Case Study- UK Chandler Hospital Emergency Department

Transcription

1 Case Study- UK Chandler Hospital Emergency Department P e n n e A l l i s o n, R N, B S N, M S O M D i r e c t o r, E m e r g e n c y & T r a u m a S e r v i c e s P a t r i c i a K u n z H o w a r d, P h D, R N, C E N, C P E N, N E - B C, F A E N O p e r a H o n s M a n a g e r, E m e r g e n c y & T r a u m a S e r v i c e s

2 Case Study ObjecHves Upon complehon of this presentahon the parhcipant will be able to: Describe at least two design assumphons for the Chandler ED project. IdenHfy two or more implementahon strategies used in the Chandler ED project. Delineate successes and challenges from lessons learned in the Chandler ED project.

3 UK Chandler Hospital 57,000 visits ( 16% increase over last FY) Lantern Award Recipient ACS verified Level One Trauma Center for Adult and Pediatrics Level III NICU Emergency Medicine Residency Emergency CommunicaHons Center Pediatric/Neonatal Transport Service Adult Ground Transport Service Quaternary Referral Center serving Kentucky and conhguous states

4 Organizational planning Selected key stakeholders Agreed on guiding principles PaHent Access & Care Priority Academic Mission IntegraHon of Clinical Services (seamless episode of care) Efficiency Flexibility Image

5 Design AssumpHons Quiet environment Behavioral emergency treatment areas away from Pediatrics SimulaHons to test performance and design ophons Site visits to implement best prachce Linear model adopted

6 UK Nutter Center Indoor Training Facility

7 UK Nutter Center Indoor Training Facility

8 Simula5ons

9

10

11 SimulaHons Staff and leaders parhcipated in center core lay- out simulahons in the parking structure Staff determined layout for combined clinical spaces College of Nursing model ICU and standard rooms Lennon and Associates throughput simulahons

12 Design ConsideraHons Linear model selected Added break room in the Pediatric Emergency Center Added EMS Expect Board for ambulance arrivals Satellite lab implementahon delayed No metal detectors, security presence in Welcome Center Computers at bedside PaHent centeredness Chair centric re- design Pebble Project

13 Pavilion A - GROUND LEVEL Main Entry 13

14 Pebble Project Goal- Efficiency Pebble Project Chair Centric Pod A 3 single- bed Fast Track Rooms with dual entries Pod B 3 single- bed rooms converted to 1 large 6 chair room and 1 exam room Phased study: Apply to current area on limited basis Phase 1 Six months, Open Room (WaiHng room concept with limited amenihes) Phase 2 Six months, Modular area (With addihonal amenihes) Area can be converted back to single- bed exam room fast track Phase 1 ConfiguraHon t Chair Centric Area Phase 2 ConfiguraHon

15 Pebble Project Chair Centric Phase 2 Pod A 3 single- bed Fast Track Rooms with dual entries Pod B 3 single- bed rooms converted to 1 large 6 chair room and 1 exam room Area includes semi - private cluster areas lounge chair, family chairs, TV, divider unit Area can be converted back to single- bed exam room fast track Pod B2 Chair centric with addi5onal ameni5es

16 Pebble Project Hypotheses Hypothesis 1 PaHent throughput will be greater in the Chair- centric pod of the Fast Track (Pod B) than in the Exam- bed based pod of the Fast Track (Pod A). Hypothesis 2 PaHent throughput will be greater in single- pahent Exam- bed based pass- through Fast Track rooms with two points of entry (Pod A) than in single- pahent Exam- bed based ED rooms with one point of entry used for Fast Track overflow. Hypothesis 3 PaHent and family sahsfachon will be greater in the Chair- centric pod with increased amenihes (Pod B2), than in either the basic Chair- centric pod (Pod B1) or Exam- bed based pod (Pod A1 or Pod A2). Hypothesis 4 Staff will have a higher sahsfachon score with the work environment in Phase II (Pod A2 and Pod B2) than in Phase I of the trial (Pod A1 and Pod B1) of the trial. Hypothesis 5 The average reduchon in pain level from pre- treatment to post- treatment will be greater in pahents assigned to Pod B2 than in pahents assigned to Pod B1, Pod A1, and Pod A2. Hypothesis 6 Staff efficiency will be greater in Pod B2 than in Pod B1, Pod A1 and Pod A2.

17

18

19

20

21

22 Planning, planning and planning Playbook development Enterprise involvement Staff designed supply lay- outs at point of care Scripted staff training 3 separate sessions in new space prior to move in

23 What Do We Know Overall design a success Center core design is a posihve LighHng is good Standard work is a plus Pediatric Welcome Center well received Separate pediatric entrance a success InteracHve wall a sahsfier Maximized clinical space

24 Lessons Learned RegistraHon area needed some re- design Triage appears cut- off from center core Minor decon could have benefited from a different design More staff break space Swing rooms are really in pediatric Need storage space Walls in break room and trauma work space need to be tough PaHent flow from trauma resus to crihcal care has been challenging

25 Design Changes Added ice machine in trauma Elevated counters at registrahon Modified badge access from trauma to radiology ConHnue to work on our own efficiencies as volume has increased Encouraging staff to change prachce takes Hme Bedside documentahon Bedside report

26 QuesHons?