Post on 03-Jul-2018
transcript
V H ATogether we’re greater than TMUnited to Improve
America’s Health®
ED Benchmarks and Best Practices
Jeanne McGrayneVHA’s Consulting Services
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
VHAVHA Inc. is a cooperative that serves 2,200 of nation's leading community-owned health care organizations and their affiliated physicians, providing services to help them improve financial and clinical performance. VHA provides products, programs and services to 1,400 not-for-profit hospitals, to help them improve operational efficiency and clinical effectiveness. Based in Irving, Texas, with 18 local offices across the U.S., VHA was named one of the “100 Best Companies to Work For” by Fortune in January 2003, for the fourth year in a row. As a cooperative, VHA distributes income annually to members based on their participation.
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
VHA’s ED Consulting Services
Emergency Department Operational AssessmentData Analysis/BenchmarksSimulationFacility DesignFinancial AssessmentImplementation Assistance
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
What is the difference between benchmarks and benchmarking?
Benchmarks are the actual measurements used to gauge the performance of a function, operation, or business relative to others.
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
What is the difference between benchmarks and benchmarking?
Benchmarking is the continual and collaborative discipline of measuring and comparing the results of key work processes with those of the best performers.It is learning how to adapt Better and Best Practices learned through the benchmarking process that promotes breakthroughs in process improvements and builds healthier communities.
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
What is the difference between benchmarks and benchmarking?
The objective of benchmarking is to identify Better and Best Practices so that an organization can set higher goals and improve performance. Comparing benchmarks can do this.
Jeanne McGrayne/VHA
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Seven Step Benchmarking Model
Identify what to benchmarkDetermine what to measureIdentify who to benchmark against?
Criteria vs. CharacteristicsCollect dataAnalyze data and determine performance gapSet goals and develop an action planMonitor the process
Jeanne McGrayne/VHA
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Key ED Processes
• Patient Access
• Door to Test/Treatment
• Test to Disposition
• Disposition to Discharge/Admission
Jeanne McGrayne/VHA
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Key Supporting Operations
• Staffing
• Facility
• Customer Service
• Technology
• Leadership
Jeanne McGrayne/VHA
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Benchmarks and Measures
CDC Trends in Hospital Emergency Department Utilization: United States 1992-2001; June 2003
VHA ED Process Data
HBSI ACTION 1st Quarter, 2003
VHA On-Line ED Participant Data Data
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Access Between 1992 and 2001, ED utilization increased by 20% from 89.8 million to 107.5 millionVisit rate increased by 8% from 35.7 visits/100 persons in 1992 to 38.4 visits/100 persons in 2001
Annual Volume of ED Visits: NHAMCS, 1992-2001
80859095
100105110
1992 1993-1994
1995-1996
1997-1998
1999 2000 2001
Jeanne McGrayne/VHA
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Regional ED Volume % Distribution and
Visits per 100 persons per year
West17.5 %
33.0
Midwest25.1 %
40.1
South39.3 %
43.8
Northeast18.2%37.6
Data Source: National Ambulatory Medical Care Survey: 2000
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
Annual ED Volume
0%5%
10%
15%
20%
% o
f Hos
pita
ls
Rep
rese
nted
Lessthan
20,000
20,001-30,000
30,001-40,000
40,001-50,000
50,001-60,000
60,001-70,000
70,001-80,000
80,001-90,000
90,001or more
Staying the Same9%
Decreasing5%
Increasing86%
Source - VHA On-Line Survey
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
Reasons for Increased Demand
Less restrictive management of ED visits and reimbursement by HMO’sGreater enforcement and compliance with EMTALAIncreased demand from the uninsuredLimited access to Primary Care ProviderInpatient bed capacity/staffing limitationsLack of multi-lingual care providers at all levels
Jeanne McGrayne/VHA
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Age and Payer Mix
CDC ED Payer Mix (2001)
Medicaid17%
Medicare15%
Other9%
Self Pay15%
Workers Comp3%
Commercial/HMO40%
Age Distribution of ED Patients
Under 15
21%
15-2416%
25-4430%
45-6418%
65-746%
75+9%
Jeanne McGrayne/VHA
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Access
Jeanne McGrayne/VHA
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Access
• Immediacy with which patient should be seen:
• Emergent: 15 min
• Urgent 15-60 min
• Semi-Urgent 1-2 hours
• Non-Urgent 2-24 hoursVHA Comparative Average Acuity
Urgent42%
Emergent7%
Non-Urgent
51%
Jeanne McGrayne/VHA
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Trend in ED Visit Rates for Visits Triaged as Emergent
5658606264666870727476
1997 1998 1999 2000
Number of EmergentVisits per 1000Patients
Data Source: National Ambulatory Medical Care Survey: 2000
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Leaving Without Being Seen %
2.15%
0%
8%
2%
0.00%
1.00%
2.00%
3.00%
4.00%
5.00%
6.00%
7.00%
8.00%
Average Minimum Maximum Median
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
Reason for Visit (top 18)
0100020003000
400050006000
7000
Number of Visits in Thousands
Abdo
min
al P
ain
Ches
t Pai
nFe
ver
Head
ache
SOB
Back
Pai
nCo
ugh
Non
spec
ific
Pain
Lace
ratio
nSo
re T
hroa
tVo
miti
ngAc
cide
ntDy
spne
aEa
rach
eSk
in R
ash
MVA
Low
Back
Pain
Inju
ry
Data Source: National Ambulatory Medical Care Survey: 2000
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0:04 0:
10
0:05 0:
240:13
0:06
0:28
0:38
0:01 0:02 0:03
0:080:05 0:04
0:07
0:27
0:00
0:07
0:14
0:21
0:28
0:36
Avg Max Avg Min Avg Median Avg
Avg 0:05 0:04 0:10 0:24Max Avg 0:13 0:06 0:28 0:38Min Avg 0:01 0:02 0:03 0:08Median Avg 0:05 0:04 0:07 0:27
Time from Arrival to Triage Triage Time Triage to
Registration Triage to a Room
Triage and Registration
VHA ED Database
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Access Best Practices
Nurse managed health triage lineUrgent Care facilitiesExtended office hoursWalk-in medical clinic adjacent EDPatient EducationFaith based clinics in neighborhoodsStreet clinics for the homelessCase/Care management
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0:24
0:54
0:32
1:05
1:31
0:50
0:12 0:14
0:240:31
0:20
0:54
0:00
0:14
0:28
0:43
0:57
1:12
1:26
1:40
1:55
Avg Max Avg Min Avg Median Avg
Avg 0:32 0:24 0:54Max Avg 0:50 1:05 1:31Min Avg 0:12 0:14 0:24Median Avg 0:31 0:20 0:54
Arrival to Room In Room to First MD Visit
Arrival to First MD Visit
Door to Doctor
VHA ED Database
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Visible, Involved Triage NurseAbility to generate account number at or before triageAssessment Separate from TriageTriage driven room placementRegistration at BedsideNursing Room AssignmentsPhysician Room AssignmentsTracking System
Door to Test or Treatment Best Practices
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Triage
75% Perform Bedside Registration
31% use Mobile Computers
13% use Bedside Computers
69% Staff Collect Data in Room
Escorted to room
58% by Triage Nurse
60% by ED Tech
35% by Charge Nurse
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What Impacts Patient Flow?
Case Management/Care Coordination
Test Utilization
Ancillary Turnaround Times
ED Staffing/Teamwork
Consultant Availability
Technology/Communication
Information Flow
Incentives
Jeanne McGrayne/VHA
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Don’t Bother Fixing the Front End if you Don’t Fix the Back End!
Jeanne McGrayne/VHA
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Patient Flow Best Practices
Active Use and Support of Protocols
Nurse/Physician Teams
Collaborative Practice
Point of Care Order Entry
Visual Cueing System
Jeanne McGrayne/VHA
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Visual Cueing
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ED Technology
55.84%
44%
4%
34%
19%
10%
1%0%
10%
20%
30%
40%
50%
60%
% o
f ED
's
% With an EDInformation
System
% PatientTracking
% Staff Tracking % D/CInstructions
% PhysicianDocumentation
% NurseDocumentation
% Auto Coding
Source - VHA On-Line Survey
Jeanne McGrayne/VHA
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ED Documentation
62%
51%
30%
0%
10%
20%
30%
40%
50%
60%
70%
Dictation Template Handwritten
Source - VHA On-Line Survey
Jeanne McGrayne/VHA
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0%
10%
20%
30%
40%
50%
Percent Utilization
% of all ED Patients Requiring Test/Procedure
VHA 2003 32% 37% 15% 7% 2% 19% 8% 2% 16%2001 CDC Data 29% 40% 14% 6% 2% 18% 8% 10% 12%
Lab Xray EKG CT US IV Monitor Sutures%
Admitted
Utilization Percentages
Source: VHA ED Database
Jeanne McGrayne/VHA
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0%
1%
2%
3%
4%
5%
6%
7%
Percent Utilization
CDC and VHA Data
Percent of CT per 100visits per year
2% 3% 3% 4% 5% 5% 6% 7%
19921993-1994
1995-1996
1997-1998
1999 20002001 VHA
2002 VHA
CT Utilization
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
X-Ray Turnaround Time
0:110:
20 0:20
0:19
0:470:55
1:34
0:35
0:45
0:33
0:110:08
0:230:18 0:18 0:16
0:08
0:46
0:01
0:10
0:00
0:14
0:28
0:43
0:57
1:12
1:26
1:40
Avg Max Avg Min Avg Median Avg
Avg 0:20 0:19 0:20 0:11 0:47Max Avg 0:33 0:35 0:45 0:55 1:34Min Avg 0:11 0:08 0:10 0:01 0:23Median Avg 0:18 0:18 0:16 0:08 0:46
MD VISIT TO ORDER
ORDER TO TRANSPORT
TRANSPORT TO RETURN
RETURN FROM X-RAY TO RESULTS
ORDER TO RETURN
Source: VHA ED Database
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
CT Turnaround Time
0:330:
39
0:30
0:54
1:47
2:40 4:022:28
0:53
1:13
0:12 0:14
0:380:390:46
0:30 0:30
1:35
0:00
0:12
0:00
0:14
0:28
0:43
0:57
1:12
1:26
1:40
1:55
2:09
2:24
Avg Max Avg Min Avg Median Avg
Avg 0:39 0:54 0:30 0:33 1:47Max Avg 1:13 2:28 0:53 2:40 4:02Min Avg 0:12 0:14 0:12 0:00 0:38Median Avg 0:39 0:46 0:30 0:30 1:35
MD VISIT TO ORDER
ORDER TO TRANSPORT
TRANSPORT TO RETURN
RETURN FROM X-RAY TO RESULTS
ORDER TO RETURN
Source: VHA ED Database
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
Ultrasound Turnaround Time
0:17
1:07
0:340:
39
1:31
1:25
2:38
1:16
1:02
2:15
0:240:15
1:05
0:53
0:380:33
0:13
1:26
0:000:10
0:00
0:14
0:28
0:43
0:57
1:12
1:26
1:40
1:55
2:09
2:24
Avg Max Avg Min Avg Median Avg
Avg 1:07 0:39 0:34 0:17 1:31Max Avg 2:15 1:16 1:02 1:25 2:38Min Avg 0:24 0:15 0:10 0:00 1:05Median Avg 0:53 0:38 0:33 0:13 1:26
MD VISIT TO ORDER
ORDER TO TRANSPORT
TRANSPORT TO RETURN
RETURN FROM X-RAY TO RESULTS
ORDER TO RETURN
Source: VHA ED Database
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
CBC
0:50
0:19
0:36
0:16
1:37
0:34
0:52
0:31
0:120:09
0:180:15
0:38
0:44
0:28
0:18
0:00
0:07
0:14
0:21
0:28
0:36
0:43
0:50
0:57
1:04
1:12
Avg Max Avg Min Avg Median Avg
Avg 0:19 0:16 0:36 0:50Max Avg 0:31 0:34 0:52 1:37Min Avg 0:12 0:09 0:18 0:28Median Avg 0:18 0:15 0:38 0:44
MD VISIT TO ORDER
ORDER TO COLLECTION
COLLECTION TO RESULT READY
LAB ORDER TO RESULTS
RETURNED
Source: VHA ED Database
Jeanne McGrayne/VHA
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Chemistry
1:00
0:19
0:46
0:18
1:41
0:39
0:59
0:29
0:13
0:04
0:16 0:17
0:48
0:59
0:44
0:38
0:00
0:07
0:14
0:21
0:28
0:36
0:43
0:50
0:57
1:04
1:12
Avg Max Avg Min Avg Median Avg
Avg 0:19 0:18 0:46 1:00Max Avg 0:29 0:39 0:59 1:41Min Avg 0:13 0:04 0:38 0:44Median Avg 0:16 0:17 0:48 0:59
MD VISIT TO ORDER
ORDER TO COLLECTION
COLLECTION TO RESULT READY
LAB ORDER TO RESULTS
RETURNED
Source: VHA ED Database
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
Serum Pregnancy
0:47
0:13
0:38
0:11
1:05
0:21
1:00
0:16
0:11
0:01
0:13 0:12
0:35
0:50
0:28
0:17
0:00
0:07
0:14
0:21
0:28
0:36
0:43
0:50
0:57
Avg Max Avg Min Avg Median Avg
Avg 0:13 0:11 0:38 0:47Max Avg 0:16 0:21 1:00 1:05Min Avg 0:11 0:01 0:17 0:28Median Avg 0:13 0:12 0:35 0:50
MD VISIT TO ORDER
ORDER TO COLLECTION
COLLECTION TO RESULT READY
LAB ORDER TO RESULTS
RETURNED
Source: VHA ED Database
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
Urinalysis
0:58
0:29
0:45
0:25
1:58
0:51
1:23
0:55
0:12
0:01
0:220:28
0:42
0:55
0:280:23
0:00
0:14
0:28
0:43
0:57
1:12
1:26
1:40
Avg Max Avg Min Avg Median Avg
Avg 0:29 0:25 0:45 0:58Max Avg 0:55 0:51 1:23 1:58Min Avg 0:12 0:01 0:23 0:28Median Avg 0:22 0:28 0:42 0:55
MD VISIT TO ORDER
ORDER TO COLLECTION
COLLECTION TO RESULT READY
LAB ORDER TO RESULTS
RETURNED
Source: VHA ED Database
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
Troponin
1:08
0:26
0:56
0:14
1:54
0:36
1:21
0:41
0:120:05
0:26
0:13
0:56
1:09
0:47
0:35
0:00
0:14
0:28
0:43
0:57
1:12
1:26
1:40
Avg Max Avg Min Avg Median Avg
Avg 0:26 0:14 0:56 1:08Max Avg 0:41 0:36 1:21 1:54Min Avg 0:12 0:05 0:35 0:47Median Avg 0:26 0:13 0:56 1:09
MD VISIT TO ORDER
ORDER TO COLLECTION
COLLECTION TO RESULT READY
LAB ORDER TO RESULTS
RETURNED
Source: VHA ED Database
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
Ancillary Best PracticesDirect stick draw if IV > 20 gaugePneumatic TubePoint of Care TestingDedicated Phlebotomist if > 50,000 visitsStat Lab if > 70,000 visitsDedicated Room and Staff24/7 Service – cross trainingPACSED MD Preliminary InterpretationGastrographin Contrast
RadiologyRadiology
Medical RecordsMedical Records
Criteria for Early Access Automated RecordED Based MR Staff
LaboratoryLaboratory
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Point of Care Testing
79%88%
61%
76%
35%
51%
19%
32%
13%
25%
13%22% 21%
30%
0%10%20%30%40%50%60%70%80%90%
Glucose Urine Dip Urine Preg ISTAT RapidStrep
Troponin Blood Gas
20022003
Source - VHA On-Line Survey
Jeanne McGrayne/VHA
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MD Assessment to Disposition
0:18 0:
200:38
1:11
1:53
1:09
0:33
0:250:19
0:13 0:11
0:430:36
0:17 0:19
1:11
0:00
0:14
0:28
0:43
0:57
1:12
1:26
1:40
1:55
Avg Max Avg Min Avg Median Avg
Avg 0:38 0:18 0:20 1:11
Max Avg 1:09 0:25 0:33 1:53Min Avg 0:19 0:13 0:11 0:43
Median Avg 0:36 0:17 0:19 1:11
Consultant Called to Present
MD Visit to First Lab Order
MD Visit to First Xray Order
First MD Visit to Disposition
Source: VHA ED Database
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
Percent of ED Patients Admitted
12%
15%
18%
0%2%4%6%8%
10%12%14%16%18%20%
25th %tile 50th %tile 75th %tile
ALL HOSPS
Data Source: Solucient ACTION Database, 3rd Quarter 2002
Percent of Hospital Admissions that Arrive through the ED
Average - 49%
Minimum -11%
Maximum - 85%
Source - VHA On-Line Survey
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
Admission Effect on Cost/Visit
Direct Cost per Visit
Direct Cost = Salary Cost + Supply Cost + all other
$0.00
$20.00
$40.00
$60.00
$80.00
$100.00
25th %tile $47.97 $59.56 $70.05 50th %tile $57.71 $69.18 $86.48 75th %tile $75.99 $78.81 $95.19
0-10% ED Adm
11-20% ED Adm
21-30% ED Adm
Data Source: Solucient ACTION Database, 3rd Quarter 2002
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Disposition to Discharge/Admit
0:58
0:28
0:16
1:26
2:00
0:40 0:42
1:34
0:050:14 0:14
0:42
0:16
0:58
0:27
1:33
0:00
0:14
0:28
0:43
0:57
1:12
1:26
1:40
1:55
2:09
Avg Max Avg Min Avg Median Avg
Avg 0:16 0:58 0:28 1:26Max Avg 0:40 1:34 0:42 2:00Min Avg 0:05 0:14 0:14 0:42Median Avg 0:16 0:58 0:27 1:33
Disposition to Discharge
Disposition to Bed Ready
Bed Ready to Unit
Disposition to Admit
Source: VHA ED Database
Jeanne McGrayne/VHA
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Disposition to Discharge/Admission
2:21 2:
39
4:23
7:23
4:133:52
2:49
1:38 1:44
4:06
2:17 2:27
0:00
1:12
2:24
3:36
4:48
6:00
Avg Max Avg Min Avg Median Avg
Avg 4:23 2:21 2:39Max Avg 7:23 3:52 4:13Min Avg 2:49 1:38 1:44Median Avg 4:06 2:17 2:27
Arrival to Admit Arrival to Discharge
Arrival to Discharge/ Admit
Source: VHA ED Database
Jeanne McGrayne/VHA
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DischargesVideo Discharge InstructionsDischarge Area to Increase CapacityDischarge Instruction SystemAuto Fax to Primary Care or Referral MDFinancial Counseling
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Admissions
No Refusal PolicyFax ReportED assigns bedBegin Admission process earlyED Staff TransportsCritical Paths/ Protocols
Jeanne McGrayne/VHA
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Admissions
Express Admission UnitAdmission TeamBed ‘czar’“Be a Bed Ahead”Housekeeping triageTelemetry/OximetryAccountabilityCharge Transfer
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0.00
1.00
2.00
3.00
4.00
Patients per StaffedPhysician Hour
1.32 2.27 2.24 3.50
Minimum Average Median Maximum
Average Number of Patients Per Staffed Physician Hour
Source: VHA On-Line Survey69% Use Physicians Assistants42% Use Nurse Practitioners29% Have Staff On-call
Jeanne McGrayne/VHA
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Patients per MD/PA/NP Worked Hour by Volume
0.00
0.50
1.00
1.50
2.00
2.50
3.00
Pts. per Staffed Hour 1.75 2.08 2.38 2.07 2.44 2.60 2.11 2.91
Less than
20,001-30,000
30,001-40,000
40,001-50,000
50,001-60,000
60,001-70,000
70,001-80,000
80,000 Plus
VHA On-Line Survey
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ED Physician Relationship
Small local contracted
group38%
Independent Contractor
29%
Employed by Hospital
24% National ED Contract Mgmt Co.
9%
Source: VHA On-Line Survey
Jeanne McGrayne/VHA
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ED Physician Practice
30%
55%
17%
32%
51%
73%
22%
47%
0%
10%
20%
30%
40%
50%
60%
70%
80%
% Write AdmittingOrders
% OutsourceCoding/Billing
% Bill for XRayInterpretation
% Bill for EKGInterpretation
Source: VHA On-Line Survey
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
Nurse/Tech/Clerical Staffing
0
1
2
3
25th %tile 2.08 1.84 2.17 2.36 2.5550th %tile 2.45 2.17 2.49 2.55 2.9175th %tile 2.8 2.42 2.7 2.82 2.97
All Hospitals
ED Pt Vol 0-20K
ED Pt Vol 21K-40K
ED Pt Vol 41K-60K
ED Pt Vol 61K+
Worked Hours per Visit
Data Source: Solucient ACTION Database, 1st Quarter 2003
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Nurse/Tech/Clerical Staffing
Worked Hours per Visit
0
1
2
3
4
25th %tile 2.48 2.08 2.0550th %tile 3.14 2.45 2.2575th %tile 3.53 2.80 2.81
Level 1 Level 2 Level 3
Data Source: Solucient ACTION Database, 1st Quarter 2003
Jeanne McGrayne/VHA
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Nurse/Tech/Clerical Staffing
Worked Hours per Visit
0
0.51
1.5
22.5
3
25th %tile 1.86 2.17 2.3950th %tile 2.19 2.49 2.8275th %tile 2.39 2.67 2.96
0-10% ED Adm
11-20% ED Adm
21-30% ED Adm
Data Source: Solucient ACTION Database, 1st Quarter 2003
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ED Staff Worked Hours/Visitby Region
Southwest2.72
Mid-America2.52
Gulf States2.23
West Coast2.24
Mountain States2.49
Oklahoma/Arkansas2.20
Upper Midwest2.60 Michigan
2.48
Empire State2.56
East Coast2.52
Central2.38
Central Atlantic2.31
Pennsylvania2.24
Southeast2.72
Georgia2.68
Data Source: Solucient ACTION Database, 3rd Quarter 2002
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
ED Labor Cost/Visitby Region
Southwest
$64.05
Mid-America
$52.52
Gulf States
$54.58
West Coast
$80.59
Mountain States
$56.61
Oklahoma/Arkansas
$49.06
Upper Midwest
$69.75Michigan
$57.57
Empire State
$55.72
East Coast
$78.04
Central
$55.56Central Atlantic
$51.31
Pennsylvania$51.98
Southeast
$57.34
Georgia
$57.69
Data Source: Solucient ACTION Database, 2nd Quarter 2002
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
ED Staff Skill Mix
0%
20%
40%
60%
80%
2000 Staff Skill Mix 71% 17% 12%2001 Staff Skill Mix 63% 23% 14%2002 Staff Skill Mix 65% 22% 13%
Registered Nurse
ED Tech/NA
Unit Secretary
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
Technology
Wireless data entry and access = Paperless!Low frequency cell phones
Telematics – remote access to real time videoSmart cards; scanners for ID and insurance documentsDigitized radiography Bedside ultrasoundNon-Invasive physiologic monitoringPOC testing
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
Technology
Registration/Discharge kiosks On-Line medical informationBiometric monitoring (“wristwatch” monitor)Stretchers and floor tiles to measure weightUltrasound monitors to record respiratory rateAmbient air samples to assess exhaled breathThermographic sensors for heart rate and tempScanning lasers to assess pupil size, shape and reaction to light
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
Facility Size and Admission %
BEDSBased on % of admissions15% admissions 2,000 patients per ED bed10% admissions 2,250 patients per ED bed20% admissions 1,750 patients per ED bed25% admissions 1,500 patients per ED bed
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
Facility
Build Process Before WallsStrategic PlanningInvolvement of EveryoneTriage VisibilityDischarge areaDesign Supportive of Team EnvironmentCDU/Observation /Express AdmitPsychiatric ED
51% Recently Renovated33% Planning or in Process51% Recently Renovated33% Planning or in Process
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
Customer Service
Be ProactiveSecurityScriptsChecklistFollow-up Phone callsCommunicate Time ExpectationsCommunicate Plan of Care
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
Leadership
Medical Director active in Medical StaffArticulate Goals Communicate Outcomes Allocate ResponsibilityAssign AuthorityAccountability/Courage
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
The benchmarking process is a journey…
We learn during and from the process. We must not be so caught up in the numbers that we forget the journey.
We are reaching toward excellence, improving quality as well as financial results. True improvement and excellence are part of the journey and a process by-product.
Benchmarking is more of an art than a science. We begin with paint by number and end with a masterpiece.
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
Internet References
http://www.cdc.gov/nchs/about/major/ahcd/ahcd1.htm
http://www.hospitalconnect.com/aha/hret/emergency.html
http://www.acep.org
http://navymedicine.med.navy.mil/BBP/BBP/faq_bbp.asp
http://www.riskinstitute.org/ptrdocs/Benchmarking_Guidelines.pdf
http://www.bshsi.com/tews/docs/TEWS.FutureInED.pdf
VHA On-Line Survey - http://www.vhatools.com/ed
Jeanne McGrayne/VHA
V H ATogether we’re greater than TM
Questions?
Jeanne McGrayneVHA’s Consulting Services
(910) 947-6075jmcgrayn@vha.com