Hospital Off-Load Process Improvement Team February 23, 2007

Project Team  Team Members Jennifer Higgins Traci Acton Benjamin Abes Mariellen Shields Janet Quinn Paul Hellriegel  Team Leader Shared responsibility  Team Facilitators Eileen Briscoe John Norton  Sponsor Deputy Director H. C. Hansen

Define Phase  Problem statement  Lee County hospitals are not off-loading EMS patients in a timely manner. This results in fewer ambulances available for response at any given time. It also results in more available units having to move around the County to provide coverage.  Justification for project  Lee County EMS and hospital partners are losing opportunities for faster return to available status of ambulances and more timely processing of patients to admission or release. The effort to better manage these resources will pay monetary benefits to both.

Project Impact  County objective  Project will prove a savings in unit availability hours and manpower. Quicker off-loads will allow ambulances to turn around quicker and be available for calls, thus potentially reducing response times allowing LCEMS to meet the benchmark response time of < 8min 59sec. To become more knowledgeable about hospital processes and assist hospital partners in streamlining the ED intake process. The estimated savings is ≈$350,000; using $140/hr of unit utilization hour.  Project goal  EMS patients should be off-loaded 90% of time within 15 minutes of arrival at the hospital and within 30 minutes 100 percent of the time.

Project Scope  In scope  All Lee County EMS ambulances.  Out of scope  All other transport agencies in Lee County.  Hospitals in other counties.

Process Flow Chart Please see hand-out.

SIPOC Diagram SuppliersInputsProcessOutputsCustomers Medics EMS Admin Hospital Admin ER BOCC Medics: Return 10-8 Record trip detail Continue pt. care EMS Admin: Political issues Return units 10-8 Resources Hospital Admin: Political issues Generate revenue Foster good relations ER: Staffing Beds Equipment BOCC: Resources Budget/taxes Unit arrives at hospital Patient is offloaded Unit becomes available Offload time Unit is available for calls Patients EMS Hospital Admin BOCC

Measure Phase

Analyze Phase Destination Coordination

Analyze Phase Turn Around Times in ER

Analyze Phase Available Beds in ER

Analyze Phase  Root Causes Found Destination Coordination: Ambulance clumping at ERs Available beds at ERs Hospital Turn Around Time: Hospital boarding patients in ER

Improve Phase Solution Prioritization Matrix SOLUTIONRANK Mandatory Transportation Officer Contact 1 Standardize ER Status Codes 6 ER Update With Bed Status Via EMSystems 2 Hospital Assigns Off-Load RN 5 No Patient Choice 4 Room Assignment When EMS Calls 2

Improve Phase Solutions Implemented  Transportation Destination Coordinator contact prior to transport. Transportation Officer must be a paramedic  EMSystems update by hospitals.  Lee Memorial Hospital ER nurse finding bed space prior to EMS arrival.

Improve Phase  Pilot ran from February 1 st to February 14 th  The only facility implementing all three solutions was Lee Memorial Hospital  Shift Command took on the role of Transportation Officer

Improve Phase  Results: Pilot proved a statistically significant reduction in the average off-load times for Lee Memorial Hospital. A decrease in the variation (range).

Improve Phase

t-Test: Two-Sample Assuming Unequal Variances Feb-07Feb-Mar 2006 Mean Variance Observations36115 Hypothesized Mean Difference0 df14 t Stat P(T<=t) one-tail E-05 t Critical one-tail P(T<=t) two-tail E-05 t Critical two-tail

Improve Phase

 Recommendations: Team to review results with Process Owners and hand off (2 nd week in March). Pilot demonstrated significant reduction in range. Recommend that process used in pilot be continued with Lee Memorial as normal part of operation. Recommend that process used in pilot be implemented on an incremental basis in all other hospitals within county.

Control Phase  Process owners: EMS Shift Commanders EMS Transportation Officer

Control Phase  Process data to be reported via weekly reports from Public Safety Information Resources.  Data will be in Microsoft Excel format.  Reports will be input to worksheets which are formatted to calculate timelines.

Control Phase

Hand-off Issues (Parking Lot Issues)  Hand off should not present any unforeseen difficulty.  Following recommendations will require workload adjustment for Shift Commanders or addition of an EMS Transportation Officer.  Future projects will be decided by management with recommendations from Six Sigma Steering Committee.

Questions?