Emergency Department Waits and Patient Flow April 12, 2016

Current State

Improvement Goals Provincial Breakthrough Initiatives: By March 31, 2016, 90% of patients waiting for an inpatient bed (from the time a decision is made to admit, to actual admission) will wait <=17.5 hours. *Ministry alignment Ensure that patients and families receive the right care at the right time in the right place.

Improvement Goals By March 31, 2016, the LOS in the ED at BUH, LH, and MLH for 90% of non-admitted patients will be <=5.9 hours. * Ministry Alignment 20% reduction in total Acute Care Length of Stay for patient awaiting transfer to their home region from tertiary care. *Ministry Alignment and Measurement

Improvement Goals Implementation of Interdisciplinary Bedside Rounds Reduce length of stay by 10% where bedside rounds are fully implemented New Targets for ED Waits and Flows Set by Ministry January 2016 emergency wait time measures - a reduction of 35% by March 2017 50% by March 2018 60% by March 2019 Using the 2013/2014 data as baseline

Quality

Delivery

Safety

Engagement

Cost

Strategy for meeting goals ED Waits and Patient Flow Service Line has concluded that the ED reflects current state in our sister sectors: community: prevention, control and wellness, access home care: triggers for intervention, Home First plan acute care: flow of patients, iatrogenic disability, IDBR - physician/primary nurse/other disciplines long term care: wellness, iatrogenic disability

Next Steps Quarter 1, 2016/2017 April to June PLANNING: Value Stream Map – Current State Understand Drivers, Write A3s Decide on tools: RPIW, Just Do Its IDBR implementation ALC implementation Regular Communication Evaluate Patient Flow

Challenges patients are arriving for admission to acute care units before they are fully treated and stabilized – this is reported by both BUH and Lloydminster Hospitals. Health care is complex, turbulent focused determination, need healthy supply of grit Competing priorities for all – there is never enough cash Other strategies: Acute Stroke Strategy Recruitment and Retention Sick Time and Overtime

Opportunities Team and Supportive Culture are difference-makers Reviewing past RPIWs in ED for replication Horizontal and vertical communication Commitment, Continuous Action trumps all Support vertically and horizontally Physician engagement is the waking giant! Hurrah for Quality Improvement Specialists

QUOTE BY A MENTOR FROM JBA IMPROVEMENT