Mount Sinai/ 1199 SEIU/NYSNA Labor-Management Partnership Quality and Service Telemetry Patient Flow Project

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Herbert Jenkins
8 years ago
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1 2008 Share Conference Working Together for Quality and Service Mount Sinai/ 1199 SEIU/NYSNA Labor-Management Partnership Quality and Service Telemetry Patient Flow Project Labor-Management Project 1

Labor-Management Partnership Quality and Service

2 Telemetry Patient Flow Team Co-Sponsors Norma Calame Betty Wharton Henry Williams Denise Campo Co-Leads Cecilia Martin-Dabu, Clinical Nurse Manager Mary Yianelis, RN Team Members Mariana Brudasca, CNA Nuala Quigley, Unit clerk Roland Regis, Housekeeping Alice Ruiz, Admitting Rajinder Singh, RN Lorraine Calderone Sonia Campbell Elizabeth Nicolas Labor-Management Project 2

Mariana Brudasca, CNA Nuala Quigley, Unit clerk Roland Regis, Housekeeping Alice Ruiz,

3 Setting The Project Target Strategic Priority Improve Patient Flow/Patient Satisfaction Focus on ED and Telemetry Senior Hospital Leadership Labor-Management Committee Co-Sponsors/Shaping Group Executable Challenge Reduce the amount of time it takes to move a patient on Telemetry unit from MDs decision to downgrade until the bed/room is ready. Co-Sponsors / Project Coleaders Shaping Group Telemetry Project 100-Day Goal Reduce the time from an avg of 6.8 hours to less than 5 hours on the telemetry unit in weeks. Telemetry Quality and Service Team 1199 SEIU/ League Labor- Management Project 12 Labor-Management Project 3

downgrade until the bed/room is ready. Co-Sponsors / Project Coleaders Shaping Group Telemetry Project 100-Day Goal Reduce the time from an avg of 6.

4 Reaching the Project Goal Completed a process map to help identify barriers. Brainstormed solutions to barriers and translated to action steps. Collected baseline data over several weeks, determined avg. time and decided on an achievable, but challenging goal. Reviewed different interventions, ideas for achieving the project goal. Collected and reviewed patient flow data regularly to monitor progress. Labor-Management Project 4

Collected baseline data over several weeks, determined avg.

5 What is different? Qualitative Improvements Housekeeping is available on floor during 3-11 p.m. shift M-F to respond to high demand times. Bed turnover is faster because beds are cleaned and ready. Telemetry unit clerk is rounding and checking status of room/beds every two hours and calling admitting. Improved communication on unit and between units and admitting. One contact person is pro-active in assigning beds and informing housekeeping. Attending physicians are more pro-active in downgrading or discharging their patients. Labor-Management Project 5

Telemetry unit clerk is rounding and checking status of room/beds every two hours and calling admitting.

6 What is different? Quantitative Improvements Need data on Project goal From Beginning of November Average time from MD downgrade to bed/room ready for new patient improved from an average of 6.8 hours at the beginning of project to an average of 4.03 hours at the end of project Include data/impact on ED (from Dr. Nierman) Labor-Management Project 6

time from MD downgrade to bed/room ready for new patient improved from an average of 6.

7 What did you do to achieve results? Educated telemetry staff about the project through individual and staff meetings. Prepared and distributed memo and discussed project with colleagues. Involved senior administration from the beginning and received their full support. Involved select department heads to get their feedback and support. Set a two hour window for patient transfers. Asked admitting to assign one bed per nursing district. Labor-Management Project 7

Involved senior administration from the beginning and received their full support.

8 What did you do to achieve results? Tracked downgrades from 7 a.m. to 11 p.m. Conducted a bed huddle twice per day, Monday- Friday. Huddle included admitting, ER, nurse managers, social services, care management and housekeeping. Telemetry unit clerk is rounding and checking status of room/beds every two hours and calling admitting. Labor-Management Project 8

Huddle included admitting, ER, nurse managers, social services, care management and

9 Challenges and Strategies Challenges Communication need to speak to one person in admitting, ER and Station 6 who is dedicated to patient flow. Strategies Used walkie talkies between housekeeping and admitting Two bed huddles per day M-F High turnover during 3-11 p.m. shift Assigned specific housekeeping staff on 3-11 shift M-F to improve efficiency/meet high demand. Labor-Management Project 9

Strategies Used walkie talkies between housekeeping and admitting Two bed huddles per day M-F High

10 Remaining Challenges Per diem doctors on weekend not downgrading patients or calling the attending. Unfamiliar with paperwork and not communicating properly with other staff about patient status. Causes backup on Monday. Inadequate housekeeping staff pattern on weekends Inconsistent use of bed tracking system Moving isolation patients. No private rooms on telemetry. Lack of progress on weekends. Not enough support from weekend ADNs. Labor-Management Project 10

11 What s Next? We will collect and review data on quarterly basis to measure progress. Examine/Review housekeeping staffing patterns hospitalwide. Focus on Communication by dedicating point people on units to discuss patient flow (i.e. charge nurse to charge nurse). We will discuss potential of new project with the ED employing similar methodology. Consider expanding project focus to other units. Labor-Management Project 11