patient admission from ed to acute care
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Patient Admission from ED to Acute Care. Tech 581: Analyze Presentation November 11, 2008 xxxxxx. Sound Removed. Brief review of project: Patient Admission from the ED to Acute Care. - PowerPoint PPT PresentationTRANSCRIPT
Patient Admission from ED to Acute Care
Tech 581: Analyze Presentation
November 11, 2008
xxxxxx
Sound Removed
Brief review of project: Patient Admission from the ED to Acute Care
The aim of this process is to reduce the lead time for safe and timely patient admission from the ED to Acute Care services. By improving the efficiency of this process, the organization will improve their accessibility, capacity, patient safety, quality of care, and patient and staff satisfaction. The primary target of this process improvement effort is to decrease patient length of stay in the ED from the time an admission order is written.
As health care moves into the era of reporting quality indicators; improving quality of care and patient safety rankings will positively affect the organization’s reimbursement rates. The consequences of not improving the efficiency of this process are reduced quality and patient safety (and possibly reimbursement rates), increased costs associated with increased elopement rates, and lost revenue as a result of increased time on diversion. Therefore, it is important to improve this process now in order to maintain reimbursement, control costs, and prevent losing revenue.
16. CTQ Tree
CTQ KPIVs Customer(s) KPOV(s)
Dept. Directors
Bed Placement Manager
ED Physician
Unit Nurse
Patient
Pt. families
Patient admission time
Time between admission order written and time bed request is made
Time between bed request and patient admission to unit
ED staffing levels
Ordering protocol
Communication process b/w ED staff and Bed Placement staff
Unit staffing levels
Bed turnover time
Lab/imaging result time
Patient transport and admission protocol
Communication b/w Bed Placement staff and admitting unit
Data Collection Plan
Time (min) from the time an admission order is made in ED to the time a bed request is made
Time (min) from the time request is made to patient arrival in Acute Care
Reasons for delays will ultimately identify new KPIVs Data collected for 8 week days over an 11 day period (10/7 – 10/17) Collected data on 5 patients/day over 8 days = 40 patient sample
size Will graphically present:
Average order to request time/day Average request to placement time/day Total average time/day
datepatient number
order to bed request
bed request to pat. Admission total time
Avg order to request time/day
Avg request to placement time/day
total avg time/day
10/7/2008 1 13 16 29 17 36.6 53.610/7/2008 2 25 10 35 17 36.6 53.610/7/2008 3 5 45 50 17 36.6 53.610/7/2008 4 14 71 85 17 36.6 53.610/7/2008 5 28 41 69 17 36.6 53.610/8/2008 6 6 56 62 64.8 32.8 97.610/8/2008 7 36 19 55 64.8 32.8 97.610/8/2008 8 135 31 166 64.8 32.8 97.610/8/2008 9 83 23 106 64.8 32.8 97.610/8/2008 10 64 35 99 64.8 32.8 97.610/9/2008 11 62 13 75 41.6 31.2 72.810/9/2008 12 53 60 113 41.6 31.2 72.810/9/2008 13 45 40 85 41.6 31.2 72.810/9/2008 14 20 20 40 41.6 31.2 72.810/9/2008 15 28 23 51 41.6 31.2 72.8
10/10/2008 16 54 17 71 46.8 31.6 78.410/10/2008 17 6 37 43 46.8 31.6 78.410/10/2008 18 39 26 65 46.8 31.6 78.410/10/2008 19 52 27 79 46.8 31.6 78.410/10/2008 20 83 51 134 46.8 31.6 78.410/14/2008 21 23 60 83 24.2 65.4 89.610/14/2008 22 15 26 41 24.2 65.4 89.610/14/2008 23 45 69 114 24.2 65.4 89.610/14/2008 24 4 78 82 24.2 65.4 89.610/14/2008 25 34 94 128 24.2 65.4 89.610/15/2008 26 80 113 193 55.2 71.8 12710/15/2008 27 79 54 133 55.2 71.8 12710/15/2008 28 5 72 77 55.2 71.8 12710/15/2008 29 85 53 138 55.2 71.8 12710/15/2008 30 27 67 94 55.2 71.8 12710/16/2008 31 52 43 95 43.6 55.4 9910/16/2008 32 9 39 48 43.6 55.4 9910/16/2008 33 83 58 141 43.6 55.4 9910/16/2008 34 47 78 125 43.6 55.4 9910/16/2008 35 27 59 86 43.6 55.4 9910/17/2008 36 16 88 104 59.8 74.8 134.610/17/2008 37 66 83 149 59.8 74.8 134.610/17/2008 38 54 49 103 59.8 74.8 134.610/17/2008 39 86 59 145 59.8 74.8 134.610/17/2008 40 77 95 172 59.8 74.8 134.6
Data file used to create trend chart
ED order to Acute Care arrival
0
20
40
60
80
100
120
140
160
Date
Tim
e (m
in)
Avg order to request time/day
Avg request to placement time/day
total avg time/day
Fishbone Diagram
Materials Processes
Adm Order
Bed Req
Equip
Lab OrderTransport
Unit admiss
Bed assign
Adm Order
People Machines
Lab/image
Bed Plcmt
Env Svcs
Admitt staff
Phys/nurses
IV pump (equip)
Lab/image
Computers
KPOV:Patient AdmissionTime
Data Collection Plan Cont…
Graphically present the distribution of total time, for sample data, from Admission Order to patient arrival in Acute Care unit
Further breakdown of data; identify which step(s) are contributing the most to overall time Column chart: % contribution to overall time of each step Pie Charts: distribution of reasons for delays
Anecdotal information/data used to eliminate KPIVs
Total Time (mins)
0
50
100
150
200
250
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40
Patient #
Tim
e (m
ins)
total time
Distribution of total times from Order Written to Pat. Arrival in Acute Care
% Contribution to overall time of each step
0%
20%
40%
60%
80%
100%
% Contribution
total avg time/day
Avg request to placement time/day
Avg order to request time/day
10/1710/1610/1510/1410/1010/910/810/7
% of sample that was admitted in goal time (<= 50 mins)
Percentage Admitted in <= 50 mins
15%
85%
# pats admitted in goal time
Total # of patients
% distribution of reasons why patients were not admitted in goal time
Reasons for Delays
35%
23%
42%
Bed not ready
Lab not ready
poor communication/order not sent on time
Information to eliminate KPIVs
Transportation is not an issue: the hospital has successfully implemented a transportation team
Lab Delays: Recently implemented I-Stat; software that will produce lab results in 5 minutes
Ordering and admission protocol/communication: subject to patient census and unit staffing levels PCU 3:1 patient to nurse ratio – regulated ICU 2:1 patient to nurse ratio – regulated ED 8:1 patient to nurse ratio – not regulated ER census increased by 8% this year Budgeted for 118 pts/day; currently 134 pats/day
Acute Care: # of beds cleaned/month and average turnaround time
Month Total # beds cleaned Av. Turnaround time (mins)
May '08 165 51
Jun '08 172 55
Jul '08 168 47
Aug '08 154 50
Sep '08 180 45
Oct '08 172 48
Total = 1011 Avg = 49 minutes
Bed Turnaround Time
Avg. Turnaround time (mins)
0
10
20
30
40
50
60
May '08 Jun '08 Jul '08 Aug '08 Sep '08 Oct '08
Month
Tim
e (
min
s)
Av. Turnaround time (mins)
Conclusions
Following thorough examination of KPIVs; Bed turnaround, staffing levels, patient volume are the main reasons for delays in the KPOV (Patient Admission Time)
Lab results delay is being rectified Communication/ordering/placement protocol significantly
affected by staffing levels and patient volume Bed turnaround time is all that is measurable; delays in
turnaround time stem from poor communication b/w unit nurses and Env. Svcs staff