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

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

3. 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. 2003 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

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

5. 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

6. 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

7. Current State Data 2005

8. Average LOS is 3.7 Hours

9. ED Layout

10. ED Figures Patient LWOT Patient Emergent & Imminent Patients

11. 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%

12. 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%

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

14. 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% 2005 110 2007 2009 2015 154 107 115 Average Daily Volumes 2011 126 2013 139

15. Results

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

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

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

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

20. 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.

21. 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?

22. 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

23. Questions Jamey Koontz Sr. Management Engineer Baylor Health Care System JameyK@baylorhealth.edu