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          Flow - Track # 4               

Starting on the Flow Journey Using Real Time Demand and Capacity Forecasting
9:35 am - 10:35 am
View the video of this session

Starting on the Flow Journey
Debra Kaczynski, MS, University of Pittsburgh Medical Center

In order to perfect your patient flow, you need to proactively anticipate your discharges and admissions. 
Patient flow is all about getting the right patient to the correct type of bed in the appropriate amount of time,
and providing timely access to care.
Traditional project based approaches to patient flow such as getting all patients discharged by 11 am and
adding bed capacity have not been effective in changing the overall system of care.  As the healthcare system
continues to be stretched by decreasing revenues, the imperative to function effectively, at high levels of
capacity, becomes even more significant.
 
A systems approach, which responds to this ever increasing need, is real time demand and capacity
management.  It is truly the first step in a longer journey of full capacity management.
 
This approach is outlined in the following steps:

  1. Predict capacity
  2. Predict demand
  3. Develop and implement a plan if demand exceeds capacity

Remember perfecting patient flow is not a process change.  It’s a journey.

Tackling Flow Bottle Necks- Exchange Your Issues and Successes Through a Facilitated Discussion
10:55 am - 11:55 am

Tackling Flow Bottle Necks
Debra Kaczynski, MS, University of Pittsburgh Medical Center

Have you started on the flow journey but  are encountering challenges along the way? In this session, Deb
Kaczynski, facilitated an open dialogue with individuals from various organizations, interested in perfecting
patient flow.  In this all-teach-all-learn breakout, members of the audience were encouraged to share what has
and has not worked in their settings.
 
Topics included:

Some commonly used success strategies were protocols and feedback.  Getting everyone to know the
important role they have in patient flow cannot be underemphasized.

To learn more about perfecting flow in your organization go to:
BEACON Resources, Search Keyword: Flow

 

Improving Flow in the ED
2:20 pm - 3:20 pm

Improving ED flow: a work in progress 
Kate Nakfoor, Ed.D, MBA, MSIS, RN, University of San Francisco

Improving ED flow is a work in progress at many organizations.  Using a projects-based approach, Kate
Nakfoor shared some of the strategies that she has used to improve ED throughput.  These strategies include
structural and process changes.  At the beginning, there must be a desire for change and support from
leadership to make change a priority.

Tips for success include:

Lasting change occurs when there is a shared vision matched with a “how can we make it happen” attitude.


The Evidence Is In: Nurse Initiated Pain Management Protocols Improve Patient Outcomes & Patient Flow
Cydne Holte, RN, BS, CEN & Brenda Brennan, RN, MS, CEN

Although the nurses in the Emergency Department at Washington Hospital did not start out with the intent of
improving flow through the department, that is exactly what happened when they implemented nurse initiated
pain management protocols in the triage area.  They discovered that by treating pain in their patients with
minor musculoskeletal injuries they were successful in decreasing: time to medication, pain, and length of stay.
It all started with the following question, “In ED, patients 13 years and older with closed distal extremity injuries,
will a nurse initiated non-narcotic medication pain protocol, compared to pain treatment deferred until seen by
ED physicians, decrease the patient’s pain scale within 60 minutes of triage”?  Nurses reviewed the evidence
and discovered that nurse initiated pain management protocols can do just that.  With the evidence in hand,
they designed a standardized procedure and obtained approval for the new process with all appropriate
governing bodies.  Following approval, all involved staff were educated using various approaches such as:
change of shift announcements, staff meetings, flyers and posters.  A new order set was developed in the
EDIS (organization’s EMR) and operational issues such as, where the medications would be stored, were
addressed.

These nurse driven, evidence based, changes made an impact!  More patients received pharmacological pain
interventions resulting in decreased time to medication, decreased pain scores and decreased length of stay in
the ED.

Suggestions from Cydnee and Brenda include:

At the end of the day, getting patients the treatment they need more rapidly will improve flow and increase your
organizations capacity.

 

Link to complete list of presentations and highlights from the 2010 Exchange

Download a pdf of the complete Highlights of the 2010 Exchange