Black Belt Project

Bed Management Unit

Sonya Cotter

Background CUH only Level 1 Trauma Centre

Model 4 hospital

40 Specialties on site

65,000 ED presentations

48,000 Inpatient Discharges

86,000 Day Cases

Current Process 35% ED attendances

require hospital in- patient admission daily.

CUH needs 73 discharges / day.

White Boards on wards.

PDD recorded daily

Multiple ward rounds , multiple phone calls.

Aims and Objectives. To record and examine the Predicted Date of

discharges (PDD) provided daily from the wards to the Bed Management Unit.

To examine what the current work process is and using lean methodologies with a stakeholder group to produce a revised process that would increase the documentation and accuracy of PDD.

Aims and Objectives To implement changes that meet with the National targets

of 80% documentation of PDD thus improving patient flow, reducing waste and ensuring Patients are discharged from CUH in a safe and timely manner.

To enhance team performance and staff well-being and to

add value and improve efficiency. To develop new policies and procedures to support the

changes introduced and to implement a quality control programme to monitor compliance and to ensure the changes are maintained.

Define SIPOC

Pie Chart

Project Charter

Ganntt Chart

Stakeholder Analysis

Stakeholder Map

Define

Define Predicted Vs Actual Discharges

3113

1759

Actual

Potential

Problem Statement In May 2015 there was a recorded gap of 53 % between

PDDs and Actually discharges. This impacts on both patients’ experiences and outcomes and also impacts on the staff caring for the patients.

Goal is t0 reduce down the gap between Potential discharges and Actual discharges by 50% by December 2015.

Stakeholder Map

Measure Data Collection Plan

Histogram

Control Chart

Measure

0

5

10

15

20

25

30

-10.95 -5.05 0.85 6.75 12.65 18.55 24.45 30.35 36.25 42.15 48.05 53.95 59.85 65.75

Nu

mb

er

% Discrepency

Predicted vs Actual (Bed Management)

LSL 10.00 USL 10.00

Mean 20.95 Median 19.00 Mode 17, 15, 28 n 106 Cp 0.00

Cpk -0.30 CpU -0.30 CpL 0.30 Cpm 0.00 Cr #DIV/0! ZTarget/DZ 0.87 Pp 0.00 Ppk -0.29 PpU -0.29 PpL 0.29 Skewness 0.40 Stdev 12.56 Min -5.00 Max 54.00 Range 59.00 Z Bench 0.89 % Defects 97.2% PPM 971698.11 Expected 1000000.00 Sigma -0.41

Measure

UCL 13.1

CL 4.0 0

5

10

15

1 2 3 4 5 6 7 8 9 10 11 12 13 14

Ran

ge

Period

mR Count

UCL 18.2

CL 7.6

LCL -3.1

-5.0

0.0

5.0

10.0

15.0

20.0

25.0

30.0

1 2 3 4 5 6 7 8 9 10 11 12 13 14

Co

un

t

Period

X Count

Analyse Current Process Maps

Fishbone

Brainstorming

Analyse

Improve

Brainstorming

Pilot Sites

Roll out to remaining wards.

Improve

Patient Flow ;CNM iPMs to be updated by CNM.

PDD to be updated by CNM.

Ward view of iPMS to be discussed at 8am hub each

morning.

CNM2 to confirm discharges at 8am.

Bed Management Confirm discharges at 8am hub.

Patient will be allocated to wards at this time.

Patients acuity, age and time on trolley will be prioritised.

Ward rounds to continue daily, at the white boards.

Staff Nurses All Ward rounds to have a nurse present .

Discussions with MDT re discharge plans.

White boards with PDD to be updated .

PDD documented over bed and communicated to families.

Control Control Plan

CUSUM control chart

Run Weekly

Available to view for all Stakeholders

Unscheduled Care Governance Group

Results

0

5

10

15

20

25

30

-10.95 -5.05 0.85 6.75 12.65 18.55 24.45 30.35 36.25 42.15 48.05 53.95 59.85 65.75

Nu

mb

er

% Discrepency

Predicted vs Actual (Bed Management)

LSL 10.00 USL 10.00

Mean 20.95 Median 19.00 Mode 17, 15, 28 n 106 Cp 0.00

Cpk -0.30 CpU -0.30 CpL 0.30 Cpm 0.00 Cr #DIV/0! ZTarget/DZ 0.87 Pp 0.00 Ppk -0.29 PpU -0.29 PpL 0.29 Skewness 0.40 Stdev 12.56 Min -5.00 Max 54.00 Range 59.00 Z Bench 0.89 % Defects 97.2% PPM 971698.11 Expected 1000000.00 Sigma -0.41

Results

Lessons Learnt Communication

DMAIC Tools

Data

Stakeholders

Quadrant of Productivity Productivity

Distraction Burn out

Fire fighting

Thank You