Success Stories-Triage and Process Desig

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Information about Success Stories-Triage and Process Desig
Science-Technology
cis

Published on January 12, 2009

Author: aSGuest10258

Source: authorstream.com

Slide 1: Chris DeFlitch, MD, FACEPPenn State Hershey Medical CenterConnected (CIS) Physician ChampionFounder, Penn State Partners for Healthcare Engineering Director & Vice-Chair, Dept of Emergency Medicine Healthcare Engineering with Physician Directed Queuing (PDQ)TM Success Stories-Triage and Process with EDIS HEALTHCARE TODAY : HEALTHCARE TODAY BOARDERS No Beds for ED Patients HALLWAY Patients Ambulance DIVERSION Dissatisfied Providers Dissatisfied Patients Regulatory Issues Define Capacity as Bed Emergency Department (50,000) : Emergency Department (50,000) Traditional Targets 37 patient stations (1350 visits/station) 44K sq ft 0 stations short <1% LWOTS 0 Hallway beds 0 Boarders Satisfied Providers Satisfied Patients Patients Safe Right Care, Right Location Reality Capacity for 28,500 20 open stations (2589 visits/station) 24K sq ft 17 stations short >7% LWOT Hallway care 10+ Boarders Dissatisfied Providers Dissatisfied Patients Safety, Regulatory? Some Care, Any Location Use EDIS for Success : Use EDIS for Success Understand workflow, map processes Critical Resources Demand-Capacity Interdependencies Apply Queuing and IE science to flow Define Value with EDIS DATA Redefine & Expand Capacity to Care Limited Resources Limited Capital Actually DO IT…..TRANSFORM Add Operational DATA to Workflow : Add Operational DATA to Workflow Arrival distributions Critical Interval Processing Times Resources data, number and type Perspective Flows Patient Provider Resources Provider Perspective Flows : Provider Perspective Flows “Typical” Arrival Patterns : “Typical” Arrival Patterns Define the ISSUE with Operational Data : Define the ISSUE with Operational Data No Capacity High Demand Understand Queuing Systems : Understand Queuing Systems Science of WAITING All queuing systems possess the same basic elements: Customer (Demand) Resources (Capacity) Queues When analyzed, it is clear that queuing systems are ubiquitous in healthcare. “One mans WAIT is another mans WORK” Value-Added Activity : Value-Added Activity Must be performed to meet customer needs Adds form or feature to service Enhances service quality Customers willing to pay for this work George ML. Lean Six Sigma Pocket Toolbook. 2005 WASTE (non-value added) : WASTE (non-value added) Handling beyond what is minimally required to move work Rework to fix errors Duplicative work Wait Idle time Delays Unnecessary motion Over processing (too many steps to complete the job) George ML. Lean Six Sigma Pocket Toolbook. 2005 Clinical Value Analysis : Clinical Value Analysis Clinical Value Streaming - TRIAGE : Clinical Value Streaming - TRIAGE Clinical Value Streaming- CP Triage : Clinical Value Streaming- CP Triage “Healthcare is the only industry I have ever heard of that actually has a name for a major category of waste. You have waiting rooms. Most organizations outside of healthcare would go bankrupt if they thought like this”. : “Healthcare is the only industry I have ever heard of that actually has a name for a major category of waste. You have waiting rooms. Most organizations outside of healthcare would go bankrupt if they thought like this”. Page 33 Lean-Six Sigma for Healthcare Caldwell et al “Infuse care into the queue (waiting) ….define capacity to CARE not a bed” Penn State Healthcare Engineering Team DeFlitch et al Critical to Healthcare Engineer : Critical to Healthcare Engineer Burning Platform Defined CRITICAL Resource(s) & interdependencies Boarders Ancillaries Information Providers Minimal Space WITHOUT Adding Resources Slide 17: Physician (or MLP) Determines Queue passively Listens to RN traditional “triage” Delegates Procedures Initiates work-up when no beds Triage Nurse(s) Arrives patient Manage Minor Emergency Technician support Splint Transport Physician Directed Queuing (PDQ)TM PDQ Year-to-Year Results Comparison : PDQ Year-to-Year Results Comparison Baseline 5.6% 8h 6m 71 min 93 min 5h 34m 5h 51m Healthcare Engineered 2.7% 6h 16m 45 min 60 min 3h 9m 1h 23m LWBS Length of Stay Door-Rm Door-Dr ESI 4 ESI 5 52% 23% 37% 35% 44% 76% Current Front-End Space : Current Front-End Space Ambulance Walk-In TRIAGE “need” 20K sq ft …..you get 7k Currently under Construction : Currently under Construction Visitors to Hospital PDQ Triage1 Triage2 Check in Checkout Private Complex Dx Queues Technician Staffing Private Minor Dx Queues Minor Emergency, Walk In : Minor Emergency, Walk In Visitors to Hospital Triage PDQ Full Reg & Checkout Minor Emergency, Ambulance : Minor Emergency, Ambulance Visitors to Hospital Triage PDQ Full Reg & Checkout Room Required & Available, Walk In : Room Required & Available, Walk In Visitors to Hospital Triage Room Required & Available, Ambulance : Room Required & Available, Ambulance Visitors to Hospital Triage1 Mini Reg Room Not Available, Walk In : Room Not Available, Walk In Visitors to Hospital Private Complex Dx Queues FullReg Triage PDQ Room Not Available, Ambulance : Room Not Available, Ambulance Visitors to Hospital Private Complex Dx Queues FullReg Triage PDQ Next Venues of Healthcare Engineering : Next Venues of Healthcare Engineering Service Line Flow (Neurosurg) Peri-Op Processing (Operative Suites) Hospital Capacity Management Other Interdependent ED flows Informatics Project Management Quality Outcomes (MRSA, Diabetes) Process Simulation with OSGi Future of HEALTHCARE ENGINEERING : Future of HEALTHCARE ENGINEERING Process simulation models Explicitly represent variability Predict interdependency Manage complex systems in a computer Predict system performance under varying inputs (loads) Compare alternative system designs Determine the effects of alternative policies on system performance

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