Patient Flow: What the Data Tells Us and What it Doesn t

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1 Disclosure Statement The employees and/or speakers for this presentation have disclosed that they do not have any financial arrangements or affiliations with corporate organizations that either provide educational grants to this program or may be referenced in this activity. Furthermore, each of the previously named speakers has also attested that their discussions will not include any unapproved or off-label use of products. 1 Patient Flow: What the Data Tells Us and What it Doesn t Mark McClelland, DNP, RN Assistant Research Professor Center for Health Care Quality Department of Health Policy George Washington University 2013 ANNUAL EDUCATION CONFERENCE 2 Learning Objectives At the conclusion of this presentation, the participant will be able to: 1. Identify three metrics useful in assessing patient flow. 2. Identify three best practices for improving patient flow. 3. Identify emergency department activities, practices and features that can either support or interfere with effective patient flow 3

2 Agenda Framework Questions Metrics 4 Framework On-demand primary care ER ED Flow = Transitions in care Organizational Culture 5 Artifacts Espoused Beliefs and Values Schein, E.H, Organizational Culture and Leadership 3rd edition. Jossey-Bass, San Francisco, CA. Underlying Assumptions 6

3 Culture Push vs. Pull System 7 Seven Critical Success Factors 1. Recognize that ED crowding is a hospitalwide problem-not an ED problem. 2. Build multi-disciplinary, hospital-wide teams to oversee and implement change. 3. Recruit and maintain a champion. 4. Guarantee management s support. 8 Seven Critical Success Factors 5. Use formal improvement methods. 6. Commit to rigorous metrics. 7. Make transparency an organizational value. Wilson et al. Bursting at the Seams. urgentmatters.org 9

4 10 Rapid Intake Bed vs. Treatment space Vertical vs. Horizontal Demand forecasting 11 12

5 Treatment Area 13 Rapid Intake Bed vs. Treatment space Vertical vs. Horizontal Demand forecasting 14 Protocols/Standing Orders Bridge Orders Tight Bed Control Bed Czar Widespread access to Bed Board 15

6 Data Marts Shadowing CM/SW triggers Throughput Committee 16 Data Mart 17 Data Marts Shadowing CM/SW triggers Throughput Committee 18

7 Throughput Committee Multidepartmental? Multidisciplinary? C-Suite to Techs? What data is reviewed? Accountability? 19 Questions How does leadership convey the importance of patient flow? Who in the organization is held accountable for good patient flow? Ask a nurse, Do patients flow like water? 20 Questions On average how many telephone calls does it take to get a patient admitted? How conversant are staff with flow issues on their unit and recent improvements? What was the hospital s greatest accomplishment in the last year in improving flow? 21

8 Questions Does boarding occur? If so, who? when? how long? why? When does the hospital start working on bed availability? 22 My Favorite Metrics LBBS ± 2% Decision to Admit ± 4 hours (HC = 55 min) Treat and Release ± 2 hours Admitted ± 4 hours (HC = 190 min) Door to Provider 15 minutes? 23 My Favorite Metrics Time to Consults Consult to Recommendation Advanced imaging order to final read % of scheduled meds given on time % of patients out by check-out time 24

9 Annals of Emergency Medicine. 58(1) July Review and Conclusions Framework Questions Metrics 26 Questions? Mark McClelland, ANNUAL EDUCATION CONFERENCE 27

10 The Joint Commission Disclaimer These slides are current as of 01/04/13. The Joint Commission reserves the right to change the content of the information, as appropriate. These slides are only meant to be cue points, which were expounded upon verbally by the original presenter and are not meant to be comprehensive statements of standards interpretation or represent all the content of the presentation. Thus, care should be exercised in interpreting Joint Commission requirements based solely on the content of these slides. These slides are copyrighted and may not be further used, shared or distributed without permission of the content owner or The Joint Commission. The program may be electronically recorded by The Joint Commission and is subject to the protection of the copyright laws of the US. No individual or entity other than The Joint Commission may electronically record any portion of these programs for any purpose without the written permission of The Joint Commission and the content owner. Any and all reproduction or publication of these proceedings and programs are intended for internal field representative education only and will not be distributed in any other way without written permission from the content owner. 28