ed flow workshop - acep...jody crane, md, mba, facep chief medical officer, teamhealth karen...

ED Flow WorkshopJody Crane, MD, MBA, FACEP

Chief Medical Officer, TeamHealth

Karen Murrell, MD, MBA

Physician Lead-Emergency Medicine, Kaiser Northern California

EDDA, 2019

Please Estimate the Following

Annual Volume ___________

% LBTC ___________

% Admit ___________

# of ED Treatment Spaces ___________

ESI % 4,5 ___________

% Vertical 3 ___________

Door to Doc ___________

LOS ___________

Dispo to Depart Admitted ___________

# Providers at Peak ___________

# RN at Peak ___________

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% LBTC by Volume

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LOS and Admit Rate by Volume

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Door to Doc by Volume

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LOS and Boarding Time

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Median LOS by Volume

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Median LOS and Boarding Time by

Volume

Exercises – Calculate the Following:

1. Peak Arrival Rate

2. Peak Arrivals Low Acuity

3. Peak Arrivals Vertical 3

4. ED Bed Ratio

5. Target MD service rate

6. Target RN service rate

7. Target bed LOS and overall LOS

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Peak Arrival Rate

Annual Visits

_____________

5,000

=

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Peak Arrivals Low Acuity

Annual Visits

_____________ X % ESI 4,5

5,000

=

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Peak Arrivals Vertical 3

Annual Visits

_____________ X

5,000

= % Vertical 3 X

(100% - % ESI 4,5 - % admit)

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Do you Have Enough Beds?

Annual Visit : ED Bed Ratio

Annual Visits

___________

# ED Treatment Spaces

=

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Annual ED Visits per Treatment

Space by Volume

EDBA 2017 Summary Staffing Data

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ED Docs - Target Service Rate (pts/hr)

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4 docs

(Y)

Waiting10 pts/hr

(X)

? min/pt(Z)

Peak arrival rate (X) = 10 pts/hr

Takt Time (Z) = 60 min/10 pts/hr = 6 min/pt

For multiple docs, multiply Z by Y = 6 * 4 = 24 min

Peak Target Service Rate = 60 min/24 min = 2.5 pph

Peak arrival rate (X) = ____

Takt Time (Z) = 60 min/X pts/hr = ____

For multiple docs, multiply Z * Y = ____

Peak Target Service Rate = 60 min/ (Z * Y) = ____

What is Your Doc Expected Cycle Time and Service Rate?

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Y docs

Waiting

X pts/hr

Z min/pt

Peak arrival rate (X) = 10 pts/hr

Takt Time (Z) = 60 min/10 pts/hr = 6 min/pt

For multiple RNs, multiply Z by Y = 4.8 * 15 = 72 min

Peak Target Service Rate = 60 min/19.2 min = .83pph

ED RNs - Target Service Rate (pts/hr)

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15 RNs

(Y)

Waiting10 pts/hr

(X)

? min/pt(Z)

Peak arrival rate (X) = ____

Takt Time (Z) = 60 min/X pts/hr = ____

For multiple RNs, multiply Z * Y = ____

Peak Target Service Rate = 60 min/ (Z * Y) = ____

What is Your RN Expected Cycle Time and Service Rate?

© 2019, Crane

Y RNs

Waiting

X pts/hr

Z min/pt

Peak arrival rate (X) = 10 pts/hr

Takt Time (Z) = 60 min/10 pts/hr = 6 min/pt

Multiply by Y to get in-bed LOS = 6 * 25 = 150 min

Total LOS = in-bed LOS + door to doc = 180 min

Beds - Expected LOS (bed cycle time)

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25 beds

(Y)

Waiting10 pts/hr

(X)

? min/pt(Z)

Peak arrival rate (X) = ____

Takt Time (Z) = 60 min/X = ____

Multiply Z * Y to get in-bed LOS = ____

Total LOS = Z * Y + door to doc = ____

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Y beds

Waiting

X pts/hr

Z min/pt

What is Your Expected LOS?

Thank You!

© 2019, Crane