E.D. – T.V. A Simulation Capacity Analysis Jamey Koontz Baylor Health Care System

Overview The Model Methodology Current State Data ED Layout ED Figures Results Other Information - Staffing

Baylor Health Care System Non-Profit Health Care System in North Texas 14 Owned, Leased and Affiliated Hospitals 11 th Consecutive Year in U.S. News & World Report’s “America’s Best Hospitals” Celebrated 100 th Anniversary Oct Baylor Research Institute 93,324 Admissions 245,558 ED Visits 495,645 OP Visits 13,249 Babies Born 2,587 Licensed Beds 15,000 Employees 3,300 Physicians

Baylor All SaintsBaylor City ViewBUMC Baylor Heart/Vascular Baylor GarlandBaylor Grapevine Baylor IrvingBaylor Plano Baylor Waxahachie Our Children’s House BSHBIR

Methodology A Process Flow Diagram was Developed with the Current Process Data was Obtained from the 2005 MedHost Database September – October 2005 A 2005 Model was Developed as a Base Model Scenarios Tested were Based off of Volume Projections and Future Assumptions and Renovations

Current State Data 2005 Beds Main ED: 15 Trauma: 1 Treatment Area 2: 6 LWOT – 5% = 5 patients/day Admits – 16.5% = 18 patient/day

Current State Data 2005

Average LOS is 3.7 Hours

ED Layout

ED Figures Patient LWOT Patient Emergent & Imminent Patients

New Changes & Assumptions 7.0 New Beds 1.0 Trauma Bed 6.0 Main Beds Improve Triage Process Old Time – 5 minNew Time – 4 min Bedside Registration – allows for process to occur simultaneously CPOE/EMR – Reduce Patient Treatment Time 2007 – 4.5% 2007 – 4.5% 2008 – 10.0% 2008 – 10.0% 2011 – 12.5% 2011 – 12.5%

New Changes & Assumptions Lab POC Testing  Reduce TAT by 75% 1.0 Additional Radiology Unit  Reduce TAT by 75% 1.0 Additional CT  Reduce TAT by 60%

New Changes & Assumptions Will Gain 120 Inpatient Beds by FY10 Reduce Admit Length of Stay up to 2 Hours

New Changes & Assumptions Future Fiscal Year Volume Projections were Calculated as Follows: 2006 – 0% 2007 – 2% 2008 – 1% 2009 – 4% 2010 – 5% 2011 – 5% 2012 – 5% 2013 – 5% 2014 – 5% 2015 – 5% Average Daily Volumes

Results

Other Information What Else Can You Do with All this Data??

BUMC Avg. Pt. Flow / Nursing Nurse to Patient Ratio 1:4.3 Total Staff to Patient Ratio 1:2.7

GARLAND Avg. Pt. Flow / Nursing Nurse to Patient Ratio 1:3.5 Total Staff to Patient Ratio 1:2.9

ALL SAINTS Avg. Pt. Flow / Nursing Nurse to Patient Ratio 1:2.6 Total Staff to Patient Ratio 1:2.1

Service Audits The Service Audit is used to assist in evaluating the level of service and performance of the area. It provides a standard of measurement and a means of determining areas where service needs to be improved.

Service Audits Example Questions Do personnel report on duty to receive daily assignments? Each shift routinely resolves discrepancies before leaving? Is the chart signed by the nurse after completion? Are test results placed with the E.D. record prior to discharge? Have the vital signs been charted on ALL patients’ records with time?

ED Modeling Tips What is the Problem? Capacity vs. Staffing Charge Acuity System vs. Urgency Acuity Classification Simultaneous Processes Ancillary Capacity ED Hold Issue Service Audits

Questions Jamey Koontz Sr. Management Engineer Baylor Health Care System