Patient Progression - Connecting the Dots for Seamless Patient Care
By Darla VanEssen, interim vice president, Nursing, and Jenny Reese , MD, director, Inpatient Medicine
Over the past 10 months, TCH has dedicated time and resources to streamline patient flow and improve the patient’s experience. The attention to inpatient flow produced outstanding results for TCH and its patients.
Patient to Bed
Our focus on patient progression begins when there is a request for an inpatient bed. House supervisors, admitting case managers and Patient Placement specialists work to assign a bed and minimize the patient’s wait time before arriving to the nursing unit. The new Patient Placement Department is working to place patients on the right unit, timely and efficiently. The new process of utilizing an electronic bed board, PreAdmitTracking™, allows the house supervisors and charge nurses to view real-time bed status to prepare staff and plan appropriately for admissions. Performance metrics are reviewed on a weekly basis to sustain consistent performance and identify opportunities for improvement.
Care Delivery
Case managers relay the patient’s clinical status to payers, secure payments for the patient’s stay, and immediately begin planning for the patient discharge. The entire department manages more than 250 caseloads per week. Timely case reviews are essential and case managers have continued to complete new patient assessments for 90 percent of the patients within one business day of the patient’s admission.
The patient’s care plan is also discussed during daily multidisciplinary Care Coordination meetings on the inpatient units. The care team discusses each patient’s current clinical status, plan of care, anticipated discharge date, discharge needs and potential discharge barriers. Physicians, mid-levels, nurses and ancillary staff collaboratively determine and document an anticipated discharge date in the patient’s chart to keep the team focused on preparing the patient for a coordinated and safe discharge while also providing the Patient placement Department with information to better assign incoming patients to beds. House wide, multidisciplinary care teams have consistently anticipated 45 percent of patient discharges by midnight the day before discharge. This is a fantastic start and performance will continue to improve.
Bed Turnaround
Nursing can appreciate a quicker bed clean time since the installation of BedTracking™, which helps to automate the bed-clean request process. New discharge team resources helped the Environment of Care team reduce bed turnaround from 85 minutes to less than 45. This achieves industry best practice in maintaining quality while increasing efficiency.
The Inpatient Transportation Department launched in November to assist patient movement, increase nursing presence on the unit and help improve patient satisfaction. They have consistently been able to respond to requests within 12 minutes.
Congratulations and thank you to everyone involved in achieving these successes! This will allow TCH to care for approximately 830 more patients annually without adding additional beds.
Teamwork, dedication and a desire to improve the patient care experience will position TCH to continue to meet demand while maintaining its place as a top-ranking children’s hospital.
