WP Detox Admission Lean May 2017

The Issue 35% Value Added Arrival to admit complete= 4hrs 11 minutes Entry to Unit Admission Complete 175 minutes 76 minutes 35% Value Added Arrival to admit complete= 4hrs 11 minutes

Intake Forms and Paperwork 34 pieces of paper given to patient 19 forms require patient signature

History and Physical Information ART Evaluation Nurse Practitioner Paper Intake Form Nurse The same information is asked of the patient 6 times, with very little of the info flowing to the next person. Nurse assessment completely obsolete, so RNs not thoroughly filling out their documentation ART Intake Call Psychiatrist

95% Let’s design for the Designing for the 95% Process was designed to prevent inappropriate admissions. Patients that belong in ED Patients that cannot get insurance verification What does the data say? 5% are transferred to ED* 0% are turned away for financial reasons Let’s design for the 95% *From March 1- May 11, five patients were transferred to ED. 96 total were admitted to Detox

AIM Looks like: Emptier lobby, no patients sleeping in the lobby, cleaner, team looks professional and cohesive Feels: Personal touch, less chaos, more private, less like an assembly line. Welcoming from the 1st call. Our “chaos” is not visible to patients and families. Sounds: Quiet voices, people explaining to patient what is happening in the process, consistent messaging from all staff, personal patient info kept more private. Arrival to Patient on the Unit < 45 minutes with assessment complete

Tools and Decision Making Process Maps Affinity diagrams Simple schedule modeling A Sticking point Who Brings down the labs to the hospital? Batching versus 1 piece flow? What time should admits start? Morning Admit Model Patient Arrival Time Lab draw time Bring to Assessment Room First Meds given Onto the Unit Lab pick-up time Lab delivery time Lab result time 1 8:00 8:15 8:30 9:00 10:30 10:45 11:30 2 9:15 9:30 10:00 3 10:15 11:00 4 11:15 12:00 13:30 13:45 14:30 5 13:00 13:15 14:00

What changes are we making? Better Flow of information between team members More info collected in initial screening calls Nursing documentation flows to subsequent assessments/evaluations Reduced paperwork Creating intake/assessment room on the unit Freed up Assessment and Referral Team to take on new initiatives Teams working to the top of their license. Intake performed by someone they will see throughout their stay. Eliminated one handoff

Lessons Learned & Next Steps Let the team know the team being freed up will be used for new initiatives. Begin change management even earlier. How is the project being presented to participants and other staff?

Next Steps Engage the team using POPin Training Refurbishing of clinical evaluation room on the unit

Comments from the Leaders

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