time to talk throughput webinar

Maureen Anderson, MD, Physician Executive

Time to Improve Your ED Throughput - Part I5 Steps to Select the Right Technology

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Smarter Emergency Care: everywhere, every time

Today’s Presenter

Maureen Anderson, M.D.

T-System Physician Executive

Dr. Anderson is a practicing physician at William Beaumont Hospital in Troy, Michigan and a physician consultant for T-System. She provides input and strategy for new services and solutions designed to enhance the performance of emergency departments. She also works with clients to help them leverage our products to optimize clinical quality and efficiency.


Low Throughput Has Negative Implications for EDs

Patient Safety

• Longer waits increase morbidity

• EDs on diversion may increase mortality for MI patients

Patient Satisfaction

• Time to provider most important to patients

Revenue Reduction

• Each LWS costs $300-$500

• Each ambulance diverted costs >$3000k

75/100 dissatisfied patients

Tell 465 potential patients


Current Trends Are Further Exacerbating The Issue

• Healthcare Reform– More patients in the ED

– MU is promoting EHR adoption which doesn’t promise support of ED processes

• ICD-10– Requiring documentation of

more specific information

• ACO / Initiatives to keep patients in-network

With the right strategy, EDs can provide evidence-based, efficient and compassionate care


Significant Financial Incentives for Improving Throughput

• 50,000 APV ED

• Avg LOS of 200 min

• Physician group – bill $100 per patient

• Facility – Bill $500 per ED visit

– Bill $3,000 - $7,000 per inpatient admission

• Reduced LOS by 60 min – New LOS 140 min

– 50,000 hours of increased ED capacity

– 21,739 in potential new visits

• Physician group increases revenue by – $2,173,900

• Facility increases revenue by – $8,696,000 for discharged

patients

– $13,041,000 for admitted patients

Metrics Results

1. Build your team

2. Define your needs

3. Look for key attributes

4. Understand requirements

5. Measure the ROI

5 Steps to Select the Right Technology

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1. Build Your TeamWho needs to be involved?

• CIO– How will it fit enterprise system

strategy

– Plan for support resources

– How will it support key priorities such as MU, ICD-10, ACO

• CFO– What financial savings and growth

will result

– Adequate funding for training, upgrades

• CNO / CMO– How will it support quality initiatives

and care coordination

• HIM / coding– How will system support

efficient coding and billing

• ED medical director– How will physician group

productivity and reimbursement be impacted

• ED nurse director– Own and drive plan for ED

workflow and management

• Frontline providers

Supportive and engaged leadership

Other key stakeholders


Assess “Readiness” for a Change

• As a facility/organization Clear vision/direction/goals Strong/committed/engaged leadership Resources; financial/IT

• As an ED Leadership Staff buy-in Staffing levels ED space/layout

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Working Together

1. Define desired outcomes and prioritize– Understand motivation and communicate benefits for each

member

2. Define potential project barriers and plan to address– Technology proficiency and adoption

– Conflicting projects

– Travelling clinical staff / high turnover

– Staffing levels

3. Define baseline

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Assess, re-assess, fine-tune and celebrate


2. Define Your NeedsCan Technology Help?

• Dictation/Scribe cost• Illegible or incomplete records• Lost charts/lost revenue/undercoding• Prolonged los• Capacity; volume/space mismatch• IPD Bed Availability• Safety/cleanliness of the ED/Waiting Room• Inadequate staffing• Patient Satisfaction• Medication errors• Medicolegal risk/Quality issues• Meeting regulatory requirements• Communication across the continuum of care• Variability in clinical practice/documentation

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3. Look for Key Attributes

• Intuitive• Flexible• Robust, ED-appropriate

content to minimize typing and clicking

12Smarter Emergency Care: everywhere, every time

• Provides cues without causing alert fatigue

• Supports communication between all team members

• Features that support rather than impede workflow


EDIS Functionality: ED Workflow

• Registration• Tracking• Task Management• CPOE &

e-prescribing• Discharge planning

• Maintain EMTALA compliance • Allow for non-sequential, parallel processes • Provide data and information to identify bottlenecks • Identify patients and procedures exceeding time thresholds• Provide visual queues for next steps in workflow• Allow for seamless transition of care• Streamline and standardize order process

Features Objectives


EDIS Functionality: Clinical Documentation

• Triage, physician/nurse/ancillary

• Clinical decision support

• Allow consistency and efficiency

• Reduce or eliminate free text

• Help providers make evidenced-based decisions faster and easily document their MDM and ED course

• Present information sequentially and one a single plane

Features

Objectives


EDIS Functionality: Data / Integration

• ADT / Lab / Radiology

• Patient monitors

• Medications and allergies

• Integrate with clinical and business applications to reduce duplication of information in disparate systems

• Reduce re-entry of information that already exists

• Support current and future ED and hospital workflow and best practices

Features Objective


EDIS Functionality: Management & Reporting

• Patient load

• Patient flow (Throughput)

• Staff productivity

• Accurate, actionable reports to enhance – Throughput

– Patient safety and outcomes

– Patient satisfaction

– Staff efficiency

– Staff satisfaction

– Identify opportunities for improvement

Features Objective


4. Understand Requirements

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• Server needs or remote hosting

• Vendor staged or in-house staging resources

Hardware needs, staffing and expenditure

• In-house or HIS or other

Interface work and time line requirement

• On-site, remote, travel• Trainer and end-user

training

Training resources and time requirements

• Design time and resource availability

Content build requirements

• Site specific fields, reports

Customization time and requirements


Potential Pitfalls in Selecting an EDIS Partner

• “Product flexibility”-Total cost of ownership• “Staged deployments”• Vaporware

• Make sure to actually try out the product to assess usability in your clinical environment.

• Consult KLAS and other references

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5. Measure the ROISetting Baseline PerformanceCapturing Facility Metrics

• ED annual patient volume

• Revenue per discharged / admitted patient

• LOS for discharged / admitted patients (min)

• % patients discharged / admitted

• Infusions down-coded to IV pushes per month

• Infusions not billed per month

• Denied radiology claims per week

• # of patients with denied lab claims per week

• % of patients that require ‘Imaging Only’, ‘Labs Only’, ‘Imaging and Labs’

• Annual lost charts not billed

• Annual cost to find lost charts

• Annual cost of paper / dictation

• Annual cost of discharge instructions

• Clerical FTEs required to manage paper charts

• % of charts incomplete

• Coder time to rework incomplete charts (minutes per chart)

• Nursing time for follow-up calls (minutes per call)

• % of patients that require nursing follow-up calls

Patient Population Charting HIMFacility CPT

CodeUtilization

99281 8%

99282 22%

99283 25%

99284 17%

99285 23%

99291/99292 5%Radiology/Lab

Payor Mix• Medicare (% of APV)• Medicaid• Insurance• Workers

Compensation/Other• Self Pay*


Setting Baseline PerformanceCapturing Physician Metrics

• Cost of dictation

• Cost of paper documentation

• Annual cost to find lost charts so they can be billed

• Clerical FTEs required to manage paper charts

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Physician Group Operational

Billing MetricsProfessional Fee

Billing LevelUtilization

Level 1 0%

Level 2 1%

Level 3 29%

Level 4 31%

Level 5 36%

Critical Care 3%

Calculate Expected ROIOne Hospital’s Results with T SystemEV

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Anticipated ROI (All Benefits) 8X ROI Good breadth and distribution

Top Benefits (Annual Value): Reduces TAT on radiology and lab results

(facility benefit) = $651K Improves infusion charge capture (facility

benefit) = $529K Improves support for facility charge levels

(facility benefit) = $496K

Payback period: 4.3 months

Investment: $189K Year 1

3 Year ROI: 744%

59%

5%

5%

31%

Benefits by Value Driver

Optimize Revenue Capture

Reduce Cost of Care

Increase Operational Efficiencies

Improve Quality of Care/ Patient Safety


Key Takeaways

Addressing throughput issues requires a multipronged strategy

Technology is not enough without the right team planning and processes that make the most of new automation capabilities

Not all technology is equal – must support the unique workflow of the ED and gain adoption

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Join us for Time to Improve Your ED Throughput Part II:

6 Effective Strategies Across the Patient Experience

Thursday, Oct. 11, 2012

9 a.m. PT, 10 a.m. MT, 11 a.m. CT, 12 p.m. ET

Click here to register now

Q&A

https://tsystemevents.webex.com/tsystemevents/onstage/g.php?t=a&d=667222126

Cheryl Ann Graf, ARNP, MSN, MBA – Client Relationship Executive

Maureen Anderson, MD – Physician Executive

Time to Improve Your ED Throughput - Part II6 effective strategies across the patient experience

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Today’s PresentersMaureen Anderson, M.D.

T-System Physician Executive

Dr. Anderson is a practicing physician at William Beaumont Hospital in Troy, Michigan and a physician consultant for T-System. She provides input and strategy for new services and solutions designed to enhance the performance of emergency departments. She also works with clients to help them leverage our products to optimize clinical quality and efficiency.Cheryl Ann Graf, ARNP, MSN, MBAClient Relationship Executive

Cheryl is a nurse practitioner that currently works in 4 client sites, and is a Client Relationship Executive for the T-System. She has worked at the T-System for 5 years and has 25 years of ED practice in WA.


Low Throughput Has Negative Implications for EDs

Patient Safety

• Longer waits increase morbidity

• EDs on diversion may increase mortality for MI patients

Patient Satisfaction

• Time to provider most important to patients

Revenue Reduction

• Each LWS costs $300-$500

• Each ambulance diverted costs >$3000k

75/100 dissatisfied patients

Tell 465 potential patients


Current Trends Are Further Exacerbating The Issue

• Healthcare Reform– More patients in the ED

– MU is promoting EHR adoption which doesn’t promise support of ED processes

• ICD-10– Requiring documentation of more

information – (stat on negative impacts to productivity = throughput)

• ACO / Initiatives to keep patients in-network

With the right strategy, EDs can provide evidence-based, efficient and compassionate care


Significant Financial Incentives for Improving Throughput

• 50,000 APV ED

• Avg LOS of 200 min

• Physician group – bill $100 per patient

• Facility – Bill $500 per ED visit

– Bill $3,000 - $7,000 per inpatient admission

• Reduced LOS by 60 min – New LOS 140 min

– 50,000 hours of increased ED capacity

– 21,739 in potential new visits

• Physician group increases revenue by – $2,173,900

• Facility increases revenue by – $8,696,000 for discharged

patients

– $13,041,000 for admitted patients

Metrics Results

Opportunities for Performance Improvement at Each Stage

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EMS or Walk-in

Door to Doctor

Doctor to Decision

Decision to Dispo

Disposition or

Discharge

Pre ED

Registration & Triage

Placement

MD Discharge / Call for Bed

Patient Handoff

Room Utilization


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#1 – Pre ED: Redirect Patients To Most Appropriate Settings

• EMS pre-triage and transport to appropriate healthcare provider

• Mobile units provide regional care

• Provider at triage performs MSE and directs patient accordingly

Using Technology to Direct Patients and Provide Pre-notification of Their Arrival


#2 – Registration & Triage: Creating a No Wait ED

• Patient pre-notification• Quick registration• Rapid triage• Provider at triage• Patients pulled to open beds• Vertical patients remain

vertical• Order sets/protocols


Fast Track System at Grady Health System, Atlanta, Ga

• Patients with acute but non-life-threatening conditions to be treated more quickly and then released

• Sort patients by status and indicate services required

• Mid-level or nurse more active to make sure patients receive needed tests.

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• 2 hour reduction in Fast Track throughput

• 1/3 increased productivity

• 50% decrease in avg time from arrival to bed placement

• 19% decrease in avg time from bed placement to initial exam

How they did it Outcomes

Source: http://www.rwjf.org/qualityequality/product.jsp?id=29978

http://www.rwjf.org/qualityequality/product.jsp?id=29978

http://www.rwjf.org/qualityequality/product.jsp?id=29978


#3 Door to Doctor: Rapid Medical Evaluation

• Treatment process begins immediately

– Initial assessment

– Ordering of labs, DI

• Some cases have rapid discharge without using a bed

• Patients placed immediately in a bed and provider examination completed

• ED culture change

• Metrics can improve and you can make the difference

• Sites have reduced TTP from 10-80 minutes

• Increased patient/family satisfaction scores

• Increased revenues both hospital and provider

• Every dept must own the process

The What The Vision


RME: Case Studies

This 99-bed, acute care facility decreased its TTP to 8 minutes and increased its Press Ganey Patient Satisfaction Percentile Ranking from the 25th to the 85th percentile.

After reengineering its front-end process, this ED experienced a 75% decrease in TTP from 100 to 25 minutes.

Through a number of modifications, including the addition of wireless bedside registration, this ED reduced its TTP from 100 to less than 40 minutes.

By creating an RME team consisting of a physician provider, triage nurse and an ED Technician, this ED team found its TTP decreased more than 70%, its LWBS percentage reduced by 55%, and its diversion hours per month diminished by 75%.

#4 – Doctor to Decision: Bedside Documentation/CPOE

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#5 – Patient Hand-off: Active Management of Processes

Reduce readmissions and improve efficiency at hand-off• Physician outreach process – Optimize for admitted

and discharged patients • Case management process – identify and flag

patients at highest risk of re-admission

Registration Triage TreatmentAdmitted

(in-patient)Discharged

Medical Home Hand-off

Transferred

ED Discharge

Workflow Automation Technology to Improve Hand-off and Reduce Avoidable Readmissions

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#6 - Realigning Staffing to Peak Times

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Throughput Technology to Calculate ED Statistics and Trends

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Key Takeaways

Throughput can be addressed at every stage

Addressing throughput issues requires a multipronged strategy

Specialized technology can help identify bottlenecks and streamline processes

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time to talk throughput webinar

Health & Medicine

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baselinesmarter emergency

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continuum of care variability

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