Driving Change with VPS Data:Shaping Care Delivery and Operational Management

Sherri Kubis RN, BSN, CCRN

Danielle Traynor RN, BSN, CCRN

Children’s Hospital of Philadelphia

Goals Describe Successful Utilization of VPS Data in Care Delivery

and Operational Management Efforts: Care Delivery

Care Model Initiative

Operational Management Daily Flow Predicted Flow PACU Utilization

Care Model & Innovation Transformation Committee

Hospital Operating Plan Directive with the goal:

“Develop a care model to deliver excellent patient care by optimizing the human and physical resources and care processes with attention to responsible stewardship.”

Four units chosen to initiate investigations and pilot testing

PICU VPS Team requested as permanent team member to provide relevant data and insight into PICU population, multiple patient cohort characteristics and care delivery.

Care Delivery

Utilized VPS Data to provide a comprehensive descriptive analysis of the PICU patient population over the course of the three prior years.

Age, LOS, Severity of Illness, Discharge Disposition Medical and Surgical Services Reason for ICU admission (Primary Dx and/or Chronic Condition

necessitating ICU level of Care) ICU level of Care Interventions Census and Capacity Trends

Utilized VPS Data to provide in depth review of specific populations identified that Care Model adaptations could yield significant improvements in patient care quality and efficiency.

Care Delivery

Daily Patient Churn Seasonal Capacity Unit LOS in relation to Hospital LOS

Utilized VPS Data to Analyze Census Trends

1-Interventions or therapies only delivered in the ICU 2-Ventilation dependent patients admitted for separate ICU need3-Neurologic ICU Care 4-Patients admitted for Airway ICU Monitoring5-Other

Utilized VPS Data to Analyze Patient Types and Prevalence

Identified PICU discharges to General Care Floor with Non-Invasive Ventilation present at Discharge

Compared PICU LOS to remaining HLOS

Utilized VPS Data to Analyze Specific Patient Cohorts

Patient Flow and Capacity planning Operational Management

Daily Flow Predicted Flow

Scheduled vs Unscheduled PACU Utilization

Manage capacity challenges and plan for expanded growth

Daily PICU Patient Flow Review

Operational Management

Staffing and Assignment Planning

Operational Management

Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

7pm-11pm 4.6 4.0 5.1 3.8 4.5 4.5 4.1 4.0 4.6 4.7 4.0 4.5

11pm-7am 6.7 7.3 7.3 6.9 7.0 6.4 6.3 5.9 6.3 6.2 7.5 6.7

4.6 4.0 5.1 3.8 4.5 4.5 4.1 4.0 4.6 4.7 4.0 4.5

6.7 7.37.3

6.97.0 6.4 6.3 5.9

6.3 6.2 7.5 6.7

Average Unscheduled PICU Ad-missions 7pm-7am

Capacity Planning -PACU Utilization

Operational Management

% of CHOP Unit Admissions

% VPS Reference Group Unit Admissions

% Difference

Operating Room

28.9 % 16.0% 12.9%

PACU

3.7% 12.8% 9.1%

Benchmark reports revealed increased utilization of PACU

beds from reference hospitals. Supported plans to strategically utilize PACU for recovery

and patient care during high volume/census. Plan developed to identify patients within predetermined

populations to recover in PACU.

Partnerships with Perioperative Area Have Optimized Appropriate Patient Placementless ‘double booking’ for same patient in 2 different inpatient locations

Sep Oct Nov Dec Feb Mar Apr May Jun Aug2013 2014

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Provided VPS data useful to the investigative phase of this Hospital Operating Committee

Information guided efforts in developing high impact Care Model changes

Identified unique populations in which care coordination among units is key

Admission and Transfer Guidelines for requiring non-invasive ventilation

Identification of post operative patients to be sent to PACU or surgical unit utilizing predictability of scheduled vs unscheduled and patient flow

Provided patient flow insight through VPS data that influenced workflow and staffing.

Driving Changes with VPS Data

Driving changes with VPS Data…And it continues

Expanding our partnerships to other areas in the hospital EDEmergency Transport Team Anesthesia Resource CenterBed Management and Nursing Central Staffing

OfficeGeneral Pediatric Units