For: 500-Bed Metropolitan Hospital
A backlog in the ER was causing high emergency divert rates for this metro hospital leading to lost revenue, lower fixed cost absorption and a potential for reduced patient survivability due to longer time from incident to treatment. The length of a patient’s stay in the ED varies depending on patient volume, staffing and space. The hospital team initially decided to increase the staff to drive faster turns in an effort to avoid diverts. However, they soon discovered that this strategy was only effective if the hospital had inpatient beds available for patients flowing out of the ED. The team found that inpatient beds were often unavailable, inhibiting their ability to maximize patient turns.
Supported by a Productivity Healthcare consultant, the team dug through mounds of data, and discovered that delayed inpatient discharges were holding inpatient beds longer than necessary, resulting in the unavailability of beds for ED patients. This was contributing to the ER backlog which subsequently caused unnecessary ED diverts. In a kaizen event, the team identified the major causes of delayed discharge as demand patterns, nursing staff availability, and the availability of patient home transportation.
The Kaizen team went on to discover that ED transfers were at their peak between 10am and 1pm. Timing inpatient discharges before 1pm would accommodate these peak transfer hours and reduce the capacity strain on the ED. To do this, they realized that they needed to plan each patient’s departure earlier in their stay. Discharge planning activities were integrated into role-based standard work for hospital staff. Morning shift handoff checklists were updated to include a review of patients/rooms anticipated discharge for that day.
The team discovered 3 or more morning discharges per nurse meant assistance was required to provide patient care and manage discharge timelines. The hospital took responsibility to communicate discharge procedures with family members outlining expectations and ensuring transportation availability. Hospital Social Workers integrated the activity of arranging home transportation into their patient checklist and informed nursing of arrangements the day before discharge.
The Productivity Healthcare consultant facilitated development and integration of work standards with operations staff to assure these new processes were competent.
Improvements, Benefits, and Key Outcomes
The length of Emergency Department stays was reduced as inpatient bed availability improved.
Other Improvements and Outcomes:
- Revenue increase of $180,000/year due to fewer diverts.
- Patients experienced quicker transportation to the Emergency Department.
- Patients’ incident survivability increased due to a reduction in time between an incident and treatment.
- 4 months