Transcript Slide 1
Real Time Demand Capacity Management
Deborah J. Kaczynski, MS
March 23, 2015
The Changing Face of Healthcare LOVE doesn’t work any more
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veryday There is a new kind of LOVE
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Today More Than Ever Right Patient Right Level of Care Right Time The First Time
The Right Level of Care Is: Not a stretcher in the hallway of an ED Not overnight in the PACU Not in a Clinic waiting room Not in a critical care bed when critical is not needed
Why are we here today?
Need to be successful every day, not matter what the obstacle We need to ensure that the first decision we make about a patient’s placement is the right decision and that it is a timely decision Need to identify the critical constraints to patient flow We cannot afford to solve problems in silos Value and outcomes are crucial to success
Suboptimal Patient Flow long wait times ambulance diversion patients leave without being seen (LWBS) boarding increased length of stay (LOS) patients treated in a suboptimal unit for their care patients are unable to move to higher or lower level of care
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Patient Flow – Historical Approaches If only we could …… • Have every discharge out by 11am • Build as many beds as we need • Have ambulances queued up at the entrance to transport patient The project approach …… • Discharge appointments, discharge lounge • Add a discharge RN • Redesign AM lab draw process
Why these approaches won’t work They focus on only one aspect of patient flow The discharge lounge The AM blood draw They take time and may not actually address the critical constraint you face Nothing worse than solving the wrong problem They won’t help you get through today
Real Time Demand Capacity Management This approach to hospital wide capacity management looks at the entire picture each and every day. Assesses how well demand and capacity will match each day Sets in place a plan –early in the day- to help create the capacity or reduce the demand to avoid backups and delays in the ED, PACU and Cath Lab Helps to identify critical constraints and bottlenecks for offline process improvement work
RTDCM can help you answer Do I have the right number of: Oncology beds Is my telemetry unit too small Physical therapy treatment slots in the morning Transporters during the early afternoon
RTDCM can help you answer Should I have improvement work focusing on: Environmental Services response times to dirty beds Admissions to post-acute facilities on weekends Timely reading of echos
RTDCM At its very core RTDCM Ensures that through proper communication and planning that the capacity that the ED, the PACU, the Cath Lab and the Referral Center requests have been anticipated and created This will get the patient to the right level of care at the right time the first time
RTDCM Predict Capacity Predict Demand Plan for Mismatches Evaluate the Success
RTDCM
During a 6 hour period
RTDC and Queuing Theory The art and science of matching relatively fixed capacity to unscheduled demand
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A Telephone Help Line Example
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What we learn from queuing theory
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With relatively fixed capacity and unscheduled demand, high utilization results in long queues (wait times and delays) At times when utilization is high, small increases in available capacity or small reductions in demand will result in large reductions in waits and delays.
SO……
At times when utilization is high in a hospital, planning for the timely transitioning of appropriate patients can increase available capacity and have a substantial effect on delays
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Example of Discharge Pattern
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The Flow of RTDC
Predict Capacity Evaluate the plans Predict Demand Implement the plans Plan for Mismatches P 20
The Flow of RTDC Unit Discharge Huddle Unit Discharge Huddle Hospital Wide Bed Meeting Unit Discharge Huddle
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12E 11E 10E 9E 8E 7F NSDU 5A Available Beds 6 5 2 1 4 DC's 11 7 11 0 1 0 12 10 5 0 4 CV ICU ICU TBC 2 1 0 4 1 1 By 2pm 4 2 3 2 1 0 7 2 2 0 2 Admits 8 4 8 3 4 1 10 8 5 3 6 By 2pm 4 4 4 1 2 0 10 3 2 2 2 3 0 0 6 3 1 -2 3 0 -1 0 PLAN
12E 11E 10E 9E 8E 7F NSDU 5A Available Beds DC's 6 5 2 1 11 7 11 12 4 0 1 0 10 5 0 4 CV ICU ICU TBC 2 1 0 4 1 1 0 2 2 1 0 By 2pm 4 2 3 7 2 2 3 6 3 4 1 Admits 8 4 8 10 8 5 2 2 1 2 0 By 2pm 4 4 4 10 3 2 3 0 0 6 3 1 -2 3 0 -1 0 PLAN
A Real Life Example 6am census of 461 (7 th highest census in 4 years, highest August census ever) 15 overnight boarders in the ED High census alert went out at 6:30am
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A Real Life Example 6am census of 461 (7 th highest census in 4 years, highest August census ever) 15 overnight boarders in the ED
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August 28 th - Business as Usual 8:15am discharge huddles on all units ONE hospital wide bed meeting at 9am Plans put in place that predicted 55 discharges by 2pm 103 discharges predicted total for the day All non-essential meetings cancelled
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August 28 th – The Results 44 discharges by 2pm 111 total discharges ZERO boarders in the ED
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In Summary We recognize that managing best practices in patient flow saves patient lives. We also recognize that optimal patient flow occurs when the patient receives the right care, at the right time, in the right place, every time, without waiting or delays.
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