1. Emergency Department Waits and Patient Flow April 12, 2016

2. Current State

3. 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.

4. 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

5. 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

6. Quality

7. Delivery

8. Safety

9. Engagement

10. Cost

11. 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

12. 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

13. 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

14. 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

15. QUOTE BY A MENTOR FROM JBA IMPROVEMENT