1. 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

2. 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

3. 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

4. We know that…..

5. Increase the Urgency

6. Get the Vision Right

7. Build the Guiding Team

8. 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

9. Relationships- Key to Success

10. Empower Action

11. 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

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

13. Swing Bed Checklist

14. Swing Bed Brochures

15. Swing Bed Capabilities

16. Create Short Term Wins

17. 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

18. 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

19. Make it Stick

20. Excellence: