED patient flow 3

4 Objectives Improve patient flow by optimizing the discharge process Improve the percentage of discharges completed by noon Identify and work to eliminate challenges to earlier discharges Reduce bed turnaround times (TAT) Improve the time between one patient leaving to the next patient physically occupying the bed 4

5 Performance Improvement Processes Information baseline Pareto analysis Daily bed board meeting Tools Formal bed board Standardized report forms Management reports Workflow analysis

6 Discharge Baseline Discharge Times Distribution July 2009 June

7 Quality Ratings HCAHPS scores are now a part of CMMS Value Based Purchasing (VBP) 1% of reimbursements held back and distributed to best performing and best improving hospitals Lots of red scores! HCAHPS FY11 Indicator Q1 Communication with Nurses 65% Communication with Doctors 72% Responsiveness of Hospital Staff 48% Pain Management 66% Communication About Medicines 58% Cleanliness of Hospital Environment 64% Quietness of Hospital Environment 49% Discharge Information 76% Overall Rating of Hospital (0-10) 54% Willingness to Recommend this Hospital 58% 7

8 Pareto Analysis Discharge Delay Reasons 8

9 Bed Board 9

10 Standardized Report Form Discharge checklist used to track and plan discharges on a unit 10

11 Discharge Delays Hospital Day of discharge delays divided into several categories Hospital categories are delays associated with services within the hospital Hospital Related Delays 76 reported Radiology 35 (46%) Hospital Related Delays by Unit Echo 7 (9%) Dialysis 6 (8%) EEG 1 (1%) Labs 10 (13%) Pharmacy 9 (12%) Other 7 (9%) 11

12 Discharge Delays Planning Planning delays are those in which issues exist in the coordination with external agencies (e.g. SNF, rehab), case management, insurance companies, etc. Planning Related Delays 376 reported External Agency 267 (71%) Case Management 41 (11%) Physician Orders 8 (2%) Insurance 38 (10%) Family Uncooperative 11 (3%) Ambulance Late 11 (3%) Planning Related Delays by Unit 12

13 Discharge Delays Physicians Physician related delays are associated with getting the proper paperwork in order to ensure that the patient is dismissed on time Physician Related Delays 504 reported Consult Rounding 234 (46%) Attending Rounding 211 (42%) Test on Day of D/C 15 (3%) Waiting for Rx Orders 19 (4%) Physician Coordination 8 (2%) Other 17 (3%) Physician Related Delays by Unit 13

14 Workflow Inconsistent process on how the Charge Nurse was conducting day of discharge activities Standardization of CN workflow across all units Mandatory training and rotation of CNs among best performing units 14

15 Successes Implemented formal bed board and daily meeting Adjusted staffing levels in EVS to better correspond with busy periods Developed standard ADT logs to track bed TAT Standardized the patient discharge process to ensure timely discharges and bed turnaround Implemented day-before-discharge planning and nightbefore-discharge patient identification Enhanced communication protocol for admitting physicians and consults 15

16 Results Patients discharged before noon has improved from 5% to 20% Bed TAT has improved from 7 hours (+/- 2 hours) to 3 hours (+/- 1 hour) Bed TAT ADT data completeness has improved from 20% to 96% Improvements in 8 of 10 HCAHPS indicators First year ROI of 218% HCAHPS FY11 Quality Measures Indicator Q1 Q4 Communication with Nurses 65% 71% Communication with Doctors 72% 72% Responsiveness of Hospital Staff 48% 59% Pain Management 66% 68% Communication About Medicines 58% 51% Cleanliness of Hospital Environment 64% 67% Quietness of Hospital Environment 49% 54% Discharge Information 76% 78% Overall Rating of Hospital (0-10) 54% 62% Willingness to Recommend this Hospital 58% 65%

17 About CTC Enterprise Ventures Corporation

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