Presentation on theme: "Presented by, Matthew Rusk, D.O. Advisor: Khalid Qazi, M.D."— Presentation transcript:
Presented by, Matthew Rusk, D.O. Advisor: Khalid Qazi, M.D.
Objectives Introduce a concept that augments the admission process by improving: Admission wait times Patient satisfaction Quality Cost Effective Care Explain how change was implemented Discuss results Compare results to current literature
Introduction—Lean Flow Business concept that is well known and implemented daily by successful businesses Often ignored in the healthcare industry Gaining recognition in healthcare Can make healthcare efficient and improve quality
Introduction ED overcrowding is associated with worse quality of care and service delivery quality (1); Recent studies have shown clearly that wait time directly affects patient satisfaction (1-9); Time to evaluation can also influence whether or not a patient is seen at all (1, 2, 10).
Hypothesis Utilizing lean flow will improve the admission process at Sisters of Charity Hospital by: Decreasing the total admission process time Improving patient satisfaction Enhancing quality Improving Cost Effective Care
Methodology Implementation of Lean Flow X32 Healthcare ‘Rapid Improvement 3-day Program’ ○ CHS Staff; ○ Four Residents; ○ Lean Flow Education; ○ ‘Front end’ Improvements; ○ Little focus on admission process
Methodology Applied concepts to improve admission process Key Changes: ○ Admission Orders within 30 min; ○ ED Holding Orders in certain situations; ○ Earlier Bed Search; ○ Easier access to order sets, charts and labels
Methodology Outcome measures Time Patient Satisfaction Quality and Safety Cost Effective Care
Methodology Pre-intervention March 1 through October 31, 2008-2011 Intervention November 2011 – February 2012 Post-intervention March 1 through October 31, 2012
Methodology-Time Intervals Arrival to Departure (total admission time) Arrival to ED Provider ED Provider to Time Admitting Physician Informed of admission (TAPI) TAPI to Admit Order Admit Order to Departure ArrivalED ProviderTAPIAdmit OrderDeparture
Methodology-Patient Satisfaction Questions: Got help as soon as wanted Quiet around room at night Treated with courtesy and respect by doctors Treated with courtesy and respect by nurses Rate Hospital Would recommend hospital to family Answers 9 or 10 out of 10 defined as perfect score 8 or below defined as non-perfect (negative response)
Methodology-Quality Indicators Inpatient Specific ED Specific Fall Rate Core Measure Compliance AMI, HF, PN, SCIP RRT calls Inpatient Mortality Left Without Being Seen (LWBS) ED Mortality
Methodology—Cost Effective Care Average LOS ED Volume Total Admissions
Results—Time Variables Summarized using means and standard deviations. An independent two-sample t-test using assumption of equal variances was used to test for differences in means. A multiple regression model was used to test for differences adjusted for baseline variables (age, gender, race, Arr Method, and Bed Type).
(Decrease of 78.8 minutes [417.8 – 339 = 78.8]) Statistically Significant, P-value <.0001 Time (minutes)
(Decrease of 35 minutes [168.5 – 133.5 = 35]) Time (minutes) Statistically Significant, P-value <.0001
(Decrease of 36.2 minutes [61.9 – 25.7 = 36.2]) Time (minutes) Statistically Significant, P-value 0.0015
Summary of Time Variables Arrival to Departure (Total Admission Time) Decrease of 78.8 minutes 19% reduction in total admission time Most of our overall improvement during TAPI to Dep TAPI to Departure Decrease of 71.2 minutes 31% reduction of this TAPI to Admit Order Decrease of 36.2 minutes 58.5% reduction of this interval Admit Order to Departure Decrease of 35 minutes 21% reduction of this interval
Results—Patient Satisfaction Summarized using frequencies and percentages. A Pearson chi-square test was used to compare the proportion of satisfaction between pre and post. Odds ratio and corresponding 95% confidence interval was calculated.
Hospital Rating StatisticDFValueProb Chi-Square116.7623<.0001 Chi-square test: Type of StudyValue95% Confidence Limits Case-Control (Odds Ratio) 1.79811.35612.3843 Odds Ratio:
Would Recommend Hospital To Family StatisticDFValueProb Chi-Square112.50090.0004 Chi-square test: Type of StudyValue95% Confidence Limits Case-Control (Odds Ratio) 1.69311.26292.2698 Odds Ratio:
Treated With Courtesy and Respect By Doctors StatisticDFValueProb Chi-Square110.02760.0015 Chi-square test: Type of StudyValue95% Confidence Limits Case-Control (Odds Ratio) 1.71131.22462.3914 Odds Ratio:
Treated With Courtesy and Respect By Nurses StatisticDFValueProb Chi-Square111.02640.0009 Chi-square test: Type of StudyValue95% Confidence Limits Case-Control (Odds Ratio) 1.77031.26062.4861 Odds Ratio:
Patient Satisfaction Results All questions showed significant improvement post-intervention. Hospital Rating Scores improved to 70.2% (from 56.74%) Recommend to Family Scores improved to 74.94% (from 63.85%)
Results—Quality Summarized using means and standard deviations An independent two-sample t-test using assumption of equal variances was used to test for differences in means.
Improved ED Left Without Being Seen (LWBS) 38% reduction in LWBS p-value is < 0.0001
Improved Core Measure Compliance Percentage of Perfect Care Pre (%)Post (%) P-value AMI91.41100.000.0956 HF84.35100.00 <0.0001 PN84.9994.44 0.0293 SCIP84.9892.61 0.0006
Decreased Number of Rapid Response Team Calls p-value = < 0.001 Statistically Significant
Mortality InpatientED p-value = 0.9053 No significant difference p-value = 0.6264 No significant difference
Quality Summary Inpatient Specific ED Specific Improved Inpatient Fall Rate Improved Core Measure Compliance AMI, HF, PN, SCIP Decreased RRT calls No change in Inpatient Mortality Improved Left Without Being Seen (LWBS) No change in ED Mortality
Results—Cost Effective Care Summarized using means and standard deviations An independent two-sample t-test using assumption of equal variances was used to test for differences in means.
Improved Length of Stay Average LOS decreased from 4.68 days to 4.36 days (p-value < 0.0018 )
Increased ED Volume and Admissions ED Volume increased 13.5%: Pre Volume avg = 23,624 Post Volume = 26,799 (March-Oct) Admissions Increased 3.5%: Pre Admission Avg = 4,002 Post Admission = 4,141 (March-Oct)
Cost Effective Care Summary Improved Average Length of Stay Increased ED Volume Increased Admissions
Discussion Yale-New Haven Hospital utilized lean and reduced the time from decision to admit [TAPI] to transfer to floor [departure] by 33% (11) Anecdotal recount We had a 31% reduction of this time frame. Lack of studies focus on admitted patients. Lack of focus on admission times, affect of overall hospital rating after admission Limited investigation on inpatient quality.
Conclusion Our study fills void ○ focus on how lean affects the admission process and subsequent hospital stay. Implementing Lean Flow at Sisters Hospital Significantly Improved Admission Times Significantly Improved Patient Satisfaction Significantly Enhanced Quality Facilitated Cost Effective Care
Conclusion Further improvements are possible Focus on specific time intervals Re-evaluate processes Lean Flow works and is an essential tool implement in healthcare.
Acknowledgements Marylin Boehler, RN, Director of ED and Critical Care Julie Morgante, Quality Analyst, Quality & Patient Safety Department Terry Mashtare, PhD, UB Statistics Department Jingjing Yin, UB Statistics Department Entire Sisters Medical Records Department Abid Hussain, MBBS, IM Resident Sameer Waheed, MBBS, IM Resident Mohammad Tantray, MBBS, IM Resident Nancy Roder RN, BSN, Application Analyst, CHS Information Technology X32 Healthcare—Lean Consulting Firm Chuck Noon, PhD Brian Livingston, MD, MBA Jody Crane, MD, MBA Kim Adams, RN
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