1. Patient Flow Mystery Case Whose Problem is it?

2. What is “Corporate Patient Flow”  The movement of patients through the entire Corporation of St. Joseph’s ED unit DI unit unit ALC home  Why recent focus on Patient Flow?

3. Why recent focus on Patient Flow? ED unit DI unit unit ALC home MOHLTC reduction of ED wait times Goal = 90% admitted in 6 hrs SJHH = 90% admitted in 25.6 hrs Alternate Level of Care 1/3 of SJHH’s inpatient capacity is used by ALC patients

4. The whole patient flow story… ED unit DI unit unit ALC home Nursing Physicians Families Housekeeping Portering Allied Health CCAC Diagnostic Imaging Lab Bed Allocator Patient Flow Manager Off-site Supervisor So….whose problem is it????

5. Emergency Admissions 123 25 116 LWBS ED Discharge 6 Discharges Home Other Acute Care Home care / Rehab LTC, Rehab, CCC Died 37 7 1 3 1 OR Cancellation OR ICUs CCU Units 2 1 1 0 Data Sources: NACRS, DAD Same Day Admit MNC EPT 5 4 10 12 SSD 3 Picture Source: Sunnybrook Healthcare Newborn 10 14 10 Average SJHH Activity Per Day

6. Real life pressures – Jan 5/09  0830 Status:  16 admit to no beds in ED  9 of these patients waiting >24 hrs  0 Critical Care & 0 Resuscitation ED beds  1 Assessment bed  1 Ambulance off-load  9 patients waiting in the community  18 scheduled surgeries

7. Flowing Patients  0830 bed meeting  All surgeries placed  No information on medical bed availability  1100 bed meeting  11 patients from ED assigned bed  Patients generally don’t begin to move from ED until after 1pm

8. How can we improve? Corporate Patient Flow Policy GREEN / YELLOW / RED & TEAMWORK

10. Additional Strategies  Patients identified and planned for discharge 24 hours in advance  Physician rounding complete by 0930  Patient discharges are immediately entered into the system  Allied Health will report to assigned areas by 0900 with discharge plan for patients