Emergency Room Diverts Project

Linda Kosnik, RN, MSN, ANP, Chief Nursing Officer

Medicare ALOS Project

Patty Colligan-Levine, MSW, LCSW, Manager, Care Management
Barbara A. Plucienik, MSN, RN, CNA, Systems & Data Specialist, Care Management Resources
Linda Kosnik, RN, MSN, ANP, Chief Nursing Officer

Endoscopy Patient Transport & Discharge Project

Jill Stefanski, RN, BSN, Clinical Coordinator, Endoscopy
Yvette Lewis, Manager, Patient Express (Support Services)
Susan Manfredo, CAVS, Coordinator, Volunteer Services

ER Diverts Project – To significantly increase the mean time between ER diverts at Overlook Hospital.

Medicare ALOS Project – To decrease the average length of stay (ALOS) for Medicare patients from 7.2 days to an interim target of 6.4 days within 6 months at Overlook Hospital, as a first step towards the eventual target of 5.8 days (case mix index).

Endoscopy Patient Transport & Discharge Project – To improve the efficiency of the patient transport and discharge process and improve post-procedure nurse productivity by 2 percent by decreasing time spent on coordination phone calls and show a statistically significant improvement in staff satisfaction.

• ER Diverts Project - Number of days between diverts as tracked by hospital records.
• Medicare ALOS Project – Medicare patients weekly ALOS as tracked by the Case Management department.
• Endoscopy Patient Transport and Discharge Project – Staff productivity: Number of calls made per day and duration of call, Staff satisfaction: as per survey conducted every month starting on Sept. 1, 2004.

ER Diverts Project – Mean time between diverts increased from an average of 7 days to an average of 193 days between March 1998 and September 2004. Before March 1998, diverts occurred on average almost every 7 days. Changes implemented:

1. Put in place a method to track and share information about demand criteria and capacity criteria to rapidly respond to bottlenecks.
2. Automated the manual process of tracking demand and capacity through Acute Care Operations Management System (ACOMS).

Medicare ALOS Project – Medicare patients weekly ALOS decreased from 7.2 to around 6.5 as of 09/10/04.

1. Increased frequency of clinical team rounding based on demand & capacity thresholds indicated by ACOMS.
2. Aggressive case management rounding triggered on the basis of demand & capacity thresholds indicated by ACOMS.
3. Adjusted staff assignments to match demand & capacity thresholds indicated by ACOMS.
4. Increased visibility to patients with LOS of 10+ days and focused attention to those patients.
5. Started tracking and sharing daily information with case management teams (intra-departmental) and nursing units (inter-departmental) to encourage them to achieve our goals.

Endoscopy Patient Transport & Discharge Project – Changes made include:

1. Matched capacity to the demand by assigning a “unit-based” resource when the demand crossed a certain threshold through ACOMS.
2. Provided timely visibility of latest schedule, including last minute changes, to volunteers and inpatient transport departments by sharing the latest schedule and updating ACOMS.

Using a demand and capacity management software solution (ACOMS) to lead quality improvement projects within Overlook has been successful in the following areas:

ER Diverts Project

• Communication, Communication, Communication. Encourage all people to use ACOMS to be aware of their own microsystem’s status and the overall macrosystem situation, thereby, improving inter-departmental collaboration and giving them the opportunity to address bottlenecks faster.
• Shorten Learning Curve. Create an institutional memory and record of hospital best practices through ACOMS.
• Empower Nurses. Overlook has enjoyed greater than 90 percent retention of nurses since program put in place.
• Improved Patient ER Experience - The admission time (time between a patient entering the ER to being put in a bed) was reduced to about one hour.

Medicare ALOS Project (In progress, to be completed by December)

• Get the Case Manager involved earlier, within 24 hours of admission as against the previous benchmark of 1 business day.
• Communication, Communication, Communication. Ability to track and share daily information about Medicare patient distribution through ACOMS intra- and inter-departmentally.
• Promote Collaboration between care management department and nursing, clinical services (Physiotherapy and Respiratory) and physicians.
• Adjust staffing flexibly to better match capacity to the ever-changing demand.
• Collect and track data on specific patient populations to serve them better.

Endoscopy Patient Transport and Discharge (In progress, to be completed by December)

• Focus on two often overlooked departments that are crucial to the patient flow process within the hospital (Volunteers and inpatient transport).
• Improved staff satisfaction and productivity by improving the processes for outpatient discharges and inpatient transport.