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Center for Patient Placement Improving Safety through Excellence in Patient Access Brian Laneau, MSN, RN Clinical Nursing Director, Center for Patient.

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Presentation on theme: "Center for Patient Placement Improving Safety through Excellence in Patient Access Brian Laneau, MSN, RN Clinical Nursing Director, Center for Patient."— Presentation transcript:

1 Center for Patient Placement Improving Safety through Excellence in Patient Access
Brian Laneau, MSN, RN Clinical Nursing Director, Center for Patient Placement Therese Hudson-Jinks, MSN, RN, NEA-BC Chief Nursing Officer & Senior Vice President Patient Care Services

2 Regulatory Requirements
The Joint Commission Leadership Chapter LD : The hospital manages the flow of patients throughout the hospital. Rational: Managing the flow of patients throughout their care is essential to prevent overcrowding , which can undermine the timeliness of care and, ultimately, patient safety. Effective management of system-wide processes that support patient flow can minimize delays in the delivery of care.

3 Portals of Entry Source of admissions/inpatient volume: Operating Room
Procedural Labs Electrophysiology Cath Lab Interventional Radiology Ambulatory Clinics Emergency Department Referring Facility Transfers ED-to-ED Transfer requests

4 Challenges Increasing inpatient census
High ED boarder times > 200 mins OR Holds Opportunities for enhanced communication between the following key areas and roles Case Management Hospitality ED OR Inpatient Care Areas Admitting Outside Facilities MDs and others

5 Access: Our commitment to our patients & families, care team & affiliates
Efficient Access to Care for Patients in Need of Expert Care at Tufts Medical Center and Floating Hospital for Children Coordinated care 24/ Data driven process Highly Reliable processes Right patient Right level of care Right time Cared for in the right “care team”

6 Consequences of ED Boarding
Patient’s leave without being seen (LWBS) Weiss, S., Ernst, A., Derlet, R., King, R., Bair, A., Nick, T. (2005). Relationship between the National ED Overcrowding scale and the number of patients who leave without being seen in an academic ED. The American Journal of Emergency Medicine, 23(3), Delays in care Horwitz, L.I., Green, J., Bradley, E.H. (2010). US Emergency department performance on wait time and length of visit. Annals of Emergency Medicine, 22(2), Increase in medical errors Kulstad, E.B., Sikka, R., Sweis, R.T., Kelley, K.M., Rzechula, K.H. (2010). ED overcrowding is associated with an increased frequency of medication errors. American Journal of Emergency Medicine, 28(3), Increase in overall length of stay Foley, M., Kifaieh, N., Mallon, W. (2011). Financial impact of emergency department crowding. The Western Journal of Emergency Medicine, 12(2), Increase in mortality Singer, A.J., Thode Jr., H.C., Viccellio, P., Pines, J.M., (2011). The association between length of emergency department boarding and mortality. Academic Emergency Medicine, 18(12),

7 Interventions Structure: Creation of a communication and decision making hub- Center for patient placement Process: Data driven process enhancements CPP ED

8 Team work across areas of influence

9 Structure: Center for Patient Placement
Hospitality EasCare Case Management Admitting Triage RN Central Staffing Nursing Supervisor

10 Systems Visibility Tufts MC = RAPID VIEW Room And Patient Information
Display Siemens RCO Invision – HIS Cerner – Soarian Clinicals Medhost – EDIS FacilityFit (Transport and EVS)

11 Process: A Day in The Life of the CPP Proactive Management vs
Process: A Day in The Life of the CPP Proactive Management vs. Reactive Decisions Weekly OR Schedule Forecasting Forecast Staffing Daily Hand-Off with CPP Nurse Supervisor (Night to Day Shift) Daily Safety Huddle – Led by CNO, CEO Bed Meeting CAPP Rounds (Communication and Patient Planning Rounds) Expected Day of Discharge Discharge ‘Appointment’ End of Day Huddle (Current State Reconciliation for Discharges) Next Day Preview: Discharges, OR Volume, Scheduled Admissions, Etc. Nurse Supervisor Rounding

12 Process: Emergency Department
Case Management Role Collaboration with Floors Clinical Leader Forum ED Boarder Committee Daily Processes A.M. Contact CPP for Availability of Med/ Surg Beds & ICU Beds Review of Current ED Volume & Staffing Recommendation for In-House Placement ED Observation Level of Care ED Volume Surge Priority Alert Code Help

13 Role of EVS & Transport – Everyone is on the team

14 Reporting – Data Driven Processes
Monthly Patient Progression Meeting’s by Product Line; LOS Management Reporting Facility, Product/ Service Line, Unit, & Patient Level Key Capacity Statistics Key Performance Indicators Care Progression Events Patient Placement Performance – Bed Request Process Discharge Planning & Utilization Review Metrics Resource Management – Bed Turnaround (EVS)

15 Results Enhanced Operations while increasing volume
ED Boarder Time reduced from > 200 mins to ~ 120mins Door to provider time reduced by 21% (34 mins) LWBS reduced by ~ 20% to < 2% (~ 1.7) Near elimination of Code Help (1-2/year) Enhanced communication Near elimination of OR Holds

16 Emergency Department Visits and Admits

17 ED Boarder Time Relative to ADC

18 ED: LWBS Average per Month

19 Overall LOS Index Trend – TuftsMC Overall
LOS Index ( < 1 is Better) With Outliers

20 Commitment to Patient Safety
Safety huddle focus Review of ED safety event reports ED-Floor handoff process Infection prevention and isolation precaution reports Case management involvement on outside hospital transfers when clinically indicated

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