Download - The art of ed patient flow
The Art of ED Flow
©2014 Sean Carney, LLC.Sunday, February 23, 14
ED Flow Hubs
IntakeThroughput
OutflowSurge CapacityFlow CatalystsInfrastructure
Patient Satisfaction
© 2014 Sean Carney, LLCSunday, February 23, 14
ED Patient Intake
Sunday, February 23, 14
Ambulatory
• Disrupt Triage
• Eliminate or Flow Gate
• Rapid Entry Only
• Keep vertical/vertical
• Consider segmenting the unscheduled lower acuity
• Protocols during delays
• Implement Kiosks/Greeters
• Consider Call ahead programs or mobile
© 2014 Sean Carney, LLC
ED Patient IntakeEMS
• Consider mapping EMS triage through main triage.
• Protocols
• Kiosks/Greeters
• Call ahead programs
Sunday, February 23, 14
ED Throughput
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• ED Sub-system management
• Push/Pull concept
• Bilateral flow monitoring
• Shared targets
• Imaging, lab, EVS, Transport, Pharmacy bed control, etc.
ED Partner Relations
© 2014 Sean Carney, LLCSunday, February 23, 14
ED Cascading Communications• Agile ED Operations
• Regular quick standup-No sitting!! No more than 10 min
• Running the board
• Everyone participates
• What do you need from me to keep flow for every patient
• Administration attends, listens and fixes, has no direct role
© 2014 Sean Carney, LLCSunday, February 23, 14
Cascading Communications ED Team
• Cascades down from Agile Ops and continues through team
• Decentralized
• Running the board-target times
• Regular team rounding-what are we waiting for?
• Defining “done” at first patient interaction
• Identifying potential admissions at first patient interaction
© 2014 Sean Carney, LLCSunday, February 23, 14
ED Leadership Cascading Communications
• Facilitate Agile Ops and decentralized team communications
• Running the board
• Eliminate flow blocks
• Initiate escalation and decompression plans
• Responsible for Intake and Output targets
© 2014 Sean Carney, LLCSunday, February 23, 14
How to Eat The ED Elephant (please don’t really eat elephants)
Sunday, February 23, 14
Make The ED Smaller• Break the ED and staff up
into teams or functional areas
• Areas mirror each other in clinical operations and size
• Scalable based on studied ED patient demand
• Team owned and incentivized
© 2014 Sean Carney, LLCSunday, February 23, 14
ED Tracks Or Pods• Scalable by hour and day of week
• Breaths with predictable and non-predictable surge
• Mirror in capability and capacity
• Generalize ED beds, avoid specialty rooms.
• Stop saving code rooms use for patients be walked out quickly when needed
© 2014 Sean Carney, LLCSunday, February 23, 14
ED Output• Optimized Discharge Flow
• Identify “done” target
• Think flow constraints
• Pre-plan logistics
• Optimized Admission Flow
• Same as DC flow + early admission potential
• ETA to Admit Units
• Push and Pull Incentives© 2014 Sean Carney, LLC
Sunday, February 23, 14
Flow Catalysts
Sunday, February 23, 14
Flow Technology• Identify and implement technology via
ROI that can enhance flow or reduce staff tasks
• Real time flow monitoring systems
• Automate, automate, automate
• POC testing
• Kiosks
• Telemedicine
• mobile applications
• Smart rooms© 2014 Sean Carney, LLC
Sunday, February 23, 14
Flexibility in Flow• Flexibility
• Designated ED flow coordinators
• Scribes
• Task Shifting and Sharing
• Call Systems
• Cross training© 2014 Sean Carney, LLC
Sunday, February 23, 14
ED Infrastructure
ED PlanningDeveloping Cultural Sense of Urgency
© 2014 Sean Carney, LLCSunday, February 23, 14
ED Planning• Pertinent to
Operational Flow
• Functional Capacity
• Daily ED team logistics
• Defined roles and responsibilities
© 2014 Sean Carney, LLCSunday, February 23, 14
ED Team Design• Bonsai Teamscaping™
• Leverage data to allocate staff not “feel”
• Strategic resource usage
• Align functional capacity to demand by
• Hour of day
• Day of week
• Season
• ED flow should have consistent functional capacity based on demand need not on vacation, sick call, etc.
© 2014 Sean Carney, LLCSunday, February 23, 14
Designing An Urgency Culture
• First before you go
• Set Staff Up for Success
• Design Flow
• Staff led
• Standardized
• Scalable
• and Simply to follow© 2014 Sean Carney, LLC
Sunday, February 23, 14
ED Urgency Culture Shaping• Bonsai
Teamscaping™
• Hiring analytics
• Staff led collaborative flow design teams
• Staff ownership of processes and targets
Sunday, February 23, 14
Commander’s Intent
Incentivize your people, give them the latitude to do
the right thing. Lead by example so they will
maintain operations when your not forcing it.
© 2014 Sean Carney, LLCSunday, February 23, 14
ED Surge Planning
Sunday, February 23, 14
ED Decompression• ED focused standardized
scalable plans based on LOS and/or volume to make ED
• Temporarily bigger
• Temporarily faster
• Or both
• Objective is to regain smooth flow
• Example-Inside forward flow waiting areas to add capacity
Sunday, February 23, 14
ED Escalation System
• Facility wide standardized, documented escalation system based on ED LOS and/or volume
• Provides common language across facility
• Leadership line of sight to ED operations
• Layered escalation system
© 2014 Sean Carney, LLCSunday, February 23, 14
Patient Satisfaction
Sunday, February 23, 14
Patient Satisfaction • Patient Satisfaction Relates To LOS.
Simple
• Everything else is a workaround
• Greeter/Rounders
• Real time monitoring
• Communication strategies
• Service Recovery systems© 2014 Sean Carney, LLC
Sunday, February 23, 14
Thank You
www.seanmcarney.com@seancarney
Sunday, February 23, 14