An ED Throughput Hub at Lakeland Regional Medical Center

If we went back to 2009, you know, my Request
to Assign from the time that bed request went in to the time that Patient Placement assigned
it, we were looking at 108 minutes. Now if I took, right this moment, in time
I’m doing 6 minutes from my Request to Assign. You know, there’s a lot of literature and
research that also points to that view that the problem isn’t with an overcrowded E.D.,
the problem is in the hospital, it’s with in the beds and getting the E.D. patient into
the in-patient bed. We just finished I.E. and we’ve just seen
167,000 patients within our ED. Seventy percent of all of our overseas total
admissions do actually come from the Emergency Department.
So the Emergency Department itself, because our volumes were so high, presented a really
a particularly unique challenge to Lakeland Regional Medical Center.
It was our number one organizational priority to improve emergency department through-put
times. If I go back to 2009, our Request to Occupy,
was you know, the time we got the Request, the time the patient Occupied, was running
228 minutes. Year-to-date we’re running at 64 minutes.
However, if I look at my data right this second, right at this point in time, I’m pulling times
for like 44 and 45 and 43 minutes. So again over three year period I think we
have made phenomenal improvements in getting that patient not just an assigned, ready bed
but also getting them out of the E.D. and up into that bed at a lot more quicker rate
And I think it’s not just more beneficial for the E.D., but it’s more beneficial for
the patient. We realize, in essence, to fix the front of
our house we had to fix the back of our house. So if you’re E.D.’s over-crowded, if your
triage areas are packed if you’re E.D. hallways are packed, you’re going to have a much, much,
you know, higher walkout rate. So our high walkout rates were greater than
four percent. If I look at the last couple months, I’m looking
at less than 0.4%. We went to TeleTracking XT.
And TeleTracking XT allowed us a lot more functionality a lot more interfaces which
then allowed us to continue to drill-down on our throughput processes and our automated
processes and really help make our processes quicker and leaner.
Prior to 2009, we were looking at 90 minutes for a bed-turn.
Now we’re down to 40 minutes for a bed-turn. And one of the key things also we’ve done
with that, is we’ve actually aligned them with patient through-puts.
So it’s not just about cleaning that bed, it’s about cleaning that bed for the next
incoming patients. So If I’m admitting ten medical patients in
the E.D., then I need ten medical beds not ten cardio beds.
So it’s about also aligning that clean next bed, that next dirty bed that’s got to be
cleaned, with patient through-put and not just about cleaning a bed.
And that’s what we’ve been able to achieve, too.
So we’re constantly aligning all our services to get that patient moving.
Anecdotally, what we’ve heard is that patients are now coming to Lakeland Regional because
they’re now hearing that there’s no wait for triage and that they can get in the back quicker.
So, in essence, our business is increasing, not just because we don’t have those walkout
rates anymore, but because the reputation of the E.R. and the hospital is now going
out to our community that there’s literally no wait, they can get in our E.R.
very quickly. We are doing some work again on the back-end,
looking at the discharge milestones to further drill-down on– and that’s, again, an advantage
of TeleTracking– but because it’s allowing us to take the data and drill-down is, you
know, when that physician initiates his discharge order through the Electronic Health System
is one of the delays in getting the patient out of here.
So we’re actually now taking the data that we can get from those discharge milestones
and we’re breaking those down so we can drill-down further and find out “what are our delays?”
Now we have really hard data we can pull to find out what’s causing us the issues.
You have to have data to drive your outcomes. You have to have data to drive your processes.
You have to have data to prove or disprove your processes.
The data has been very important in pushing us in
right direction.

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