Communication is essential to an effective PULL system - One of the ways that we support Pull is through Alert Paging CC-Bed Alert: M/S near full-capacity LLM/High-level at full-capacity 20 post-ops, 7 ED holds, 2 to EAU-N at 0900 projected census to 99% within 3 hours Brenda
Bed Alert Page CC-Bed Alert: M/S near full-capacity LLM/High-level at full-capacity 20 post-ops, 7 ED holds, 2 to EAU-N at 0900 projected census to 99% within 3 hours Brenda Level 0 Level 1 Level 2 Level 3 Level 4
Projected Census
Level 4 Bed Alert Level 4 Triggers Site Occupancy >95% >5 ED Holds (patients waiting for inpatient beds) ED approaching or on diversion PACU approaching or at full-capacity Expected Actions: case managers, physicians, & nursing staff work together to facilitate early discharge all pending/confirmed discharges are entered into E-board physicians write complete order set at the time the order for discharge is written newly admitted patients are transferred into assigned bed within 30 minutes of clean bed assigned PFCs report to ED/PACU to assist with transfer of assigned patients
Definitions PACU Alert System a collaborative approach that proactively looks at perioperative demand and capacity to avoid putting the OR on hold using alpha-page notification of predetermined capacity measures that trigger specific action by a multi-disciplinary group of key staff Level 0 Level 1 Level 2 Level 3 Level 4 Steady flow Approaching full capacity Full-capacity Overflow OR Hold
The PACU Alert System utilizes the bedboard to streamline communication and prevent OR HOLD for incredible results. OR HOLD COMPARISON - PRIOR YEAR, SAME MONTH Total Minutes 1320 1200 1080 960 840 720 600 480 360 240 120 0 1311 1132 1009 905 797 723 582 614 614 608 572 528 330 197 140 70 54 15 March April May June July August Sept Oct Nov Dec Jan Feb LAST YEAR 2005
Life After the Magic!
Awesome results! Enhanced patient throughput Beds available for assignment earlier in the day Significant reduction in bed turnaround time Increase in Admissions Increased ED Patient Satisfaction
Bed Availability % of Discharges during Hour of Day 20.0% 18.0% 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% LVH-CC Bed Availability - Discharges plus Bed TAT by Hour of Day 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Hour of Day FY02 Effect FY03 Effect FY04 Effect Take Away: GOC supported a shift in the capacity curve to earlier in the day; there are six more beds available at noon. LVH-M showed a similar capacity shift; yielding two more beds available at noon.
BedTurnaround Time - CC Site 240 5000 Minutes 210 180 150 120 90 60 30 4500 4000 3500 3000 2500 2000 1500 1000 500 Beds Cleaned 0 0 FY06-Jul FY05-Jun FY05-May FY05-Apr FY05-Mar FY05-Feb FY05-Jan FY05-Dec FY05-Nov FY05-Oct FY05-Sep FY05-Aug FY05-Jul FY04-Jun FY04-May FY04-Apr FY04-Mar FY04-Feb FY04-Jan FY04-Dec FY04-Nov FY04-Oct FY04-Sep Baseline - CC TAT CC Volume
CC ED PG Improvements FY 04 1st Q - 4th Q FY 05 77.9 to 86.6 (30% tile - 98% tile) Overall Assessment Overall Rating 70.5 to 82.2 (20% tile - 85% tile) Arrival 74.7 to 87.0 (25% tile - 93% tile) 81.1 to 88.2(35% tile - 93% tile) Personal Issues 69.8 to 83.0 (20% tile - 93% tile) Personal/ Insur. Info. 83.2 to 88.7(35% tile - 85% tile) Patient & Families Nurses 83.0 to 89.9 (55% tile - 97% tile) Doctors & PAs Family/Friends Tests 82.7 to 88.5 (45% tile - 93% tile) 82.6 to 85.9 (40% tile - 65% tile)
Capacity Throughput Council Maintain the gain. Communication of key capacity metrics to senior management Bed Turnaround Time Pull Times by nursing unit Admission Volume Transport Trip times Transport Delay Monitor/audit of established processes to ensure compliance Functional leaders of each area will receive detailed TeleTracking report information
LVH Capacity Dashboard Measure July 2005 Actual Target Achievement Volume Indicator LVH Admissions 1 3,876 3,122 124% LVH Length Of Stay 2 4.6 4.6 100% ED Visits - Cedar Crest 1 4,734 4,380 108% Patient Flow/Demand Discharges Before 11:00 am 1 7.89% 20.00 39.4% DBST Turn Around Time 2 64 60 93.7% ED Diversions in Hours 2 76.9 25.0 32.5% ED Time to Seen 2 79 31 39.4% OR Holds in Minutes - Cedar Crest 2 38 300 789.5% Pull Average Times 2 84 60 71.4% Transfer Center Acceptance Rate 1 100% 95% 105.3%
Lessons Learned Strong senior management support is necessary Capacity initiatives must be hospital-wide not just a bed management initiative or specific to the ED Attention must be paid to redesigning process - technology cannot fix bad processes Technology can be successfully added to enhance process improvements Communication must be streamlined and occur real-time A burning platform for change must built - with culture change an organizational priority Lehigh Valley Hospital - Built to Last
Questions? Lisa Romano RN, MSN Administrator, Patient Logistics/Patient Access Lehigh Valley Hospital Allentown PA 18105 Lisa.Romano@LVH.com