Emergency Department Directors Academy Phase II. The ED is a Business: Intelligent Use of Dashboards

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1 Emergency Department Directors Academy Phase II The ED is a Business: Intelligent Use of Dashboards May 2011

2 The ED is a Business; Intelligent Use of Dashboards Katherine Haddix-Hill, RN, MSN Acknowledge: Diana S. Contino, RN, MBA, FAEN Senior Manger, Deloitte Consulting, LLP 1

3 Objectives Define Dashboards Discuss the value of data and identify critical metrics used in Emergency Medicine Identify key data management strategies and best practices for leveraging data using business intelligence to improve processes in the Emergency Department e t Discuss lessons learned "You cannot manage what you cannot measure Lord Kelvin 2

4 Your Part of the Session: Utilizing an Audience Response System At the end of the session or when you leave please return your clicker to an attendant What is a Dashboard? Executive information system (Wikipedia) Visual presentation of data obtained during ED visits Specific metrics used for real time warnings or retrospective review of reports User friendly, easy to read and understand Graphs and reports Report card Spot trends and delays Management tool to view drive operational performance Todd C. Rothenhaus, MD, FACEP ED Information Systems: Implementing the ED of the Future 3

5 Where Did Dashboards Come From? History Auto Dashboards Designed to help monitor what is going on at a glance (speed, mileage, maintenance, alerts) Healthcare Patient s right to know Need to report data publicly Different Types Timeliness Real time data compared to retrospective data Digital Intuitive and interactive EMR Paper Excel 4

6 More Than One Chart on a Page Sales 1tQt 1st Qtr 2nd Qtr 3rd Qtr Series 1 Series 2 Series Series 1 Series 2 Series 3 1/9/2 1/7/2 1/5/ Close Low High Volume We are swimming in a rapidly rising sea of data... How do we keep from drowning?... 5

7 ED Inpatient Handoff Data is Power 6

8 Scorecard that is Posted Publicly Value of Data Identify bottlenecks in the system Delays in the process Detailed facts to make decisions i for change in staffing, patient flow, hospital operations Identify negative trends Assist senior leadership in understanding patient flow Quick identification of outliers Drill down to specific shifts and providers 7

9 What metrics do you measure for patient flow? 1. Door to triage 2. Door to discharge 17% 17% 3. Door to physician 4. Door to admission 5. Don t measure 17% 17% 17% 17% 6. All of the above Emergency Department Metrics Numbers Total patients Admissions i Discharges LWBS Transfer 72 hour returns Pediatrics Psych Boarders Arrival times Core measures Times Front End Door to triage Door to bed Door to provider Middle Ancillary Services Consultant times Back End Door to disposition Door to discharge Door to admission Bed request to bed assigned 8

10 COMPETENCY (QUALITY) PERFORMANCE INDICATORS Targets '10 '11 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec YTD AMI Door to Balloon < 90 minutes AMI Aspirin Administered CAP Door to Antibiotic < 6 hours 72 Hour Return ED LWBS CONVENIENCE (QUALITY) EFFICIENCY PERFORMANCE INDICATO Targets '10 '11 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec YTD VOLUME Average Daily Census Emergency Department Admissions Emergency Department Treated and Discharged Total CDU Observation Patients (Only) Total CDU Patient Total ED Visits ED THROUGHPUT Arrival to Triage (Time in Minutes) Triage to Tx Area Arrival to Tx Area Arrival to Provider Tx Area to Provider Provider to Disposition (DC Home) Provider to Disposition (All) Provider to Admit Dispo Consultant Called to Bed Request Bed Req to Bed Assignmt Bed Assignmt to Inpt Transport Inpatient Boarding Duration Provider to Observation Observation to Discharge Discharge Dispo to Out of Dept (out of Dept) Dispo Set to Admit Dispo Set to Transfer Arrival to D/C (Out of dept) Home Arrival to Admission (out of dept) Arrival to DC Obs Patients Total Duration in ED (All) Lab and Radiology Metrics TAT for X rays TAT for CT with contrast TAT for CT without contrast TAT for Ultrasound TAT for CBC TAT for Chemistry CARING (SERVICE) PERFORMANCE INDICATORS Targets '10 '11 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec YTD PERFORMANCE INDICATORS Targets '10 '11 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec YTD HPPV Cost per Unit of Service Business intelligence Leveraging data to improve the department Strategies for Dashboards KEY DATA MANAGEMENT STRATEGIES 9

11 Business Intelligence Decision support system Data warehouse Financial Clinical Resources Administrative Start with your organization s strategic plan Where the hospital is going over the next 1-5 years Align your goals with overall plan Leveraging Data to Improve Department Visualize the power of your data Data is growing at enormous rates. The amount of data you encompass is less important than how it is utilized. 10

12 Connect the Pieces What are you going to measure? What is the role of data? What impact are you hoping for? What do you want to accomplish? What is the criteria for decisions? 80/20 rule Regulatory What happened? to What is the best thing that can happen? & How can we make the best thing happen? Data in is data out 11

13 Strategies for Dashboards Design best practices around efficiencies in patient throughput Use the data to get what you need Pictures and numbers are better than words Link the data to outcomes Quality: Improve core measures compliance Patient satisfaction: Decrease complaints Change management Involve the entire team Robert R. Bass, MD, FACE The Institute of Medicine Report on The Future of Emergency Care in the U.S. Health System Lessons learned Resist extra data - If you can t use it to make a decision, don t include it Don t silo the information Disseminate information to your team and integrate it with key departments Don t settle keep improving the dashboard to help you improve operations 12

14 Summary Described what a dashboard is and its uses Reviewed key data management strategies Discussed application of business intelligence strategies to hospital wide patient flow and operations Identified critical data sets that hospital executives strive to capture Reviewed strategies for dash boarding and leveraging data to improve your departments 13

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