Go With The Flow- From Charge Nurse to Patient Flow Coordinator

1. Go With The Flow- From Charge Nurse to Patient Flow Coordinator Donna Ojanen Thomas, RN, MSN Cynthia J. Royall, RN, BSN Cindy and I are happy to be here today to talk about our new charge nurse role and other changes that have worked in our department. Cindy and I are happy to be here today to talk about our new charge nurse role and other changes that have worked in our department.

2. Primary Children�s Medical Center Our hospital is located in the Eastern part of Salt Lake City, just below the University of Utah and right above where the Olympic village was located in 2002. We moved into this hospital in April of 1993.Our hospital is located in the Eastern part of Salt Lake City, just below the University of Utah and right above where the Olympic village was located in 2002. We moved into this hospital in April of 1993.

3. About PCMC Not for profit hospital, part of Intermountain Health Care Only children�s hospital in Utah Designated Level I trauma center 233 licensed beds Our ED, during the time I have worked here, has gone from 4 beds, to 6, to 13, and now to 23. We are planning another remodel in 2007. We will be remodeling our triage area this spring.Our ED, during the time I have worked here, has gone from 4 beds, to 6, to 13, and now to 23. We are planning another remodel in 2007. We will be remodeling our triage area this spring.

4. About PCMC ED Staffed with board certified pediatric emergency physicians, fellows, NPs, pediatric residents, nurses and ED techs 23 beds, including 2 bed trauma bay and 2 bed resuscitation area Fast track � opened in September 2003 RTU � 18 bed short stay area adjacent to ED 39,764 visits in 2004 Fast track sees about 1/3 of all visits during the times it is open and is staffed by a pediatrician. A little bit about the RTU (it is a dumb name since it isn�t rapid and sounds more like a fast track). The RTU was created in 1998 to assist the ED mainly but now is a very flexible unit that does a variety of procedures, and patient types. The staff is separate from the ED (a separate cost center too) but all staff is cross trained to work in the ED and this has eliminated the need for the ED to have on call staff. The RTU is managed by the ED administration, and sees between 400-500 patients per month � about 6% of ED admits actually go to the RTU. Some of these are classified as inpatients who need 24 hours of care. Overall our Admission rate from the ED is about 20-22%Fast track sees about 1/3 of all visits during the times it is open and is staffed by a pediatrician. A little bit about the RTU (it is a dumb name since it isn�t rapid and sounds more like a fast track). The RTU was created in 1998 to assist the ED mainly but now is a very flexible unit that does a variety of procedures, and patient types. The staff is separate from the ED (a separate cost center too) but all staff is cross trained to work in the ED and this has eliminated the need for the ED to have on call staff. The RTU is managed by the ED administration, and sees between 400-500 patients per month � about 6% of ED admits actually go to the RTU. Some of these are classified as inpatients who need 24 hours of care. Overall our Admission rate from the ED is about 20-22%

5. PCMC Yearly Volumes I could go back as far as 1978 when we had a volume of 8690 visits. W have increased almost 50% in the last 10 years. This year, because we did not have a huge flu season like last year, our volume was a little less. Volumes are seasonal. Our patients are complex. Data from a study in 1997 showed that we had 71% Causcasian, 17% Hispanic (this is growing), 35% of the patients have had contact with a specialist at our hospital. Each patient comes with �accoutrements. 2.3 people on average come with the patient and 1/3 have 4 or more people . This is interesting because these people are �customers� and evaluators of our service as well. 24% of our patients are referred by a pediatrician or FP doctor, and 24% referred by another site or clinic. 50% of our volume already have been seen by another provider for the same illness and 44% of these had some sort of testing done � so they come with high expectations.I could go back as far as 1978 when we had a volume of 8690 visits. W have increased almost 50% in the last 10 years. This year, because we did not have a huge flu season like last year, our volume was a little less. Volumes are seasonal. Our patients are complex. Data from a study in 1997 showed that we had 71% Causcasian, 17% Hispanic (this is growing), 35% of the patients have had contact with a specialist at our hospital. Each patient comes with �accoutrements. 2.3 people on average come with the patient and 1/3 have 4 or more people . This is interesting because these people are �customers� and evaluators of our service as well. 24% of our patients are referred by a pediatrician or FP doctor, and 24% referred by another site or clinic. 50% of our volume already have been seen by another provider for the same illness and 44% of these had some sort of testing done � so they come with high expectations.

6. Why We Needed to Change Increased volumes and complexity Increased LWOTS Decreased patient satisfaction Decreased staff satisfaction Ineffective communication between caregivers Here�s what our problems were and why we needed to change. Even by increasing the staffing, we ended up having longer LOS, and increased LWOT. We just kept adding people hoping this would fix the problems. Our patient satisfaction with wait times was very bad. In April 2002, more than 1/3 of our patients rated the waiting time as fair or poor. And waiting time correlates to quality of care in many family�s opinion. We had a lot of people at work who weren�t talking to each other and we had a complex system that was not really defined. It looked like this:Here�s what our problems were and why we needed to change. Even by increasing the staffing, we ended up having longer LOS, and increased LWOT. We just kept adding people hoping this would fix the problems. Our patient satisfaction with wait times was very bad. In April 2002, more than 1/3 of our patients rated the waiting time as fair or poor. And waiting time correlates to quality of care in many family�s opinion. We had a lot of people at work who weren�t talking to each other and we had a complex system that was not really defined. It looked like this: