Transcript Business of the Hospital Presentation

Understanding the
business of the
hospital
Prepared by (15pt Arial) [Insert name of presenter 15pt Arial Bold]
[Insert title]
[Insert Hospital name]
Month 200X (12pt Arial Bold)
0
Purpose of business of the hospital
diagnostic
1

Understand the performance of the hospital

Understand demand for hospital resources – inpatient beds, ED
beds/treatment spaces

Understand capacity of hospital and existing capacity constraints

Understand where there is a mismatch in demand and capacity

Identify areas for drilldown analysis

Build understanding of the underlying issues and quantify the impact

Identify delays and reasons for delay
Emergency Department business
2
Metrics
Analysis
Data sources
Presentations
% admitted
NEAT all
NEAT admitted to inpatient ward
NEAT admit and discharge from ED
NEAT non-admitted
Representations within 24 hours
Average length of stay
Did not Wait
LOS in ED >24 hours
Activity
Monthly trend
By hour of day
By day of week
ED system –
FirstNet, EDIS
HIE – ED visit table
NEAT Performance
NEAT Performance
NEAT
80
% of patients with total time in ED <= 4 hours
(CAL YTD)
75
70
65
60
55
50
45
3
Target
Length of Stay by Disposition
LOS in ED
<4hrs
<8hrs
<12hrs
100%
>12hrs
1.8%
4.7%
16.7%
90%
25.4%
80%
8.0%
28.2%
70%
% of presentations
15.3%
24.0%
60%
50%
40%
36.1%
65.3%
30%
51.3%
20%
10%
23.2%
0%
Admitted
4
Transferred
Discharged
Patients with ED LOS > 24 hours
2010
2011
Jun
Jul
140
120
Count
100
80
60
40
20
0
Jan
5
Feb
Mar
Apr
May
Aug
Sep
Oct
Nov
Dec
ED Length of stay increased in May
ED ALOS by day
7
6.5
6
Av LOS in Hours
5.5
5
4.5
4
3.5
3
2.5
2
Data source HIE edvisit table 1/9/2012 – 31/7/2013
6
6
Admitted and non-admitted LOS in ED
120
8
110
7
100
6
90
5
80
4
70
60
3
50
2
Not admitted
Admitted
Not admitted ALOS
Admitted ALOS
Data source HIE edvisit table 1/9/2012 – 31/7/2013
7
ALOS in ED Hours
Average daily presentations
ED Presentations by admission status & ALOS
Where do patients admitted from ED go
next?
Ward 1
27%
Other Ward
47%
Ward 2
21%
Ward 3
5%
8
Patients staying in ED longer than 1 or 2 days
600
500
Count
400
Specialty 5
300
Specialty 4
Specialty 3
Specialty 2
200
Specialty 1
100
0
> 1 day
> 2 days
2008
9
> 1 day
> 2 days
2009
> 1 day
> 2 days
2010
> 1 day
> 2 days
2011
Map the patient journey
Nurse
Doctor
P/C or liaison
with transit
nurse
Transit nurse
allocates
spot
P/C or liaison
with acute
coordinator
Acute
coordinator
allocates
spot
P/C or liaison
with nurse in
consults
Consults
nurse
allocates
spot
Patient
prepared for
discharge
Doctor
completes
med form
Doctor
completes
D/C
summary
Nurse posts
discharge
time in EDIS
comments
Admin
update EDIS
and ATS
Reconcile
process and
complete
paperwork
Patient
departs the
ED
Admin
Pathology
Radiology
discharge
Process to admit patient and allocate bed
Allied
Health
Nursing coordinator
enters info
into EDIS
Wardspe
rson
Map updated
By acute
coordinator
Doctor clicks
off on patient
and finds Ax
space
In-charge
makes a bed
request
Allied Health
Ax & Tx
Patient waits
in WR, ambo,
corridor,
transit
Triage nurse
Ax
Patient
transferred to
appropriate
area
Decision to
discharge or
admit
Nursing Ax &
Tx
SMO
Admin
completes
admission
Patient
information
entered into
EDIS &
HOSPAS
Medical Ax &
Tx
Patient waits
in CIN
Electronic
request note
to medical
records
IT feed into
Web DeLacy
Medical records
transferred from
chute to inbox
on reg desk
Patient to be
admitted directly to
inpatient ward i.e.
MAU
Inpatient
team assess
in ED
JMO
JMO discusses
patient with
SMO
Pathology
ordered
Electronic
ordering if
possible
Print labels
and deliver to
triage
Radiology
ordered
10
admit
admit
CIN nurse
orders
investigations
Admin staff
to admission
paperwork
Patient signs
forms if
possible
EDIS &
HOSPAS
updated
Patient flow
or AHNUM
notified
Print MR1
Bed allocated
Doctors
handover at
change of shift
Patient
presents to ED
CIN nurse
AX and
treatment
Admin to
bedside to
check info &
private status
Paper
request
completed –
placed in slot
Wardsperson
delivers
referral to
dept
Bloods and
request
placed in
chute
Patients
booked for
tests other
than x-ray
ED consultant
utilises ‘right to
admit’ policy
ED doctors
refer to
inpatient
team
Triaged by
pathology
Wardsperson
takes patient
to radiology
Inpatient
team advised
of admission
Inpatient
team Ax
patient in ED
EMU
Inpatient
team accept
patient
Completed and
electronic results
provided
Tests conducted
and electronic
results provided
Handover to
inpatient
nursing team
Wardsperson
transfers
patient
MASH
Tracking
system
updated
Inpatient
Ward
Understanding particular patient cohorts
Paediatrics by hour into location
Av Daily
Av time in location (hrs)
3
Average Time (hours)
2.5
2
1.5
1
0.5
0
0
11
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22
Hour into Location
Metrics
Analysis
Data
sources
Third door
and other
urgent
admissions
Elective
surgery
Admissions
Source of admission
Delays
Activity
Monthly trend
By day of week
Reason for delay
PAS
Bed
management
DOSA rate
Day surgery rate
Cancellation on day of surgery
NEST
Activity
Monthly trend
Pareto reasons for
cancellation on day of
surgery
ED system –
FirstNet, EDIS
HIE – ED visit
table
Planned
medical
admissions
Admissions
Day procedure rate
Waiting list – longest wait
Activity
Monthly trend
PAS
Bed
management
Interhospital
transfers
Admissions
% via ED
Delays
Activity
Monthly trend
FirstNet, EDIS,
PAS
HIE – ED visit &
Episode table
12
Pathways to Admission
13
Metrics
Analysis
Data
sources
Admitted Day only
Overnight
patient
Activity
Monthly trend
Comparison to
peer average
and/or HRT
benchmark
PAS
HIE –Episode
Health
Roundtable
Specialty NEAT by specialty
Average expected admits
unit
Monthly trend
By day of week
Discharges by
hour of day
PAS
HIE –Episode
eMR
Medical record
review
Average length of stay
RSI
Average daily discharges
Average length of stay
Patients with LOS >=21 days
RSI
Unplanned readmissions
Time from consult request to
patient review and report
14
15
ON Discharges
ON ALOS
Jan-12
Nov-11
Sep-11
Jul-11
May-11
Mar-11
Jan-11
Nov-10
Sep-10
Jul-10
May-10
Mar-10
Jan-10
Nov-09
Sep-09
Jul-09
May-09
Mar-09
Jan-09
Nov-08
Sep-08
Jul-08
1700
1500
1400
6
1300
1200
5.5
1100
1000
5
Av LOS in days
Trend in overnight activity & ALOS
7
1600
6.5
Long Stay Patients
> 20 days
14 -20 days
7 -14 days
< 7 days
100%
90%
80%
% Long Stay Patients
70%
60%
50%
40%
30%
37918
20%
10%
0%
1061
Episodes
16
Bed Days
17
Performance – specialty units
18
Interface with inpatient teams
Median 0:14
Mean 0:54

19
0:39 0:42 2:01
1:18 1:27 2:54
2:03 3:55 4:00 7:18
2:45 4:22 4:52 10:00
Delays in inpatient teams coming to ED to review patients
following referral by ED
20
Metrics
Analysis
Data
sources
Wards
NEAT by ward
Average expected admits
Average daily discharges
% outliers
Average number of in ward bed
moves
Average length of stay
Patients with LOS >=21 days
Monthly trend
By day of week
Discharges by
hour of day
PAS
Bed
management
HIE –Episode
and Ward
episode tables
ICU
Average expected admits
Average daily transfers out
Theatre cancellations due to no
ICU bed
Monthly trend
By day of week
Transfers out
HIE –Episode
and Ward
episode tables
Operating
Theatre
Management
system
EMU
Admissions
Average length of stay
Beds occupied
% NEAT
Under Emergency
medicine
Under other
specialties
HIE –ED Visit,
Episode and
Ward episode
tables
Time to bed request & depart by destination
Time from triage to bed request and depart
ward
Av Arrival to Bed Request
Av Bed request to depart
Admits
18
800
16
700
14
600
Hours
500
10
400
8
300
6
200
4
2
100
0
0
Ward A
21
Ward B
Ward C
Ward D
Ward E
Ward F
Ward G
Ward H
No. of Admits
12
Understanding daily demand
Ward A
22
Ward B Ward C Ward D Ward E Ward F Ward G Ward H Ward I
23
24
Top 10 EMU Admitting Specialty EMU patients EMU ALOS Hrs
EMU
25
EMERGENCY MEDICINE
COLORECTAL SURGERY
GASTROINTESTINAL SURGERY
ORTHOPAEDICS 1
UROLOGY
HEAD NECK ONCOLOGY
NEUROSURGERY
GASTROENTEROLOGY
ORTHOPAEDICS 2
NEUROLOGY
1024
316
311
240
190
185
166
121
119
95
30%
9%
9%
7%
6%
5%
5%
4%
3%
3%
14.5
19.8
20.3
15.6
18.8
17.8
29.9
23.3
15.7
30.9
Metrics
Analysis
Data sources
Radiology
Time to first available
Turn around times (image available)
Report available
 Plain X Ray
 CT
 MRI
 Ultrasound
Activity
Emergency department
Ward inpatients
In hours
Out of hours
Radiology
information
system
Pathology
Emergency department
patients
Ward inpatients
In hours, Out of hours
Activity
Monthly trend
Emergency / Elective
Specialty , Doctor
Day of week
Hour of day
Pathology
information
system
Theatre
Turnaround times for key tests
 Troponin
 FBC
 UEC
Cancellations
Demand in hours
Late starts
Bed days taken by patient waiting
theatre
(also see Elective surgery section)
Discharge
Discharges
Discharge delay reasons
Cost
26
Day of week
Hour of day
Pareto delay reasons
High volume above NEP by DRG
Variance
High cost low volume above NEP by Specialty , Doctor
DRG
DRG
Operating
Theatre
Management
system, SurgiNet
Bed Board
Why am I still
here Study?
Casemix costing
data
Delays to imaging
Who Owns the Timeline Study
Request to test completed
02:00
01:48
Time (hours:minutes)
01:45
01:30
01:15
01:03
01:00
00:47
00:45
00:30
00:15
00:00
CT
27
Bloods
CXR
Radiology Data
28
29
Data source: HIE 1/1/2011 – 31/12/2011 Episode
30
Theatre business
Metrics
•Cancellations
•Demand in hours -Operating time
•Elective theatre schedule capacity
•Emergency theatre schedule capacity
•On time starts
•Time from triage to theatre for all
emergency and non DOSA surgery
•Surgery team overtime
•Elective wait lists, not, ready for care,
cases on per month and cases completed
per month, cases removed (not operated
on)
(also see Elective surgery section)
31
Analysis
Activity
Monthly trend
Emergency /
Elective
Specialty , Doctor
Day of week
Hour of day
Data sources
Operating Theatre
Management
system, SurgiNet
32
Other Surgical
Planned Surgical
Linear (Other Surgical)
Linear (Planned Surgical)
Feb-12
Jan-12
Dec-11
Nov-11
Oct-11
Sep-11
Aug-11
Jul-11
Jun-11
May-11
Apr-11
Mar-11
Feb-11
Jan-11
Dec-10
Nov-10
Oct-10
Sep-10
Aug-10
Jul-10
Jun-10
May-10
Apr-10
Mar-10
Feb-10
Jan-10
Planned and other surgical separations
400
350
300
250
200
150
100
50
0
Emergency capacity - new schedule
24
20
16
16.6
15.8
15.6
16.5
Hours
13.6
Week 1
Week 2
12
Week 3
Week 4
8
Av demand
4
0
Mon
33
Tue
Wed
Thu
Fri
Patient
Journey
34
Community Health
Clinics
Allied health
Wards
Theatres
Patient Flow
Consultant Physicians
Pathology
Imaging department
ED
Voice of the Patient
Why do I
have to keep
telling my
story?
Planning diagnostics





Start high level
Identify areas of focus
Emergency elective demand and capacity
Drilldown by Specialty unit, ward
Demand and capacity variances
– Time of day
– Day of week




35
Substantiate and quantify root causes of issues
Source the data
Source the analysis expertise
Data management plan