A Team Approach to Maximizing Patient Flow Across a System of Care Nita Dunham, Senior Director of Care Management Regional Health Lynn Simons, Director of Patient Services Sturgis Regional Hospital

Objectives Multidisciplinary approach to cultural transformation a. Utilizing steps for transformational change b. Breaking down silos to improve system communication c. Getting the team right Develop a program a. Hospitalist program in a critical access facility b. One-stop shop referral process for the system c. Accessing community resources to address transportation needs Educate for change a. Provide education to key stakeholders b. Celebrate wins and review failures in process for improvement Results of change a. Improved overall financial status for a system b. Decrease in LOS and readmission rates in a tertiary facility c. Improve swing bed utilization d. Improve patient, caregiver, and physician satisfaction

Coverage Area 5 states | 250 mile radius Integrated Healthcare System 5 Hospitals 2 Long-term Care 24 Clinics Employ 5,000+ Providers and Caregivers Recognized for Quality & Patient Experience ANCC Magnet Recognition® (Rapid City) Trauma Verified American College of Surgeons Trauma Level II (Rapid City) and Trauma Level III (Spearfish) South Dakota Department of Health Trauma Verification – Trauma Receiving Facilities Custer, Sturgis, Lead/Deadwood AHA Get With the Guidelines Stroke Award AHA Mission: Lifeline STEMI Award Healthstream: Insight Award “Overall Patient Experience” (Custer) Coverage Area Committed to the Future of Healthcare 32 Medical Specialties including: Orthopedics, Cardiac, Cancer Care 5 states | 250 mile radius Affiliations: 5 Schools of Nursing Graduate Nurse Residency program Medical Residency program 100+ active research studies 858,469 | South Dakota Population 373,618 | Service Area Population

We know that…..

Increase the Urgency

Get the Vision Right

Build the Guiding Team

Team Objectives Problem statement: Aim: Regional Health Swing bed referral process has poor role delineation, poorly defined processes, inconsistent communication and accountability resulting in overburdened caregivers and providers, poor hand-offs, unrealistic caregiver and patient expectations, and inefficient patient flow. Aim: Create a standard Swing bed referral process that coordinates the plan of care, handoffs, transparency, and a culture of appropriate care delivery in our swing bed population Identified 9 opportunities for improvement: 4 were simple projects 5 were multidisciplinary improvement invents

Relationships- Key to Success

Empower Action

Transformational Change Projects Developed a centralized intake process Referral communication Standardize referral information for providers Patient education – swing bed brochures Swing bed facility capabilities Utilized midlevel support in 1 CAH October 4, 1927 October 31, 1941

Centralized Intake Process Decreased intensive referral review and duplication Utilized Transfer Center for centralized intake Improved caregiver satisfaction Improved patient flow

Swing Bed Checklist

Swing Bed Brochures

Swing Bed Capabilities

Create Short Term Wins

Increased Swing Bed Utilization Sturgis Regional Hospital Data: Added a midlevel provider to our hospitalist program Increased Swing Bed admissions by 35% Increased Swing Bed days by 40% Average daily census increased from 13 to 15 – 14% increase

Don’t Let Up Role out midlevel support in all CAH’s Develop a standardized admission handoff that is multidisciplinary Improvement in discharge time of day

Make it Stick

Excellence: