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Breaking the Bottleneck

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Establish clear guidelines. Moses Cone created guidelines on how long the admission or transfer process should take using the new system. For example, the health system allocates 15 minutes for a department to assign a bed once it is notified. "If it is not assigned within the time frame, patient placement will assign the bed," says Joan LoPresti, RN, clinical support services director, adding that the transfer and admission process is expected within one hour from the time the patient was assigned.

The Premise system decreased the number of late discharges, which helped the health system reduce its length of stay from 5.5 in 2008 to 5.25 in 2009.

Hold staff accountable. Moses Cone monitors each shift, and because the information is in real time, the health system can intervene and reeducate staff as needed. Anyone who uses the system has the capability to question batching, says LoPresti. In addition, the health system produces a daily report showing the compliance of the department staff entering bed cleaning requests. "If they do not achieve 90% [compliance], the detail report will give us the specific rooms and time the error occurred," she says, adding that the report is monitored by departmental leadership.

Similarly, Heartland Health tracks its progress on a score card. Depending on the measures, they are collected daily, weekly, or monthly. For example, the health system created a benchmarking data set for the cath lab that includes measures like morning and afternoon start times and the time it takes to prep a patient. "There really wasn't a lot of benchmarking data for cath labs as specific as we needed," says Wheeler. "So we identified various things that delay our staying on track and on schedule."

Now the cath lab tracks those measures daily, so it can be trended by week or by month. Wheeler presents the score card to the service line leadership group weekly and to the quality management board quarterly. If the numbers are off, "I have to explain variance to the hospital administrator," she says. "The staff has learned that this doesn't end once the project is over," says Wheeler. "We look at what are we doing, and if the results are not what we wanted, we have been using rapid cycle improvement to turn it around."

Carrie Vaughan

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