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Eastern Health: Improving ED to Ward Transfer

Eastern Health: Improving ED to Ward Transfer. Lean Team Members Michael Butler. Overall Process Being Mapped.

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Eastern Health: Improving ED to Ward Transfer

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  1. Eastern Health: Improving ED to Ward Transfer Lean Team Members Michael Butler

  2. Overall Process Being Mapped • After consultation with the Hospital’s Admission & Discharge Manager, the initial plan was to map the journey of a medical patient from admission to the Emergency Department to transfer to Ward 2 East. This process was selected for a number of reasons, including: • Ongoing problem of meeting our DHS HDM access target for ‘No. of Patients with LOS in ED >24 hours’, which appeared to correlate with patients requiring admission to a medical bed • The ED had previous Lean experience, including undertaking 5S and VSM – associated with ‘InformED’ funding • Low Nursing Staff morale in 2 East • Opportunity to link this with other improvement activities occurring in 2 East and to impart Lean Thinking to the nursing staff of the ward • Following completion of the current state VSM for this process, in consultation with 2E NUM & ANUM it was decided to narrow the project focus to a process related to the admission from ED to 2E, thus the following.

  3. Project Aim & Plan Project aim: Reduce bed preparation time to 30 min in Ward 2 East (From bed vacated to next admission from ED) Project Plan: VSM, presentation to ward staff, consult’n with NUM, Nurses & WSS I dentify waste / problem areas Inefficient work areas – pan room, treatment room, work stations, etc. Non-standardised work – nurses & WSS have varying systems of identifying & notifying one another of a bed to be cleaned / once a bed has been cleaned. Key Stakeholders Medical patients, 2E NUM / ANUMs / staff, Bed Mgr, ED staff, WSS staff, Hospital executive team

  4. Current State Value Stream Map

  5. Bed Prep Value Stream Map – Future State:

  6. Kaizen Blitz Actions: • Identify ward admission takt time – Source: Trend Care • Takt time (identified using 12 months of admission data) = 3.327 admissions per day • Takt time for each day of week also identified • ‘Follow’ bed at different times in day • Progress –3 beds ‘followed’ & mapped during morning shifts, to be followed by mapping during pm shift • Further define p.r.n. by using ‘problem is/is not’ • Collect data – bed vacated & admission to ward times • Pre-implementation data collection commenced • 5S to improve efficiency in identified ward areas • Project team formed and work commenced • Ward areas identified and prioritised • Information on 5S tool provided and 5S expertise sort from ED Logistics Co-ordinator • Standardise work / roles of WSS and nursing staff in relation to bed preparation / cleaning – written guidelines • Project team formed and bed mapping completed • Issues as previously identified • Additional issues identified, including inconsistent use of Transit Lounge!

  7. Next Steps: • Project handed over to Ward 2 East (December 2006) • EH ED Patient Flow Committee formed, including 4 Angliss reps • Purpose - ????? • Angliss data presented so far has included: • 7.3% growth in patients requiring admission to a ward from ED comparing 2005/06 with 2006/07(July to Dec) • Top 10 Diagnosis for LOS >24hrs - audit of pt records of top 3 conditions (UTI, Lobar Pneumonia and CHF) is being conducted to determine reason for delay and if alternatives means of managing pt • Time of Arrival at ED for LOS >24hrs (EH data) • Majority of pts with LOS>24hrs arrive between 1000 and 1600 • Other data - 1800 to 2200 there are more bed requests than separations, 1000 to 1800 there are more separations than bed requests • Day of the Week ED presentations for LOS >24hrs (EH data) • Data showed a significant increase of 24hr LOS on Sundays, with Friday at 7% and Sundays at 25%. Separations were reversed showing 8% on a Sunday and 17.3% on a Friday • Average time for ‘Available to transfer from ED to Ward’ • Varied between 42 - 64 min, sometimes waiting up to 149 min. • Plan to develop Angliss ED Patient Flow Committee, • To implement improvements based on EH ED Pt Flow findings / data • Membership to inc. IP medical beds (2E) reps • To use Lean thinking as the improvement methodology

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