Patient Throughput - St. Francis Medical Center
The Case: St. Francis Medical Center, Monroe, LA
St. Francis Medical Center was experiencing a rising length of stay (LOS) among top DRGs. Root Cause analysis conducted by QHR determined that undefined care coordination roles and a convoluted discharge planning process were at fault. QHR partnered with the hospital to implement an organizational effectiveness strategy that clearly defined roles, responsibilities and processes for nurses, social workers, case managers and physicians.
“Effective Patient Throughput enables hospitals to serve more patients, enhance quality, satisfy physicians and improve income all at once,” says QHR Vice President of Clinical Operations Pat Cooper. “But it is a multi-faceted process that requires attention to detail from admission to discharge. Resources must be utilized properly. Performance must be measured regularly. And hospitals must have buyin from housekeeping to the C-Suite. St. Francis had that buy-in – and it’s made a huge difference in how they do business – how they serve their community.”
Q Solutions
QHR began its Throughput work at St. Francis by helping the hospital enhance its Case Management (CM) model. Most notably, the hospital began introducing CM at time of admission.
- A dedicated CM was assigned to the Emergency Department
- CM action items were included in Capacity Management Plans
- Processes were introduced to improve communication between CM and ED physicians
- Processes were designed to better predict patients’ anticipated discharge dates
- Rounding was enhanced to include anticipated patient discharges
Simultaneously, QHR assessed St. Francis’ admission and discharge processes, including bed cleaning flow, patient assignment processes, and scheduling and other processes that contribute to patient throughput.
This led QHR to:
- Recommend specific, objectively measurable behaviors to inspire process changes. For example, interdisciplinary team unit meetings were held regularly to determine each patient’s plan for the day/plan for the stay.
- Introduce quality safeguards and mentoring/training programs to support staff in their throughput improvement efforts.
- Develop a bed management process/tool that incorporates planning based on predictions of capacity and demand, as well as nationally recognized admission standards. This ensures that each patient is matched with the medically necessary and appropriate setting.
- Develop and implement a bed flow structure and daily bed meetings. This helps ensure patients get a bed quickly, get the right care and, in the end, don’t stay in the hospital any longer than necessary.
- Work with ED staff to improve processing time of arrival to disposition; and
- Assess, restructure and recommend process changes for Triage, ED Registration, Nursing Care, Physician Access, Diagnostic Testing, Discharge, Diversions and Transfers.
The Conclusion
Ultimately, St. Francis:
- Increased the capacity of its ED from 18 to 26 beds, which allows the hospital to accommodate an additional 15,000 visits per year; Created a designated “Fast Track” area;
- Implemented bedside registration, which allows patients to see a doctor faster;
- Implemented an ESI Level 5 triage system (versus the Level 3 system utilized previously), which provides patients quicker treatment time;
- Improved Lab and Radiology turnaround time, which resulted in an overall decrease in patient wait time; and
- Improved overall staffing productivity – resulting in an annual cost reduction of $775,000.
“Among other areas, our ED has seen signifi cant changes as a result of QHR’s consulting engagement,” said Darline Smith, St. Francis’ Vice President, Patient Services. “Improvements in throughput processes have decreased ED wait times by 80 minutes – reducing our LWBS rate from 6.6 to 2.7 percent – or $1,993,766.”
