AHRQANNUAL CONFERENCE

Bethesda, MarylandSeptember 26-29, 2010

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Ochsner Medical Center

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Intersections Hurricane Katrina’s crossroads

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Intersections Hurricane Katrina’s crossroads

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Intersections Hurricane Katrina’s submerged crossroads

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ED Crowding Output (admission delays) Throughput (non-lean workflow) Input (poorly engineered demand

management)

“Martha, I am not feeling too well.

Maybe we should go over to the ER

and get triaged!!”

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Solve this problem

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Cracking the code Implement lean workflow

Lean registration Lean triage

Create virtual capacity Door to Doc processing protects the most

precious resource…..the bed Rules based process

Match resources to demand Queuing Theory Grocery Store Math© for EDs

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Cost Analysis of LWBS Net revenue (for real current LWBS payor mix)

Outpatient facility net revenue @ $300/visit discharge (90% of visits )

Inpatient facility net revenue @ $5,000/visit admission (10% of visits)

Professional provider net revenue @ $125/visit all (100% of visits)

1% LWBS @ 50,000 visits = 500 visits

Lost opportunity net dollars for every 500 visits that LWBS

$135,000 facility outpatient revenue (450 pts x $300)

$250,000 facility inpatient revenue (50 pts x $5,000)

$62,500 professional revenue (500 pts x $125)

Cost of 1% LWBS at 50,000 volume = $447,500

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Requires a leap of faith (1) Unlocking old behaviors

No registration up front and no deep dive triage

Dramatically different workflow for staff Reduce scarce real beds to create more virtual beds??????

Patient perspectives “ I never got a bed!”

Privacy concerns

Physician issues No compensation benchmarks for this kind of work… and it is uniquely

different

EM MDs become internal customers…not comfortable position for them

Not every MD suitable for D2D, requires great risk stratification skills

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Requires a leap of faith (2) New roles to manage with odd job descriptions

Flow techs and flow nurses

Administrative issues “Only the uninsured leave”…..not so

Its not about the expense, its about the return (ROI)

Staffing paradigm shift MLPs and LPNs……may be perceived as threatening

Forget FTE hrs/visit……think cost/visit

Rules! Lean processing at registration and quick look

Intake beds must be protected at all cost…almost.

Accountability for the WR

Internal queuing always….not in the WR

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Joe Guarisco MD FACEP jguarisco@ochsner.org 504-842-4433

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