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Commission
Disclosure Statement
]
The employees and/or speakers for this
presentation have disclosed that they do
not have any financial arrangements or
affiliations with corporate organizations
that either provide educational grants to
this program or may be referenced in this
activity.
]
Furthermore, each of the previously
named speakers has also attested that
their discussions will not include any
unapproved or off-label use of products.
2013 ANNUAL EDUCATION CONFERENCE © Copyright, The Joint Commission 2
Patient Flow:
What the Data Tells Us
and What it Doesn’t
Mark McClelland
, DNP, RN
Assistant Research Professor
Center for Health Care Quality
Department of Health Policy
George Washington University
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Learning Objectives
]
At the conclusion of this presentation, the
participant will be able to:
1.
Identify three metrics useful in assessing
patient flow.
2.
Identify three best practices for improving
patient flow.
3.
Identify emergency department activities,
practices and features that can either
support or interfere with effective patient
flow
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Agenda
Framework
Best Practices
Questions
Metrics
5 © Copyright, The Joint CommissionFramework
]
On-demand primary care
]
ER ED
]
Flow = Transitions in care
]
Organizational Culture
6 © Copyright, The Joint CommissionArtifacts
Espoused Beliefs
and Values
Underlying
Assumptions
Schein, E.H, Organizational Culture and Leadership 3rd edition. Jossey-Bass, San Francisco, CA.
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Culture
]
Push vs. Pull System
8
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Seven Critical Success Factors
]
1. Recognize that ED crowding is a
hospital-wide problem-not an ED problem.
]
2. Build multi-disciplinary, hospital-wide teams
to oversee and implement change.
]
3. Recruit and maintain a
“champion.”
]
4. Guarantee
management’s support.
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Commission
Seven Critical Success Factors
]
5. Use formal improvement methods.
]
6. Commit to rigorous metrics.
]
7. Make transparency an organizational
value.
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Best Practices
]
Rapid Intake
]
Bed vs. Treatment space
]
Vertical vs. Horizontal
]
Demand forecasting
12 © Copyright, The Joint Commission13 © Copyright, The Joint Commission Treatment Area 14 © Copyright, The Joint Commission
Best Practices
]
Rapid Intake
]
Bed vs. Treatment space
]
Vertical vs. Horizontal
]
Demand forecasting
15 © Copyright, The Joint CommissionBest Practices
]
Protocols/Standing Orders
]
Bridge Orders
]
Tight Bed Control
]
Bed Czar
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Best Practices
]
Data Marts
]
Shadowing
]
CM/SW triggers
]
Throughput Committee
17 © Copyright, The Joint CommissionData Mart
18 © Copyright, The Joint CommissionBest Practices
]
Data Marts
]
Shadowing
]
CM/SW triggers
]
Throughput Committee
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Throughput Committee
]
Multidepartmental?
]
Multidisciplinary?
]
C-Suite to Techs?
]
What data is reviewed?
]
Accountability?
20 © Copyright, The Joint CommissionQuestions
]
How does leadership convey the
importance of patient flow?
]
Who in the organization is held
accountable for good patient flow?
]
Ask a nurse,
“Do
patients flow like
water
?”
21 The Joint CommissionQuestions
]
On average how many telephone calls
does it take to get a patient admitted?
]
How conversant are staff with flow issues
on their unit and recent improvements?
]
What was the
hospital’s
greatest
accomplishment in the last year in
improving flow?
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Questions
]
Does boarding occur?
–
If so, who? when? how long? why?
]
When does the hospital start working
on bed availability?
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My Favorite Metrics
LBBS ± 2%
Decision to Admit ± 4 hours (HC = 55 min)
Treat and Release ± 2 hours
Admitted ± 4 hours (HC = 190 min)
Door to Provider
–
15 minutes ?
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My Favorite Metrics
Time to Consults
Consult to Recommendation
Advanced imaging order to final read
% of scheduled meds given on time
% of patients out by check-out time
25
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Commission
Annals of Emergency Medicine. 58(1) July 2011
26
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Commission
Review and Conclusions
Framework
Best Practices
Questions
Metrics
2013 ANNUAL EDUCATION The Joint Commission 27Questions?
Mark McClelland,
703-963-3975
mcclellandmark2@gmail.com
28
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Commission
The Joint Commission Disclaimer
] These slides are current as of 01/04/13. The Joint Commission reserves the right to change the content of the information, as appropriate.
] These slides are only meant to be cue points, which were expounded upon verbally by the original presenter and are not meant to be comprehensive statements of standards interpretation or represent all the content of the presentation. Thus, care should be exercised in interpreting Joint Commission requirements based solely on the content of these slides.
] These slides are copyrighted and may not be further used, shared or distributed without permission of the content owner or The Joint Commission. ] The program may be electronically recorded by The Joint Commission and is subject to the protection of the copyright laws of the US. No individual or entity other than The Joint Commission may electronically record any portion of these programs for any purpose without the written permission of The Joint
Commission and the content owner. Any and all reproduction or publication of these proceedings and programs are intended for internal field representative education only and will not be distributed in any other way without written permission from the content owner.
