The art of ed patient flow
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Transcript of The art of ed patient flow
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The Art of ED Flow
©2014 Sean Carney, LLC.Sunday, February 23, 14
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ED Flow Hubs
IntakeThroughput
OutflowSurge CapacityFlow CatalystsInfrastructure
Patient Satisfaction
© 2014 Sean Carney, LLCSunday, February 23, 14
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ED Patient Intake
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Ambulatory
• Disrupt Triage
• Eliminate or Flow Gate
• Rapid Entry Only
• Keep vertical/vertical
• Consider segmenting the unscheduled lower acuity
• Protocols during delays
• Implement Kiosks/Greeters
• Consider Call ahead programs or mobile
© 2014 Sean Carney, LLC
ED Patient IntakeEMS
• Consider mapping EMS triage through main triage.
• Protocols
• Kiosks/Greeters
• Call ahead programs
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ED Throughput
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• ED Sub-system management
• Push/Pull concept
• Bilateral flow monitoring
• Shared targets
• Imaging, lab, EVS, Transport, Pharmacy bed control, etc.
ED Partner Relations
© 2014 Sean Carney, LLCSunday, February 23, 14
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ED Cascading Communications• Agile ED Operations
• Regular quick standup-No sitting!! No more than 10 min
• Running the board
• Everyone participates
• What do you need from me to keep flow for every patient
• Administration attends, listens and fixes, has no direct role
© 2014 Sean Carney, LLCSunday, February 23, 14
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Cascading Communications ED Team
• Cascades down from Agile Ops and continues through team
• Decentralized
• Running the board-target times
• Regular team rounding-what are we waiting for?
• Defining “done” at first patient interaction
• Identifying potential admissions at first patient interaction
© 2014 Sean Carney, LLCSunday, February 23, 14
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ED Leadership Cascading Communications
• Facilitate Agile Ops and decentralized team communications
• Running the board
• Eliminate flow blocks
• Initiate escalation and decompression plans
• Responsible for Intake and Output targets
© 2014 Sean Carney, LLCSunday, February 23, 14
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How to Eat The ED Elephant (please don’t really eat elephants)
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Make The ED Smaller• Break the ED and staff up
into teams or functional areas
• Areas mirror each other in clinical operations and size
• Scalable based on studied ED patient demand
• Team owned and incentivized
© 2014 Sean Carney, LLCSunday, February 23, 14
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ED Tracks Or Pods• Scalable by hour and day of week
• Breaths with predictable and non-predictable surge
• Mirror in capability and capacity
• Generalize ED beds, avoid specialty rooms.
• Stop saving code rooms use for patients be walked out quickly when needed
© 2014 Sean Carney, LLCSunday, February 23, 14
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ED Output• Optimized Discharge Flow
• Identify “done” target
• Think flow constraints
• Pre-plan logistics
• Optimized Admission Flow
• Same as DC flow + early admission potential
• ETA to Admit Units
• Push and Pull Incentives© 2014 Sean Carney, LLC
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Flow Catalysts
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Flow Technology• Identify and implement technology via
ROI that can enhance flow or reduce staff tasks
• Real time flow monitoring systems
• Automate, automate, automate
• POC testing
• Kiosks
• Telemedicine
• mobile applications
• Smart rooms© 2014 Sean Carney, LLC
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Flexibility in Flow• Flexibility
• Designated ED flow coordinators
• Scribes
• Task Shifting and Sharing
• Call Systems
• Cross training© 2014 Sean Carney, LLC
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ED Infrastructure
ED PlanningDeveloping Cultural Sense of Urgency
© 2014 Sean Carney, LLCSunday, February 23, 14
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ED Planning• Pertinent to
Operational Flow
• Functional Capacity
• Daily ED team logistics
• Defined roles and responsibilities
© 2014 Sean Carney, LLCSunday, February 23, 14
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ED Team Design• Bonsai Teamscaping™
• Leverage data to allocate staff not “feel”
• Strategic resource usage
• Align functional capacity to demand by
• Hour of day
• Day of week
• Season
• ED flow should have consistent functional capacity based on demand need not on vacation, sick call, etc.
© 2014 Sean Carney, LLCSunday, February 23, 14
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Designing An Urgency Culture
• First before you go
• Set Staff Up for Success
• Design Flow
• Staff led
• Standardized
• Scalable
• and Simply to follow© 2014 Sean Carney, LLC
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ED Urgency Culture Shaping• Bonsai
Teamscaping™
• Hiring analytics
• Staff led collaborative flow design teams
• Staff ownership of processes and targets
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Commander’s Intent
Incentivize your people, give them the latitude to do
the right thing. Lead by example so they will
maintain operations when your not forcing it.
© 2014 Sean Carney, LLCSunday, February 23, 14
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ED Surge Planning
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ED Decompression• ED focused standardized
scalable plans based on LOS and/or volume to make ED
• Temporarily bigger
• Temporarily faster
• Or both
• Objective is to regain smooth flow
• Example-Inside forward flow waiting areas to add capacity
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ED Escalation System
• Facility wide standardized, documented escalation system based on ED LOS and/or volume
• Provides common language across facility
• Leadership line of sight to ED operations
• Layered escalation system
© 2014 Sean Carney, LLCSunday, February 23, 14
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Patient Satisfaction
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Patient Satisfaction • Patient Satisfaction Relates To LOS.
Simple
• Everything else is a workaround
• Greeter/Rounders
• Real time monitoring
• Communication strategies
• Service Recovery systems© 2014 Sean Carney, LLC
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Thank You
www.seanmcarney.com@seancarney
Sunday, February 23, 14