modeling space needs with excel - institute of industrial

Modeling Space Needswith Excel

Cardiac Cath Prep and Recovery

Session Description

Use Excel to model patient flow, wait times and space needs. Learn the

formulas and steps used to analyze a unit including what-if scenarios for

changing the mix of patients among ambulatory treatment, cardiac

catheterization and surgical prep and secondary recovery, and pre-admission

testing.

Objectives:

• Steps for analysis of resource needs• Excel formulas for modeling resource

utilization from patient logs• How to conduct what-if scenarios in

Excel• Ideas for decreasing patient waits

Process Used to Complete ATC/PAT/Cath Request

• Clarify request• Interview staff• Obtain volumes, processes and job descriptions• Enter volumes by date and time• Combine volumes to determine combined need• Write summary• Review draft summary with staff for accuracy and

gain acceptance• Develop presentation for Administration

Measure Clarification Worksheet

1. What question do you want answered? What are you trying to prove or what decision will you make as a result?

2. Who is going to review this information?3. Describe the process that is being

measured.4. What population is being measured (i.e.

inpatients, outpatients, or all patients)?

Measure Clarification Worksheet (continued)

6. What is the data source?

7. How will missing or conflicting information be handled? (For example, what will you do with a record that has missing or conflicting time?)

Pre Admission TestingAmbulatory

Treatment Center

Cath Lab

200

300

400

500

600

700

Jun-

99

Jul-9

9

Aug

-99

Sep

-99

Oct

-99

Nov

-99

Dec

-99

Jan-

00

Feb-

00

Mar

-00

Apr

-00

May

-00

Jun-

00

Jul-0

0

Aug

-00

Sep

-00

Oct

-00

Nov

-00

Dec

-00

Jan-

01

Feb-

01

Mar

-01

Apr

-01

May

-01

Month

Patie

nts

Pre Admission TestingAmbulatory Treatment CenterCath LabCath Lab

Patient Volumes

Staff Skills


Treatment Center

Cath Lab

One Year Staff Nurse Experience

Space NeedsHow much space?1. Patient Volume2. Space Needs per Patient

• Equipment• Minor Equipment• Major Equipment, Control Room • No Equipment• Procedure Table• Stretcher• Bed• Chair

• # of Visitors, MDs and Staff

•Before Invasive Procedure> Assessment> Education

•Outpatients•Prior to Day of Procedure•Clothed•Sitting•Week Days

PAT ATC

CL

Pre Admission Testing

Patient Signs In At Registration

Patient Waits In Lobby

Patient Registers


Registrar Walks Blue Card &Pregistration Forms to Pre Admission Testing

Secretary Stamps Forms, Enters Orders & Adds Forms Based On Orders

Nurse Takes Chart, Old Records & Patient for Assessment, Teaching & EKG


Patient Waits For 2nd Patient To Be Ready for Anesthesiologist

Anesthesiologist Assesses & May Write Orders

Nurse Logs Orders

Secretary Enters Orders

Nurse Gets Blood Tube Labels & Copies Chest X-ray Order

Nurse Draws Blood

Nurse Escorts Patient to X-ray

Nurse Calls Retail Pharmacy With Prescriptions

Nurse Logs Out Patient

Converting to electronic data

Aggregate

Copy Values

80th Percentile

Compare Volumes, Schedule Capacity and Staffing

Patient Volumes

• Average: 26 patients each weekday• Range

– 15 patients the Friday before Memorial Day– 20 patients on the next lowest day– 33 patients per day on the highest day

• Volume does not correlate to day of week

Patient Volumes

• Patients seen from 8:30 – 5:00• From 10:00 – 4:00

– Average 3 patients being seen• Volume gradually decreases after 4:00

– Staffing does not

Average Utilization 48%, but…

Pre Admission Testing LayoutCongested Area

Rarely Used

Pre Admission Testing Patient Mix

• 97% pre-operative patients assessed by nursing and anesthesia

• 4 open heart surgery

• 6 of the 578 patients were seen outside of Pre-Admission Testing in addition

• 5 lithotripsy patients not seen by anesthesia

Pre Admission Testing Patient Throughput Times

• Patients arrive at Registration• Wait to see a Registrar

– Daily average ranged from 6 to 33 minutes• Registration

– Daily average ranged from 12 to 20 minutes


• Average patient in Pre-Admission Testing 47 minutes

• Ranged from 5 minutes to 1 hour and 50 minutes

What If?

•Invasive procedure> Conscious Sedation> Recovery Required

•Outpatients & Inpatients

•Gowned•Lying•Week Days•Specialized equipment & room

Cath Lab

Patient Prepped In Ambulatory Treatment Center Unless Know Will Be An Angioplasty, then on Cardiology

(Assessed, IV Cannula Inserted)

Groin Shaved in Holding Area (inpatients done on floors)

Patient to Cath Lab Room

Physician Paged

Cath

Leave Cath Lab Area from Cath Lab Room

Arrive in Ambulatory Treatment Center for Diagnostic Caths and on Cardiology for Angioplasties

Cath Lab

Cath Lab

Cath Lab Rooms

• 3 Cath Suites• Staging Area• Patients Leave Directly from Cath Suite

Sitting procedures

33%

Lying procedures

2%Preps38%

Recovery27%

Ambulatory Treatment Center Visit Mix

Ambulatory Treatment Center Prep

Assessment & Education

IV Cannula Inserted

Gown

Lab Draw

Procedure Area Requests

Chest X-ray, if ordered

Procedure Day if no Pre Cath Visit

Transport to Procedure

Ambulatory Treatment Center Prep

Assessment & Education*

IV Cannula Inserted

Lab Draw*


Chest X-ray, if ordered*

Procedure Day if no Pre Cath Visit

IV Cannula Inserted


Day if had a Pre Cath Visit*

Transport to Procedure Transport to Procedure

Gown Gown

Ambulatory Treatment Center Preps

•Before Invasive procedure> Assessment> Education

•Outpatients•Day of Procedure & Prior Day•Gowned & Clothed•Lying & Sitting•Week Days

Ambulatory Treatment Center Recovery

•After Invasive procedure•Outpatients•Day of Procedure, After Procedure•Gowned•Lying•Week Days

Cardiac Catheterization Recovery

• 31% of hospitals recover OP Caths in an ambulatory care area

• 15% recover in a PACU

• 82% recover in Cath

Ambulatory Treatment Center Lying Procedures

•Invasive procedure•Outpatients•Day of Procedure•Gowned•Lying•Week Days

Ambulatory Treatment CenterSitting Procedures

• Non-Invasive procedure•Outpatients•Day of Procedure•Clothed•Sitting•Week Days & Weekends

Ambulatory Treatment Center Patients

Staff

Ambulatory Treatment Center PatientsPeople

Ambulatory Treatment Center

• Preps undress and bed• Stretchers for transport• Beds cleaned before reused, daily• Treatment chairs not cleaned

before reused

Patient Throughput

Ambulatory Treatment CenterCapacity

• Hours/Day 14• Days x11• Hours 154• Spaces x14

» 2156• Downtime -5%• Capacity 2048

Ambulatory Treatment CenterUtilization

• Used 721• Capacity 2048

= 35%

Fewer Rooms Would Cause Waits

>27% Recovery patients>31% Preps>2% Liver biopsies>60% Pre cath visits and sitting procedures

AssessmentEducationClothedSitting

EquipmentEquipment

In summary

PAT ATC

CLOutpatientsWeek Days

InvasiveGowned

Lying


Treatment Center

Cath Lab


Ambulatory Treatment Center

Cath LabCath

Equipment

Sitting Procedures

Combining Patient Arrival Times and Time in Pre Admission

Testing or Ambulatory Treatment

Pre Op Short Stay Endoscopy

Cardiopulmonary Diagnostics

NeurodiagnosticsOutpatient Lab Work

Ambulatory Treatment CenterUtilization

40% of current Ambulatory Treatment Center patients could wait without causing negative

effects on others

Too much space?

Pre Admission TestingHow many Wait with X Rooms

0 18

26

64

0

10

20

30

40

50

60

70

9 8 7 6 5

Staffed Rooms 8:20 a.m. Until The Last Patient Leaves

Patie

nts

Who

Wou

ld H

ave

Wai

ted

1Out of 572

1%8

5%26

12%64

Pre Admission Testing Utilization•Pre Admission Testing Needs

Nurses Station SpacePC

Printer Fax

Phone Phone

Addressograph Log

ChartRack

registrar nurse

Potential Idea to Consider

• Replace Pre Admission Testing’s Office with a Nurses Station

• Benefits: Eliminate traffic congestion

Findings So Far:

• Pre Admission Testing, Ambulatory Treatment Center & Cath Holding Have Similar Needs for Staff Skills, Types of Rooms & Equipment

• Pre Admission Testing Needs More Patient Rooms & a Nurses Station


• Combine Pre Admission Testing • & Ambulatory Treatment Center• Benefits: Less Total Space Needed

Maximum Rooms Needed for Any Day May 2001 if Pre Admission Testing and Ambulatory Treatment Center Were

Combined

05

101520

6:30

AM

7:30

AM

8:30

AM

9:30

AM

10:3

0 A

M

11:3

0 A

M

12:3

0 P

M

1:30

PM

2:30

PM

3:30

PM

4:30

PM

5:30

PM

6:30

PM

7:30

PM

8:30

PM

Time of Day

Max

imum

Roo

ms

Ever

Ne

eded

Max Needed 80% of the Days = 14


• Schedule More Patients in the Morning & Late Afternoon

• Benefits: Decrease Space Needs At Peak


• Schedule Caths

• Benefits:– Eliminate Patient Wait for

Cath, 1 hour average, – up to 4 hours– Free Up Room Space– Staff Know Who to Prep 1st

Pre Admission TestingPatient Signs In At Registration


Patient Registers


Registrar Walks Blue Card & Registration Forms to Pre Admission Testing

Secretary Stamps Forms, Enters Orders & Adds Forms Based On Orders

Nurse Takes Chart, Old Records & Patient for Assessment, Teaching & EKG

Patient Waits For 2nd Patient To Be Ready for Anesthesiologist

Anesthesiologist Assesses & May Write Orders

Nurse Logs Orders

Secretary Enters Orders

Nurse Gets Blood Tube Labels & Copies Chest X-ray Order

Nurse Draws Blood

Nurse Escorts Patient to X-ray

Nurse Calls Retail Pharmacy With Prescriptions

Nurse Logs Out Patient

New ProcessObtain Orders, Register, Stamp Forms

Patient Arrives, Chest X-ray if Needed

Assessed Clothed In Chair, Call Anesthesiologist Without Waiting For 2nd Patient

To Lobby with Pager

Paged to Holding Area

Gown, Insert IV Cannula, Shave, Pager to Visitor

Procedure

Recovery on Stretcher, Page Visitor

Summary

• Skills needed in Ambulatory Treatment Center, Pre Admission Testing & CathHolding are Similar

• Pre Admission Testing Needs More Exam Rooms

• Combining Pre Admission Testing & Ambulatory Treatment Center Requires Less Space Than 2 Separate Areas

• Process Changes Could Be Made To Reduce Space Needs

Potential Combined Space

• Preferably Adjacent To:– Anesthesia– Cath Lab– Special Procedures– Registration (if keep current process)

• Benefits: Minimize Anesthesiologist, Cardiologist, Patient and Registrar Travel

North Tower Lobby

South Tower Lobby

Cardio-pulmonary Diagnostics

Information Desk

Stairs/elevator

Currently IS,

Medical Library

Elevator/BR/phone

Recovery Room OR

Cath Lab

Special Procedures

Chapel

Registration

Pre Op Short Stay

Current Pre Admission

Testing

Ambulatory Treatment Center is currently not on the 1st floor

Lab

Area Patient Rooms Square Feet Pre Op Short Stay 2 with adjoining bath 24’ x 11’ = 264 ‘2

Door Door

Door Door

Sink

Sink

Chair

Stretcher

Stretcher

Chair

Door Door

Door Door

Sink

Sink

ChairStretcher

Stretcher

Chair

Door Door

Door DoorS

ink

Sink

Chair

Stretcher

Stretcher

Chair

Door Door

Door Door

Sink

Sink

ChairS

tretcher

Stretcher

Chair

8 rooms with 4 shared baths = 96’ x 11’

<-11’-> 3’ <-11’->

----11’------>= toilet

Medical Library/IS Network Engineers/IS Storage= ~110’ x 30’ = 3,300 ‘2

door

door



8’ hall

<-S Tower Lobby

Cath Lab SpecialProcedures

RN Station

RN Station is 6’ x 11’ log, fax, PC, & phone

Utility Rooms

2 Utility Rooms, Each 6’ x 5 ½ ‘

What Was Done

• Pre Admission Testing Office Remodeled

• Lab space was given to Pre Admission Testing providing 6 exam rooms

• Pre Admission Testing Process Revised• Not Combined with Ambulatory

Treatment Center

What Was Done

• Ambulatory Treatment Center’s patient mix was changed– Cath Prep and Recovery was removed– Non-invasive Cardiology Patients were

added

What Was Done

• Cath Observation Area Created

Questions?

modeling space needs with excel - institute of industrial

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