1. Patient Admission from ED to Acute Care
Tech 581: Champion/Define Presentation
Sound Removed

2. Project Selection…
Project #1: Improve falls prevention techniques in order to reduce the fall rate/1000 patient days by 50%
Project #2: Time reduction between the time an ED admission order is made and the time that patient is placed in an in-patient bed within Acute Care
Project #3: Streamlining the ambulatory patient appointment reminder phone call system in order to reduce no-show rates

3. Project Selection Matrix and Ranking
Criteria #1 #2 #3
Likelihood of Success 4 7
$$ Cost/Revenue Impact 5 6
Staff/Physician Satisfaction 10
Quality of Care 8 2
Patient Satisfaction 9
Patient Safety 1
Completion in weeks
Selected project #2: Time reduction between the time an ED admission order is made and the time that patient is placed in an in-patient bed within Acute Care

4. From the Project Charter…
Principle stakeholders
Business case
Problem statement
Project Objective
Project scope
Goal Statement
Projective deliverables
Project schedule

5. Principle Stakeholders
Title/Role
Clinical Director, ED
Clinical Director, PCU 
Clinical Directors, Med/Surg 
Clinical Director, ICU
Clinical Manager, Bed Placement 
Physicians 
Nurses 
Lab/Imaging techs 
Environmental services (EVS)
EMS
Executive leadership team (ELT)

6. Business Case: Patient Admission from the ED to Acute Care
The aim of this process is to reduce the lead time for safe and timely patient admission from the ED to Acute Care services. By improving the efficiency of this process, the organization will improve their accessibility, capacity, patient safety, quality of care, and patient and staff satisfaction. The primary target of this process improvement effort is to decrease patient length of stay in the ED from the time an admission order is written. The secondary targets of this process improvement effort are to reduce the organization’s time on diversion, and decrease the ED elopement rate.
As health care moves into the era of reporting quality indicators; improving quality of care and patient safety rankings will positively affect the organization’s reimbursement rates. The consequences of not improving the efficiency of this process are reduced quality and patient safety (and possibly reimbursement rates), increased costs associated with increased elopement rates, and lost revenue as a result of increased time on diversion. Therefore, it is important to improve this process now in order to maintain reimbursement, control costs, and prevent losing revenue.

7. Problem Statement
Problem Statement: The national benchmark for the length of time it takes to admit a patient from the ED into an in-patient bed within Acute Care Services is 30 minutes. Currently, the organization’s average time for completing this process is well above the national average. Historical data shows this time to be approximately 120 minutes on the average.
The problem impacts the organization in the following ways:
Decreases physician/staff satisfaction due to increased work-arounds
Decreases patient satisfaction due to increased wait times and LOS
Increased costs associated with increased ED elopement rates
Decreased revenue capture due to increased time on diversion
Raises patient safety and quality of care concerns

8. Project Objective & Scope
Decrease the length of time from when an admission order is written in the ED, to the time that patient is placed in an in-patient bed within Acute Care Services, to 50 minutes.
Scope:
The process being investigated begins when the physician admission order is written in the ED, and ends with the patient's safe arrival in an in-patient bed within Acute Care (i.e.. Med/Surg, PCU, or ICU). Maternity services, Endoscopy, Day Beds, and Surgery are not within the scope of this project.

9. Goal Statement & Deliverables
Goal Statement: Improve through-put processes for safe and timely patient admission from ED to Acute Care Services; specifically by reducing the time from when an admission order is written in the ED, to the time that patient is placed in an in-patient bed within Acute Care Services, to 50 minutes. 
Deliverables (long-term, end results of project):
Decrease the length of time from when an admission order is written in the ED, to the time that patient is placed in an in-patient bed within Acute Care Services, to 50 minutes.
Reduce the organization’s time on diversion as a result of improved access and capacity for patients in the ED.
Decrease the ED’s elopement rate as a result of decreased patient wait times and LOS in the ED

10. Project Schedule X X X Task Owner(s) Week Milestones 1 2 3 4 5 6 7 8 9
Milestones 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Define
W.K. & team   X
 Champ/
Presentation
Measure
 W.K. & team
Analyze
Improve
Control  X X 
Improve/

11. Communication Strategy
Stakeholder
Analysis
Project Relationship
Communication Strategy
Impacted By
project
Can
Influence
Project
Outcome
Content/
Proces
Expert
Controls
res’cs
Has
dec.
Auth.
Meet
With
Reg.
Invite to
Meetings
Copy Of
mins.
No comm.
needed
Resp. for comm.
Clinical Director, ED X x
W.K
Clinical Director, PCU 
Clinical Directors, Med/Surg 
Clinical Director, ICU
 Clinical Manager, Bed Placement  x 
 Physicians 
 Nurses 
 Lab/Imaging techs 
 EVS
 EMS
 ELT

12. SIPOC Suppliers Inputs Process Outputs Customers ED physicians
Admission order
PROCESS:
ED admission order to in-patient admission
Patients admitted to in-patient bed
 ED nurses & Director
Bed placement assignment
 PCU/ICU/Med/
Surg unit nurses & Directors
Equipment (IV pump)
 Lab/Imaging
Techs & Directors
Lab/Imaging results
Bed Placement staff & Manager
Supplies (oxygen, bed pans, etc)
Admitting physicians
Vendors (IV pumps)
EMS
Environmental Services staff 
Patient
EMS  
Transport team

13. Voice of the Customer Analysis
Key stakeholders surveyed:
Clinical Director, ED
Clinical Director, PCU
Clinical Director, Med/Surg
Clinical Manager, Bed Placement
ED Physician
Unit Nurse
Imaging Department Director

14. VoC – SWOT Analysis Strengths
Advanced, automated bed tracking and patient transfer system in place
High level of physician and nurse expertise
Department Directors with a wide range of experience and knowledge
Support from the Executive Leadership Team
Available resources to accommodate changes
Addition of Transport Team has been very helpful

15. VoC – SWOT Analysis Weaknesses Animosity between departments
Communication barriers (i.e. personality conflicts) between departments
Perceived inadequate staffing levels (i.e. nurse/patient ratio)
Departments operate in silos
Lack of awareness of other department processes
Lack of standardized directions for admission orders and bed requests
Lack of standardized directions for when order/request should be made (i.e. before or after lab/imaging tests and results)

16. VoC – SWOT Analysis Opportunities
Improve communication between departments
Create a team-oriented culture
Educational sessions highlighting department-specific processes
Standardize admission order/bed requests across respective departments
Use the automated system to capacity

17. VoC – SWOT Analysis Threats Increased animosity between departments
Pushing staff too hard in a high-stress environment
Staff retaliation and push-back towards management
Disrupting the flow too much could jeopardize patient safety
Decreased quality of care without improvement
Increased diversion time and reduction in revenue capture
Increased elopement rates and associated costs
Poor quality and safety ratings could lead to reduced reimbursement rates

18. Patient admission time
ED staffing levels
Time between admission order written and time bed request is made
Dept. Directors
Bed Placement Manager
Ordering protocol
Communication process b/w ED staff and Bed Placement staff
Patient admission time
Unit staffing levels
Time between bed request and patient admission to unit
ED Physician
Unit Nurse
Patient transport and admission protocol
Communication b/w Bed Placement staff and admitting unit

19. Rough ROI Analysis
By improving the efficiency of this process, the organization will improve their accessibility, capacity, patient safety, quality of care, and patient and staff satisfaction. The organization already has sufficient technological resources in place; however, a considerable amount of leadership and staff time will be needed to analyze the current process, implement changes, and measure and track the results. Therefore, a significant investment in staff salary will be necessary to improve the process.
The downstream benefits of improving the process will significantly exceed the initial investment in staff salary. The benefits include:
Increased revenue gain as a result of decreased diversion time (lose $1800/hr when go on diversion)
Decreased costs associated with decreased elopement rates
Increased capacity to see more patients in the ED
Improved physician and staff satisfaction leads to recognition as an employer of choice
Improved patient satisfaction leads to more patient referrals
Improved quality and safety rankings