webinar: transforming operational throughput – the journey toward value-based care

ANNUAL LEADERSHIP CONFERENCEOctober 12-14, 2014 • Palm Desert, California

Texas Children’s Hospital

Transforming Operational Throughput – The Journey Toward Value-Based Care

2014 ANNUAL LEADERSHIP CONFERENCE AND MEETING OF THE MEMBERSHIP

Agenda

• Learning Objectives• Background: A Changing Industry, About TCH• Opportunities and Challenges at TCH• Where We Began • Work to Date/Results: Care Management, Care

Progression, Patient Placement, and Care Variation• Strategies for Improvement • Lessons Learned• Next Steps• A Sustainable Approach/Conclusion

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Learning Objectives

• Identify strategies to enhance integrated care across the delivery system

• Learn specific initiatives to drive improvement in throughput efficiencies

• Understand outcomes from a financial, clinical, and operational perspective

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Background: A Changing Industry

Dynamics in health care are driving unprecedented change:

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Bottom Line: A Challenging Fiscal Environment

• Shifting from volume-based to value-based purchasing

• Shifting from experience-based to evidence-based care delivery

• Focusing on eliminating waste


Background: About Texas Children’s Hospital

• 503-bed not-for-profit hospital and academic medical center in Houston, TX

• Part of a 650-bed system• Mission to create a healthier

future for children and women throughout the global community by leading in patient care, education and research

• Consistently ranked among the top children’s hospitals in the nation

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Opportunities and Challenges at TCH

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Care Management

Patient Placement

Care Progression

Care Variation


Where We Began• Transactional approach to care management

– Operational inefficiencies in utilization management– Lack of integration of care management functions– Under-resourced, both in terms of people and tools

• Need for care progression– Above average severity-adjusted Length of Stay (LOS), compared to

risk-adjusted benchmarks– Lack of consistent, coordinated interdisciplinary rounds– Spending significant hours on census alerts and unable to

accommodate outside transfers

• Inadequate or insufficient tools to support patient placement – Inefficient bed turnaround, including environmental services support– Delays in placing patients from the ED and PACU

• Challenges in care variation– Payers shifting to DRG-based payment structure– Lack of consistency in utilization of evidence-based standards

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Work to Date: Care Management • Restructured Care Management department and recommended case

loads in line with national Care Management standard• Engaged over 20 Care Managers in weekly Clinical High Risk meetings

to collaboratively resolve barriers to efficient patient flow, efficient care, transitions to the next level of care and hospital reimbursement

• Redefined roles and responsibilities of department personnel, including utilization review, discharge/transition planning, avoidable day documentation, interaction with multidisciplinary team and utilization management

• Initiated a Care Management Medical Director to provide physician leadership and expertise related to Care Management practice

• Initiated an Access Care Manager role to increase the number of patients who are screened for appropriate status and level of care at the time of admission

• Implemented Morrisey, a Care Management software tool fordischarge planning, utilization review and other work flowmanagement

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Results: Care Management

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• Prioritizing patient load• Proactively anticipating and planning for discharge• Facilitating interdepartmental communication• Managing high-risk patients• Improving utilization management • Engaging physicians


Work to Date: Care Progression

• Established 11 daily multidisciplinary Care Progression Rounds (CPR) across 35 services to proactively plan for patient’s discharge with the care team and the patient/family

• Conducted over 1,500 CPRs (and counting) since project start with participation by over 500 physicians, nurses, and supporting care team members

• Created Epic Care Progression Rounds flow sheet to facilitate timely and efficient documentation of anticipated discharge dates and barriers to discharge (i.e., education, prescriptions, transportation)

• Increased effectiveness of Care Progression Rounds by leveraging a new Quality Review process and garnering timely feedback from participants

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Results: Care Progression

• Improving interdisciplinary communication and collaboration

• Improving patient and family involvement • Improving ability to proactively anticipate and

communicate discharge dates• Increasing patient, staff and physician satisfaction

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Work to Date: Patient Placement• Redesigned patient placement department and recommended caseloads to

support responsibilities that include bed assignment, level of care assessment prior to admission, and timely interaction with nursing units, nursing supervisors and physician advisors

• Centralized patient placement process, which allows resource nurses to spend more time assisting with patient care, reduces avoidable patient delays, and maximizes the space/beds available – including a process for nursing units to provide placement input to inform placement decisions

• Created a patient placement matrix to assist in identifying the appropriate unit for each patient based on services required

• Initiated Level of Care Reviews at admission, reducing denials and ensuring beds are available for the patients that need them most

• Upgraded to TeleTracking XT™ platform, which streamlines communication between the nursing units, Bed Management, EVS, and Patient Escort and improves our ability to proactively place patients in the right bed

• Trained over 600 TCH nurses, unit clerks, EVS, and Patient Escort staff on the TeleTracking system

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Results: Patient Placement

• Improved ability to ensure patients are placed into the right bed at the right time

• Instituted new process for census management• Consistent “Bed Turnaround Time” below 50 min

– Efficient housekeeping responses to high priority requests

• Use of PatientONTRAC Summary and Detail reports by clinical leadership to:– Drive staff performance– Share successes – Review areas of opportunity

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Work to Date: Care Variation• Worked with physicians, nurses, and ancillary providers in

select DRGs to:– Streamline care– Reduce variation– Enhance existing evidence-based standards of care

• Used lean methodology and processes as the structure to perform this work

• Developed future state vision of care processes for Diabetes and Pneumonia patients at TCH that align care with IOM dimensions of quality and safety

• Developed Pneumonia multidisciplinary care pathway to be integrated into Care Progression Rounds

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Results: Care Variation

• Developed interdisciplinary Care Pathway for patient care

• Implemented vision for Diabetes Center of Excellence

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Organizational Results⬇38% reduction in acute care red census alert

hours⬇8% reduction in hospital readmissions⬇Reduction in capacity-related transfer denials ⬆Significant improvement in admission, transfer

and discharge physician and nursing metrics• Significant improvements in Length of Stay (LOS)

⬇18 hour decrease in average LOS⬇13% decrease in severity-adjusted patient LOS

• Capacity to serve + 2,296 more inpatients per year

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Results: Severity Adjusted LOS

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Strategies for Improvement

• TCH partnered with Huron to expand solutions that ensure care is:✔Clinically appropriate✔Delivered efficiently✔According to evidence-based standards

• Focused on throughput initiatives to:⬆ Improve efficiency of patient flow⬆ Improve care delivery⬆Change satisfaction system-wide

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Lessons Learned

• Key to driving results:– Utilizing a team-oriented, process-and data-driven

approach, supplemented by enabling technologies– Bringing all team members together to work on necessary

components

• Key to driving successful change:– Proper structure and methodology– Leadership, data, devoted resources, communication and

implementation

• Key to integrated care delivery:– Physician/nurse partnership

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Next Steps

– Formal Patient Flow meetings – Clinical High Risk meetings, focusing

on patients with outlier LOS– Focus on specific patient populations

where variation is high– Extending the Care Management

model beyond hospital walls

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Continuing to build upon Huron engagement:


A Sustainable Approach

• Huron’s tools and processes have enabled TCH to build on recent improvements

• TCH and Huron worked to create a sustainable solution

- TCH has seen additional improvements since the engagement and continues on a positive trajectory

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Contact InformationPresentations

www.childrenshospitals.net

Larry Burnett, RN, MSN

Managing Director, Huron Healthcare

Phone: (480) 892-2511

Email: [email protected]

Tabitha Rice, MBA

Senior Vice President, Texas Children’s Hospital


Jackie Ward, MSN, RN

Assistant Vice President of Nursing, Texas Children’s Hospital


http://www.childrenshospitals.net/

mailto:[email protected]





webinar: transforming operational throughput – the journey toward value-based care

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