Louis Liebhaber, Chief Operating Officer
Dr. Alexander Rae-Grant, President Medical Staff
Dr. John Fitzgibbons, Chairman of Medicine
Terry Capuano, RN, MSN, MBA, Senior Vice President, Clinical Services
Dr. Richard MacKenzie, Vice Chairman, Emergency Medicine
James Burke, MBA, Vice President, Administration

By June 2004, Lehigh Valley Hospital and Health Network (LVHHN) would design and implement improvements to ensure open access to meet or exceed the forecasted volumes over 5 years.

• Accommodate forecasted admissions for FY2003-FY2008
• Fewer than 25 hours of ambulance diversions per month per campus
• No operating room holds
• 95 percent of transfer center patients accepted exclusive of non-bed related issues
• 75 percent of patients with an average emergency department ED) wait time of less than 30 minutes
• 75 percent of patients with an average time of less than one hour from the decision to admit until the patient leaves the ED
• A medical-surgical occupancy not to exceed 85 percent more than 50 percent of the days

• Implemented a discharge bed swat team (D’BST)
• Expanded patient transport to include discharges for patients with a discharge disposition of home
• Implemented an internal centralized ambulance dispatch process
• Added patient flow coordinators to support a pull system of patient movement
• Opened 70 beds through "Find-a-bed"
• Standardized the system for direct admits through the utilization of an express admit unit
• Installed a comprehensive patient tracking and electronic bed board software package
• Implemented a pull system for moving patients through the network
• Implemented a priority system for patient transport
• Designed a telemetry box process to provide emergency department access to telemetry for prompt transport
• Simplified communication and reduced the number of handoffs through the implementation of a single point of contact to signal patient readiness for arrival
• Designed and scripted a "warm welcome" process for new patient arrivals on clinical units
• Developed an electronic no-delay-nurse report
• Used bed tracking for notification that a bed was being cleaned and would be ready for the next patient
• Developed a new capacity management system including a capacity dashboard (using Horizon Business Insights) and an oversight team to monitor indicators
• Implemented an emergency department pull system and alert system, and redesigned the triage and registration processes resulting in decreased emergency department lengths of stay and wait times
• Opened a short stay hospital for 24- to 48-hour overnight surgical cases
• Used the surgical staging area as a temporary recovery room overflow area
• Expanded hours of operation for echocardiograms on off-peak hours and weekends
• Expanded the former bed management department and created a new centralized function to oversee each step in the patient flow process
• Evaluated operating room and cardiac cath lab scheduling to reduce variability and improve throughput; more work in progress
• Designed a timely discharge electronic reporting mechanism
• Evaluated the feasibility of creating an observation unit and decided against implementing
• Converted the surgical staging area to an emergency department inpatient express admission area during PM hours when not being used for surgical patients
• Implemented an electronic discharge priority field in Lastword for ancillary services
• Implemented collaborative rounding on some clinical units
• Implemented a long-stay SWAT team
• Implemented a communication campaign for timely discharge
• Implemented box lunches to expedite timely discharge
• Piloted discharge by appointment to smooth discharge times
• Implemented electronic physician length of stay reporting mechanism for general internal medicine and general surgery

• LVHHN admissions have accelerated over the past 2 years; unprecedented growth rates of 6.2 percent and 5.3 percent respectively. The growing organizational capacity (GOC) project kept the doors open to our community demand. 
• It took a complex set of sequenced interventions, from 17 sub projects, to grow organizational capacity. There was no one silver bullet.
• GOC enabled fewer capacity "crunches" in 2003 and 2004 than forecasted, and despite an increase in admissions, the actual-to-actual occupancy improved.
• Pulling together of clinical and financial information into a data repository available to individuals in the network to monitor and direct change.

[Storyboard presentation at IHI's National Forum, December 2004]