How to Improve Clinical and Operational Efficiency Using Electronic Tools

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How to Improve Clinical and Operational
Efficiency UsingElectronic Tools
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Documented Results St. Josephs Hospital and
Medical Center Phoenix Arizona
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About St. Josephs

• Established 111 yrs. ago
• Part of Catholic Healthcare West
• 690 bed Not-for-Profit
• Barrow Neurological Institute
• The Heart Lung Institute
• St. Josephs Childrens Health Center
• Only Level 1 Trauma Center accredited by the
  American College of Surgeons in Arizona
• Ranked routinely by U.S. News and World Report
  among the best hospitals in the United States for
  Neurology and Neurosurgery

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Statistics (FY06)

• Admissions 32,307
• Emergency Department Visits 63,380
• Outpatient Visits 339,821
• Inpatient Surgeries 13,407
• Babies Delivered 5,622
• Average Daily Census - 437

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CHW St. Josephs ED LOS Statistics

• 67 of IP admitted via the ED
• 27.5 of total ED volume is admitted
• ED LOS
• SJHMC 247 (4.1 hrs)
• CDC 192 (3.2hrs)
• Reference Source CDC National Hospital
  Ambulatory Medical Care Survey 2002 Emergency
  Dept. Summary. No. 340
• March 18, 2004
• Baseline Data August 2005 and included 315
  patients (both D/C and admitted)

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CHW St. Josephs ED LOS Statistics

• Year to year improvement
• Opportunity still existed
• SJHMC
• 03 5.0 hr
• 04 4.3 hr
• 05 (est) 4.1 hr

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CHW St. Josephs LWBS Statistics

• Financial Impact
• Based on 61,000 Annual ED visits
• Potential revenue Lost Gross ED Revenue 3,349
  pts X 217 facility charge 746,000 annually
• (10) 344 potential admissions X 10, 298 avg.
  gross revenue 3,439,532 annually
• Avg. 5.7 LWBS (CDC- NHAMCS avg. 2.9)
• Reference Source CDC National Hospital
  Ambulatory Medical Care Survey 2002 Emergency
  Department Summary. No. 340 march 18, 2004
• Insured Americans accounted for most of the
  overall 16 increase in ED visits between
  1997-2001 (www.hschange,org) Center for Studying
  Health System Change

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Ambulance Diversions

• Financial Impact
• Potential Lost ED Gross Revenue 1152 pts X 718
  827,000 (annualized)
• Potential Lost Inpatient Revenue 576 potential
  admissions X 10,298
• 5, 931,000 (annualized)
• (assumption that 50 are admitted).

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SJHMC Operational Goals

• Change the culture!!!!
• Transition organization from thinking
  throughput into true capacity management by
  creating an environment of pull vs. push

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SJHMC Operational Goals

• Decrease wait times for Bed Assignments from
  multiple entry points
• Physician Offices/Direct Admits
• Emergency Department
• ED to Inpatient (Inter-facility)
• Inpatient to Inpatient (Interfacility)
• Post Anesthesia Care Unit (PACU
• Cath Lab
• Radiology

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SJHMC Operational Goals

• Decrease ED Boarding Burden
• Time measured from bed request is placed for an
  inpatient bed to the time the patient leaves the
  department
• Goal 1 hour from bed assigned to bed occupied
  on clinical unit

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Issues/Barriers

• ED Overcrowding
• Diversions
• Decreased ED throughput
• Lengthy Wait Times
• LWBS
• Patient Satisfaction!!!
• Patient Placement/Organizational Throughput
• Multiple entry points-different bedding
  processes
• Staffing Issues
• Average capacity for facility gt97
• High acuity 1.56 (national avg. 1.0)
• Multiple decision-makers
• 3 Ps Phone, paper, pencil

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So How Do We Fix it?

• Automation of Processes Bed Management Suite
• TransportTracking Module Implemented June,
  2002
• BedTracking Module Implemented
• Dec. 2002
• PreAdmitTracking with the electronic bedboard
  Module Implemented
• May, 2005

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Change Implementation

• Started process change before PreAdmit Tracking
  Go-live
• Included key departments in managing process
  PACU/OR/ED/Nursing/Patient Placement/Cath
  Lab/House Manager/EVS/Transport
• Established KPI and accountability at unit level
• Mini bedboards for each unit and nursing
  leadership

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Process Post Go Live

• All requests for beds must go through Patient
  Placement (406-BEDS)
• Collaboration with House Manager to determine
  priority of bed assignment
• Patient Placement initiates the bed assignment
• Once bed available patient placement will
  notify receiving unit of bed request through
  Pre-admit alert
• Clinical lead/supervisor paged with request
  simultaneously
• Has 15 minutes to assess appropriateness of
  admit/assignment if no call to change- bed is
  locked and assigned
• Requesting unit notified via alert that bed is
  assigned and unit is ready for patient transfer
• Sending unit has 1 hour to move patient into
  assigned bed
  
  

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Process Goal

• Assignment of Bed to Occupy Comparison 2005-2006
  in Hours

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It never ends

• Need to continue to create the push/pull
  environment
• Meet or exceed goal of 1 hour to assign to occupy
• Maintain accountability to those areas that can
  impact progress using data as metrics of
  performance at the clinical/ancillary support
  level
• Upgrade system to SQL server
• Add and enhance technology to ensure true
  capacity management and minimizing lost revenue
  to the organization.

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Tying It All Together

• An Illustration

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Electronic Tools Must Be

• Ubiquitous
• Easy to Use
• Allow Multiple Methods for Data Entry

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Electronic Tools Improve Clinical Efficiency When

• They enable real-time communication
• They provide the right information to the right
  people in time for them to make the right
  decisions
• They eliminate silos of information
• They capture data for objective measurement of
  all key performance indicators
• They are used to enforce accountability
  throughout the patient flow process

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Real-Time Executive Views
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Questions?

• Leigh Naig, RN, BSN, MHSA
• St. Josephs Hospital and Medical Center
• 350 West Thomas Road
• Phoenix, Arizona 85013
• 602-406-6387
• Sara Wells
• Tele-Tracking Technologies
• swells_at_teletracking.com
• 888-573-4042