Eastern Health: Improving ED to Ward Transfer Lean Team Members Michael Butler

Overall Process Being Mapped After consultation with the Hospital’s Admission & Discharge Manager, the initial plan was to map the journey of a medical patient from admission to the Emergency Department to transfer to Ward 2 East. This process was selected for a number of reasons, including: Ongoing problem of meeting our DHS HDM access target for ‘No. of Patients with LOS in ED >24 hours’, which appeared to correlate with patients requiring admission to a medical bed The ED had previous Lean experience, including undertaking 5S and VSM – associated with ‘InformED’ funding Low Nursing Staff morale in 2 East Opportunity to link this with other improvement activities occurring in 2 East and to impart Lean Thinking to the nursing staff of the ward Following completion of the current state VSM for this process, in consultation with 2E NUM & ANUM it was decided to narrow the project focus to a process related to the admission from ED to 2E, thus the following.

Project Aim & Plan Project aim: Reduce bed preparation time to 30 min in Ward 2 East (From bed vacated to next admission from ED) Project Plan: VSM, presentation to ward staff, consult’n with NUM, Nurses & WSS I dentify waste / problem areas Inefficient work areas – pan room, treatment room, work stations, etc. Non-standardised work – nurses & WSS have varying systems of identifying & notifying one another of a bed to be cleaned / once a bed has been cleaned. Key Stakeholders Medical patients, 2E NUM / ANUMs / staff, Bed Mgr, ED staff, WSS staff, Hospital executive team

Current State Value Stream Map

Bed Prep Value Stream Map – Future State:

Kaizen Blitz Actions: Identify ward admission takt time – Source: Trend Care Takt time (identified using 12 months of admission data) = 3.327 admissions per day Takt time for each day of week also identified ‘Follow’ bed at different times in day Progress –3 beds ‘followed’ & mapped during morning shifts, to be followed by mapping during pm shift Further define p.r.n. by using ‘problem is/is not’ Collect data – bed vacated & admission to ward times Pre-implementation data collection commenced 5S to improve efficiency in identified ward areas Project team formed and work commenced Ward areas identified and prioritised Information on 5S tool provided and 5S expertise sort from ED Logistics Co-ordinator Standardise work / roles of WSS and nursing staff in relation to bed preparation / cleaning – written guidelines Project team formed and bed mapping completed Issues as previously identified Additional issues identified, including inconsistent use of Transit Lounge!

Next Steps: Project handed over to Ward 2 East (December 2006) EH ED Patient Flow Committee formed, including 4 Angliss reps Purpose - ????? Angliss data presented so far has included: 7.3% growth in patients requiring admission to a ward from ED comparing 2005/06 with 2006/07(July to Dec) Top 10 Diagnosis for LOS >24hrs - audit of pt records of top 3 conditions (UTI, Lobar Pneumonia and CHF) is being conducted to determine reason for delay and if alternatives means of managing pt Time of Arrival at ED for LOS >24hrs (EH data) Majority of pts with LOS>24hrs arrive between 1000 and 1600 Other data - 1800 to 2200 there are more bed requests than separations, 1000 to 1800 there are more separations than bed requests Day of the Week ED presentations for LOS >24hrs (EH data) Data showed a significant increase of 24hr LOS on Sundays, with Friday at 7% and Sundays at 25%. Separations were reversed showing 8% on a Sunday and 17.3% on a Friday Average time for ‘Available to transfer from ED to Ward’ Varied between 42 - 64 min, sometimes waiting up to 149 min. Plan to develop Angliss ED Patient Flow Committee, To implement improvements based on EH ED Pt Flow findings / data Membership to inc. IP medical beds (2E) reps To use Lean thinking as the improvement methodology