Patient Admission from ED to Acute Care

Tech 581: Champion/Define Presentation

Sound Removed

Project Selection… Project #1: Improve falls prevention

techniques in order to reduce the fall rate/1000 patient days by 50%

Project #2: Time reduction between the time an ED admission order is made and the time that patient is placed in an in-patient bed within Acute Care

Project #3: Streamlining the ambulatory patient appointment reminder phone call system in order to reduce no-show rates

Project Selection Matrix and Ranking

Project

Criteria #1 #2 #3Likelihood of Success 4 7 7

$$ Cost/Revenue Impact 5 7 6

Staff/Physician Satisfaction 4 10 6

Quality of Care 8 8 2

Patient Satisfaction 9 10 7

Patient Safety 10 8 1

Completion in 12-16 weeks 2 9 5

Selected project #2: Time reduction between the time an ED admission order is made and the time that patient is placed in an in-patient bed within Acute Care

From the Project Charter… Principle stakeholders Business case Problem statement Project Objective Project scope Goal Statement Projective deliverables Project schedule

Principle Stakeholders

Principle Stakeholders Title/Role

Clinical Director, ED

Clinical Director, PCU 

Clinical Directors, Med/Surg 

Clinical Director, ICU

Clinical Manager, Bed Placement 

Physicians   

Nurses   

Lab/Imaging techs   

Environmental services (EVS)

EMS

Executive leadership team (ELT)  

Business Case: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. The secondary targets of this process improvement effort are to reduce the organization’s time on diversion, and decrease the ED elopement rate.

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.

Problem Statement Problem Statement: The national benchmark for the

length of time it takes to admit a patient from the ED into an in-patient bed within Acute Care Services is 30 minutes. Currently, the organization’s average time for completing this process is well above the national average. Historical data shows this time to be approximately 120 minutes on the average.

The problem impacts the organization in the following ways:

Decreases physician/staff satisfaction due to increased work-arounds

Decreases patient satisfaction due to increased wait times and LOS

Increased costs associated with increased ED elopement rates Decreased revenue capture due to increased time on diversion Raises patient safety and quality of care concerns

Project Objective & Scope

Objective: Decrease the length of time from when an

admission order is written in the ED, to the time that patient is placed in an in-patient bed within Acute Care Services, to 50 minutes.

Scope:The process being investigated begins when the physician admission order is written in the ED, and ends with the patient's safe arrival in an in-patient bed within Acute Care (i.e.. Med/Surg, PCU, or ICU). Maternity services, Endoscopy, Day Beds, and Surgery are not within the scope of this project.

Goal Statement & Deliverables

Goal Statement: Improve through-put processes for safe and timely patient admission from ED to Acute Care Services; specifically by reducing the time from when an admission order is written in the ED, to the time that patient is placed in an in-patient bed within Acute Care Services, to 50 minutes. 

Deliverables (long-term, end results of project): Decrease the length of time from when an admission order is

written in the ED, to the time that patient is placed in an in-patient bed within Acute Care Services, to 50 minutes.

Reduce the organization’s time on diversion as a result of improved access and capacity for patients in the ED.

Decrease the ED’s elopement rate as a result of decreased patient wait times and LOS in the ED

Task Owner(s) Week                               Milestones

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Define W.K. & team     X X X                        

 Champ/DefinePresentation

Measure  W.K. & team       X X X X                MeasurePresentation

Analyze  W.K. & team

                X X X          AnalyzePresentation

Improve  W.K. & team

                      X X X X    

Control W.K. & team

                       X X  X X X

Improve/ControlPresentation

Project Schedule

Stakeholder

Analysis Project Relationship Communication Strategy

ImpactedByproject

CanInfluenceProjectOutcome

Content/ProcesExpert

Controlsres’cs

Hasdec.Auth.

MeetWithReg.

Invite toMeetings

CopyOfmins.

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Stakeholder

Clinical Director, EDX X X X X X x W.K

Clinical Director, PCU 

X X XX X X X

W.K

Clinical Directors, Med/Surg 

X X XX X X X

W.K

Clinical Director, ICU X X X X X X X W.K

 Clinical Manager, Bed Placement  x  x  x  X X X X   W.K

 Physicians  x  x  x  X X X X   W.K

 Nurses  x  x  x  X X X   W.K

 Lab/Imaging techs  x  x  x  X X X   W.K

 EVS x  x  x  x X X   W.K

 EMS x        W.K

 ELT X x X X X X   W.K

SIPOC  Suppliers Inputs Process Outputs Customers ED physicians Admission order

PROCESS:

ED admission order to in-patient admission

Patients admitted to in-patient bed

 ED physicians

 ED nurses & Director

Bed placement assignment

 ED nurses & Director

 PCU/ICU/Med/Surg unit nurses & Directors

Equipment (IV pump)  PCU/ICU/Med/Surg unit nurses & Directors

 Lab/ImagingTechs & Directors

Lab/Imaging results  Lab/ImagingTechs & Directors

Bed Placement staff & Manager

Supplies (oxygen, bed pans, etc)

Bed Placement staff & Manager

Admitting physicians

Admitting physicians

Vendors (IV pumps)

EMS

Environmental Services staff 

Patient

EMS    

Transport team    

Voice of the Customer Analysis

Key stakeholders surveyed: Clinical Director, ED Clinical Director, PCU Clinical Director, Med/Surg Clinical Manager, Bed Placement ED Physician Unit Nurse Imaging Department Director

VoC – SWOT Analysis

Strengths Advanced, automated bed tracking and patient transfer

system in place High level of physician and nurse expertise Department Directors with a wide range of experience

and knowledge Support from the Executive Leadership Team Available resources to accommodate changes Addition of Transport Team has been very helpful

VoC – SWOT Analysis

Weaknesses Animosity between departments Communication barriers (i.e. personality conflicts)

between departments Perceived inadequate staffing levels (i.e. nurse/patient

ratio) Departments operate in silos Lack of awareness of other department processes Lack of standardized directions for admission orders and

bed requests Lack of standardized directions for when order/request

should be made (i.e. before or after lab/imaging tests and results)

VoC – SWOT Analysis

Opportunities Improve communication between departments Create a team-oriented culture Educational sessions highlighting department-specific

processes Standardize admission order/bed requests across

respective departments Use the automated system to capacity

VoC – SWOT Analysis

Threats Increased animosity between departments Pushing staff too hard in a high-stress environment Staff retaliation and push-back towards management Disrupting the flow too much could jeopardize patient

safety Decreased quality of care without improvement Increased diversion time and reduction in revenue capture Increased elopement rates and associated costs Poor quality and safety ratings could lead to reduced

reimbursement rates

16. CTQ Tree

CTQ KPIVs Customer(s) KPOV(s)

Dept. Directors

Bed Placement Manager

ED Physician

Unit Nurse

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

Patient transport and admission protocol

Communication b/w Bed Placement staff and admitting unit

Rough ROI AnalysisBy improving the efficiency of this process, the organization will improve their accessibility, capacity, patient safety, quality of care, and patient and staff satisfaction. The organization already has sufficient technological resources in place; however, a considerable amount of leadership and staff time will be needed to analyze the current process, implement changes, and measure and track the results. Therefore, a significant investment in staff salary will be necessary to improve the process.

The downstream benefits of improving the process will significantly exceed the initial investment in staff salary. The benefits include: Increased revenue gain as a result of decreased diversion time (lose $1800/hr when go

on diversion) Decreased costs associated with decreased elopement rates Increased capacity to see more patients in the ED Improved physician and staff satisfaction leads to recognition as an employer of choice Improved patient satisfaction leads to more patient referrals Improved quality and safety rankings