Throughput initiatives minimize delays in care
The roots of WVU Healthcare’s throughput initiatives, aimed at improving patient flow, lie in the basic mission of the clinical enterprise – providing the highest quality care for patients.
“Last year, we made a conscious effort at meeting the needs of patients of the state and region,” said Ronald J. Pellegrino, MD, associate chief medical officer. “People look to us when there are patients who need care that other hospitals can’t provide. We’ve always done a good job providing that care but now, nobody who needs us has to bypass us. We don’t put up a ‘no vacancy’ sign anymore.”
Dr. Pellegrino was reflecting on data that reveals the success of the recent throughput effort. WVU Healthcare is seeing more patients but their stays are shorter.
“It’s a great accomplishment,” he said.
The turn-around has occurred quickly through the efforts of the entire staff and with a push coming from WVU Healthcare’s Capacity Management Throughput Group, which was created in late 2013 to address goals of the organization’ s Performance Improvement Plan.
The group’s charge was to recommend process changes that would minimize avoidable delays and be more predictive of demand and capacity.
To address capacity issues, 11 observation beds were added on the second and third floors. A “flex unit,” which will feature around 20 beds, is being developed for the sixth floor.
A Daily Capacity Management Bed Meeting began in March to help strategize about capacity challenges. Led by Aaron Yanuzo, the director of process improvement, the group includes house supervisors, and representatives from Care Management and other hospital services, including cardiovascular services, radiology and physical therapy.
“The goal is to identify any avoidable delays that may occur,” Pellegrino said. “If someone needs to have a test done to advance his/her care or enable a treatment decision, the patient shouldn’t have to wait half a day or a day to move on to the next step.”
Placing staff from Environmental Services and Bed Control in the same room has helped to assure that the highest priority room assignments are attained quickly. And, on high census days, the house supervisor can adapt the roles of admission nurses to focus on discharges instead.
Also, the hospital has created a transition hospitality lounge on the eighth floor. It serves as a comfortable place to board patients who have been discharged but are awaiting transportation home.
The medical staff and throughput nurses are also working to make the admission and discharge processes more efficient. A change in the MARS admission protocols makes consultation optional, rather than mandatory, for a physician referring a patient.
Also, WVU Healthcare is focusing more on unit-based services to ensure that each member of a patient’s care team can participate in the rounding process.
The group is also working on revitalizing Intent to Discharge orders.
“The goal is to have everybody who is taking care of a patient know what’s going on with the patient, and to have all of the latest information to minimize delays in care,” Pellegrino said.