DepartmentofEmergencyMedicine
EmergencyCriticalCareCenter:
ALeanJourney
BenBassin,MD,FACEP,EDAC
CemalSozener,MD,M.Eng,FACEP,EDAC
DepartmentofEmergencyMedicine
• Customer1st
• Peoplearethemostimportant
resource
• Shopfloorfocus(GoandSee)• Kaizenisawayoflife
LeanThinking- ThingsthatMatter
DepartmentofEmergencyMedicine
• A3Thinking
• GoandSee
• RapidImprovementEvents(Kaizen)
KeyLEANTools
DepartmentofEmergencyMedicine
• A3Thinking
• GoandSee
• RapidImprovementEvents(Kaizen)
KeyLEANTools
DepartmentofEmergencyMedicine
A3
DepartmentofEmergencyMedicine
BACKGROUND/PROBLEM
DepartmentofEmergencyMedicine
• Whyisthisimportant?
• Whynow?
DefiningtheproblemisCRITICAL
DepartmentofEmergencyMedicine
CreateaClear,ConciseProblemStatement
“Improveaccesstotimelycriticalcareby
enhancingthecapacityandcapabilitytodeliver
highqualitycriticalcareintheAdultEmergency
DepartmentattheUniversityofMichigan.”
DepartmentofEmergencyMedicine
DepartmentofEmergencyMedicine
Background
DepartmentofEmergencyMedicine
MichiganMedicine
DepartmentofEmergencyMedicine
UMHSAdmissionStreams:ED=FrontDoor
16% 30%
54%
FY16UMHSinpt/obs admissions=66,620
DepartmentofEmergencyMedicine
AnAlarmingNationalTrend
ICUadmissionsfromtheEDhaveDOUBLEDoverthelastdecade- AdmissionsfromtheED:1.2à 2.2millionfrom2001-2009
- AdmissionratefromtheED:0.9%à 1.6%
- 1/3ofallICUadmissionsspend>6hrsintheED
0
2,000,000
4,000,000
6,000,000
8,000,000
10,000,000
12,000,000
2001 2009
EDCriticalCareVisits
EDCriticalCareHours
Herringetal.Crit CareMed2013
Peryear
10%/yr
24%/yr
Growth
DepartmentofEmergencyMedicine
Theeffectivenessofcriticalcare
foracuteillnessandinjuryis
time-sensitivewiththerapeutic
windowsrangingfromminutes
tohours.
AcuteCriticalCareistime-sensitive
1358 CRITICAL CARE Nguyen et al. • CRITICAL CARE IN ED
Figure 2. Predicted mortality presented as mean (%) !standard deviation computed from APACHE II andSAPS II scores in the emergency department (ED) andat intervals in the intensive care unit (ICU). Asterisk (*)indicates significant difference (p " 0.02) in predictedmortality between the corresponding time points.
TABLE 5. Predicted Mortality and Changes in Predicted Mortality (! Pred Mort) of All Patients*
APACHE II
PredictedMortality (%)
! Pred Mort (%),p-value†
SAPS II
PredictedMortality (%)
! Pred Mort (%),p-value†
0 (ED admission) 42.0 ! 20.0 — 44.0 ! 22.0 —6 (ED discharge) 34.0 ! 18.0 #8.0 ! 14.0, <0.001 38.0 ! 23.0 #6.0 ! 14.0, <0.00124 (ICU) 26.0 ! 18.0 #7.0 ! 13.0, <0.001 33.0 ! 24.0 #4.0 ! 16.0, 0.0248 21.0 ! 14.0 #1.0 ! 9.0, 0.47 27.0 ! 19.0 #2.0 ! 11.0, 0.2472 20.0 ! 12.0 #1.0 ! 6.0, 0.18 26.0 ! 18.0 #1.0 ! 8.0, 0.22
*Data are presented as mean (%) ! standard deviation computed from APACHE II and SAPS II scores in the emergencydepartment (ED) and at intervals in the intensive care unit (ICU).†P-value reflects comparison of predicted mortalities using Student’s t-test between the successive time points.
ward were excluded; therefore, all patient datawere analyzed. At ED admission, there was ahigher APACHE II score in nonsurvivors vs sur-vivors (p = 0.04), while there was no significantdifference in SAPS II or MODS scores. TheAPACHE II, SAPS II, and MODS scores were sig-nificantly lower in survivors than nonsurvivors atED discharge and throughout the study period (p" 0.001) (Table 4). General linear mixed modelingwas used to examine hourly rate of change in phys-iologic scores (Fig. 1). The hourly rates of change(decreases) in APACHE II, SAPS II, and MODSscores (#0.55 ! 0.64, #1.02 ! 1.10, and #0.16 !0.43, respectively) were significantly greater dur-ing the ED stay than subsequent periods of hos-pitalization in the survivors (p < 0.05). In the non-survivors, there was a significantly greater hourlyrate of change (decrease) in APACHE II score(#0.29 ! 1.05) compared with subsequent inter-vals during hospitalization (p = 0.02). However,there was no significant difference in the hourlyrate of change (actual increase) in SAPS II and
MODS scores between ED therapy and ICU carein the nonsurvivors. The hourly rate of change (ordecrease) in APACHE II, SAPS II, and MODSscores was uniformly greater at each time intervalin survivors compared with nonsurvivors.
There was a significant decrease in APACHE IIand SAPS II predicted mortality during the EDstay and at 24 hours in the ICU (p " 0.02) (Table5). After 24 hours there was no significant changein predicted mortality with both scoring systems.The APACHE II and SAPS II predicted mortalityapproaches actual in-hospital mortality at approx-imately 12 hours and 36 hours after ED admission(in the ICU), respectively (Fig. 2).
Mortality predictions at each time point werecompared using ROC curve analysis (Fig. 3). Therewas a stepwise increase in mortality prediction(sensitivity and specificity) as represented by theAUC from ED admission to ED discharge, and at48, 72, and 24 hours in the ICU using APACHE II.The AUC for mortality prediction using SAPS IIwas progressively increased from ED admission toED discharge, and at 24, 48, and 72 hours.
DISCUSSION
The increased provision of critical care in theED1–4 is a result of increasing patient volumes,limited ICU bed availability, increasing levels ofpatient acuity, and the use of the ED as the firstcontact for primary care. In addition, the applica-tion of therapeutic1 and monitoring23,24 technolo-gies once considered under the domain of the ICUhas made the delivery of critical care more prac-tical in the ED. Studies have quantitated that from1541 to 1864 critical-patient-days per year are pro-vided in the urban ED setting. Our data indicated464.4 critical-patient-days per year (38.7 critical-patient-days per month or 30.5 critical-patient-hours per day) were delivered at this institution.
If the findings of this study are seen in similarEDs and generalized nationally, a substantialamount of critical care is delivered in this setting.Professional organizations have recognized andare currently addressing these issues.25 The Soci-ety of Critical Care Medicine currently provides a
TheFIRST6HOURS
Mostrapidchangeinphysiology
Nguyen2000
DepartmentofEmergencyMedicine
ED-ICUInterface
EDLocation ICULocation
Time0to24hr
CriticalCareNeedsBeingAddressed?
EDTeam ICUTeamNoMan’s
Land?
DepartmentofEmergencyMedicine
CurrentState/Analysis
DepartmentofEmergencyMedicine
DepartmentofEmergencyMedicine
CurrentSituation– Wherearewenow?
DepartmentofEmergencyMedicine
Currentstate2012– ICUAdmissions
• FY12 – 1,886 ICU Admits
• 5.2 per day
• ED LOS 6 hr
• Projected 10% growth
DepartmentofEmergencyMedicine
Patient(Home/EMS/OSH)
ED
Admission
ICU
Floor
Discharge
DeclinedED-EDTransferRequests(750/yr)– 25%ICU
ShuntingofResourcesfrom
Non-CriticalPatients
Short-StayICUAdmissions<24hr
(440/yr)
EmergentTransfertoICUin<24hrs
(200/yr)
EC3CC
Boarding(6hrs)
CCD/CfromED?
CCinnon-CCarea
(450/1286ICUadmits–
35%)
DepartmentofEmergencyMedicine
• IncreasingEDvisits
• IncreasingICUdemand(EDandtransfers)
• IncreasingEDLOSforourICUpatients
• Outcomes?
Summarytodate
(wherewewerein2012)
DepartmentofEmergencyMedicine
FutureState/Goals
DepartmentofEmergencyMedicine
A3
DepartmentofEmergencyMedicine
FutureState
DepartmentofEmergencyMedicine
ParadigmShift
DepartmentofEmergencyMedicine
ApplyLEANprinciplestoproblem
identificationandsolution
DepartmentofEmergencyMedicine
• Engagefrontlineworkerstocreateoptimal
workflowsandeliminatewaste
• Architectsanddesignerstransformprocess
mapsintoadesign
• Focusonremovingphysicalbarriersfrom
theworkflows
• Paradigmshiftofarchitectsfromproject
leadstoteammemberandfacilitators
LeanFacilityDesign
DepartmentofEmergencyMedicine
• Purpose– fixpatients’problemsdefinitively
• Process– fundamentallyredesignthe
processes(notjusttighteninguptheold
way)
• People– atruemultidisciplinaryteam
LeanPatientFlowTransformation
DepartmentofEmergencyMedicine
• Assumptions:
– Currentvolume
– EC3LOS– 12hrs
– 50%ofpatientstreatedinresuscitationbayswouldpassthroughEC3
– 10-20%ofpatientswouldnolongerneedICU
• ModelOutput:– Require5resuscitationbaysand7EC3rooms
QueueingModel
DepartmentofEmergencyMedicine
GrowthProjection
DepartmentofEmergencyMedicine
ProposedFutureState
5
DepartmentofEmergencyMedicine
CreatingaMultidisciplinaryTeam
DepartmentofEmergencyMedicine
Manyteammeetings2yearsprior
DepartmentofEmergencyMedicine
• A3Thinking
• GoandSee
• RapidImprovementEvents(Kaizen)
KeyLEANTools
DepartmentofEmergencyMedicine
Roadtrips
DepartmentofEmergencyMedicine
SCHEMATICDESIGN
DepartmentofEmergencyMedicine
DepartmentofEmergencyMedicine
DepartmentofEmergencyMedicine
EC3v1.0
DepartmentofEmergencyMedicine
FullScaleMock-up
DepartmentofEmergencyMedicine
UtilizeActualEquipment
DepartmentofEmergencyMedicine
MultidisciplinaryTeams
DepartmentofEmergencyMedicine
MultidisciplinaryTeams
DepartmentofEmergencyMedicine
Egress
DepartmentofEmergencyMedicine
ImmovableBarriers
DepartmentofEmergencyMedicine
IdeaBoards
DepartmentofEmergencyMedicine
IdeaBoards
DepartmentofEmergencyMedicine
• Thisisareallygoodidea
• NoprecedentatMM
• Empowering/Inclusive/Unifying
• SignificantdesignchangesBEFORE
construction• Nosignificantchangeorders
• Underbudget
• Aheadofschedule
MockupLessonsLearned
DepartmentofEmergencyMedicine
DepartmentofEmergencyMedicine
EmergencyCriticalCareCenter
99
98 97 96 95
92
9394
EDCBA
91
EmergencyCriticalCareCenter(EC3)(91-99)
EDResuscitationBays(A-E) AmbulanceEntrance
DepartmentofEmergencyMedicine
BringintheMuscle…
September2014
DepartmentofEmergencyMedicine
DepartmentofEmergencyMedicine
DepartmentofEmergencyMedicine
ImplementationPlan
DepartmentofEmergencyMedicine
DepartmentofEmergencyMedicine
JoyceandDonMasseyFamilyFoundation
EmergencyCriticalCareCenter(EC3)
GrandopeningFebruary16,2015
DepartmentofEmergencyMedicine
LEANDESIGNFEATURES
DepartmentofEmergencyMedicine
• Cold,CATscanin
zone
• Nocrowdcontrol
• Patientsand
familiesnotin
ideal
environmentat
theirgreatest
timeofneed.
Before– 3bedResuscitationBay
DepartmentofEmergencyMedicine
OldResus Bay
Cluttered,old,
poorlydesigned
boomsystems.
ERfleamarketwith
tonsofequipment
pushedtotheback.
Can’tfindanything
quickly
DepartmentofEmergencyMedicine
DepartmentofEmergencyMedicine
DirectAccess
toEC3
Multiple
Video
Displays
Camerasfor
QAand
Teaching
DepartmentofEmergencyMedicine
Dedicated
Nurse
Charting
Station
Dedicated
Physician
OrderEntry
DepartmentofEmergencyMedicine
Abilitytocarefor
multiplepatients
Power,Data
andGas-
360˚
DepartmentofEmergencyMedicine
In-situ
teaching
technology
DepartmentofEmergencyMedicine
CustomCarts
toMaximize
Spaceand
Efficiency
DepartmentofEmergencyMedicine
Transaction
Height
Counters
KeepCarts
outof
Corridor
DepartmentofEmergencyMedicine
LineofSight
toResus Bays
DepartmentofEmergencyMedicine
OpenLineof
SightAcross
Unit
DepartmentofEmergencyMedicine
DepartmentofEmergencyMedicine
Ambient
LightHOB
ClearBariatric
Lifts
Dialysis
Boxes
Negative
Pressure
DepartmentofEmergencyMedicine
PatientCareSpaces
FamilyZone PatientZone CaregiverZone
DepartmentofEmergencyMedicine
EARLYRESULTSANDTARGETMETRICS
DepartmentofEmergencyMedicine
Patient(Home/EMS/OSH)
ED
Admission
ICU
Floor
Discharge
DeclinedED-EDTransferRequests(750/yr – 25%ICU)
ShuntingofResourcesfrom
Non-CriticalPatients
Short-StayICUAdmissions<24hr
(440/yr)
EmergentTransfertoICUin<24hrs
(200/yr)
EC3CCinnon-CC
area(450/1886ICUadmits–
24%)
CCBoarding(6hrs)
CCD/CfromED?
DeclinedED-EDTransferRequests(597/yr – 9%ICU)
14dedicatedbedsforCC
EC3– 0hrsIfnoEC3–2.5hrs
Decreased43%
IncreasedICU-ICUAcceptedTransfer32%incr FY16
0%change=safestrategy
9%(460pts)
CCinnon-CCarea
(229/1816ICUadmits–
12%)
DepartmentofEmergencyMedicine
• Improveaccesstotimelycriticalcareby
enhancingthecapacityandcapabilityto
deliverhighqualitycriticalcareintheAdult
EmergencyDepartmentattheUniversityof
Michigan.
• Inreality,themodelhascompletely
changedtheED&ICUhealthcaredelivery
paradigm
Summary/Conclusion
DepartmentofEmergencyMedicine
Thankyou
DepartmentofEmergencyMedicine
Questions?
DepartmentofEmergencyMedicine
DepartmentofEmergencyMedicine
RAPIDIMPROVEMENTEVENTS(KAIZEN)
DepartmentofEmergencyMedicine
ExcessEquipment
DepartmentofEmergencyMedicine
ProceduralLineCarts
DepartmentofEmergencyMedicine
NewLineCart
DepartmentofEmergencyMedicine
Airwaycartredesign
17 1
DepartmentofEmergencyMedicine
Airwaycartredesign
DepartmentofEmergencyMedicine
AppliedPrinciples
DepartmentofEmergencyMedicine
Content Title
• Add content here• Add content here• Add content here
DepartmentofEmergencyMedicine
DepartmentofEmergencyMedicine
EmergencyCriticalCareCenter
99
98 97 96 95
92
9394
EDCBA
91
EmergencyCriticalCareCenter
DepartmentofEmergencyMedicine
ED:EC3:Floorv.Pre-EC3Baseline
1 2 3 4 5 6 7 8-14 15+ ED:EC3:Floorv.Pre-EC3Baseline -350.42 -2,276.61 -2,498.15 -2,695.02 -2,882.40 -2,697.81 -2,886.92 -2,736.51 -2,230.10
-3,500.00
-3,000.00
-2,500.00
-2,000.00
-1,500.00
-1,000.00
-500.00
0.00
Cost
LOS(days)
DepartmentofEmergencyMedicine
• Patientmix Tertiary/quaternarycare
• Currentvolume 67,014/year
• Admitrate 35.4%
• ICUadmitrate 10%ofadmissions
• TransfersfromoutsideED 3440/year~300/month
• Transfersdeclined 750/year(25%ICUlevel)
• LWBSRate 3%
• Volumeprojections 3-4%overall,10%criticalcare
• ICUadmitsw/LOS< 24hrs ~440/yr
• FloortoICUTxfr < 24hrs ~200/yr
CurrentState- AdultEmergencyServicesFY12
DepartmentofEmergencyMedicine
TimeinEDwaitingforICUbed…
0
1
2
3
4
5
Reference Chalfin2007 Rincon2010 Singer2011 Hung2014 Cha2015
OddsRatiofordeath
>6hr
>5hr
>12hr
>4hr >6hr
DepartmentofEmergencyMedicine
• Average7patientsperday• MedianEC3LOSICUadmit=7.2hr• MedianEC3LOSNon-ICUadmit=12hr
Results:EC3OperationalCharacteristics
BiPap/Intubation/Vent 595 11.5%DKA 276 5.3%EndofLife 61 1.2%GIBleed 421 8.1%PostCardiacArrest 84 1.6%Sepsis 794 15.4%ShortnessofBreath 514 9.9%StatusEpilepticus 57 1.1%SubarachnoidHemorrhage 133 2.6%Undifferentiated 2,546 49.2%Unknown 391 7.6%
EC3PathwayMultipleperpatientpossible Count %
DepartmentofEmergencyMedicine
Pre-EC3(744d)
Post-EC3(744d)
RelativeChange
OverallED Visits 147,030 157,190 6.9%
HospitalAdmissions 51,451 55,912 8.7%
ICUAdmissions 3,742 3,279 -12.4%
Results:EDVisitsandAdmissions
DepartmentofEmergencyMedicine
Total EDVisits
ICUAdmission
ICUAdmission
Rate
95%CI
Pre-EC3 147,030 3,742 2.54% 2.4-2.6%
Post-EC3 157,190 3,279 2.08% 2.0-2.2%
EC3AssociatedwithDecreased
ICUAdmissionRatefromED
Relative Risk Reduction = 18% [95%CI:11-23%]Number Needed To Treat = 218 [95%CI:174-361]
DepartmentofEmergencyMedicine
TotalAdmissions
TransfertoICU
≤24hrsafteradmittoward
Rate
Pre-EC3 51,451 377 0.8%
Post-EC3 55,912 400 0.8%
EC3NotAssociatedwithIncreased
TransferstoICUwithin24hoursof
GeneralWardAdmission
DepartmentofEmergencyMedicine
TotalEDAdmissions
Death≤48hrsafter
admission
MortalityRate
Pre-EC3 51,451 280 0.54%
Post-EC3 55,912 281 0.50%
EC3NotAssociatedwithIncreased
ShortTerm(≤48hrs)Mortality
DepartmentofEmergencyMedicine
ICUBedDaysSaved
MinimumICUBedDaysSaved1 1,188AverageperMonth2 51.4AverageperDay2 1.7MedianICUBedDaysSaved 3,326AverageperMonth2 143.3AverageperDay2 4.7
DepartmentofEmergencyMedicine
Reductionin“ShortStay”ICU
Admissions
DepartmentofEmergencyMedicine
ReducingMedicalICUAdmissions
DepartmentofEmergencyMedicine
DiseaseSpecificOrderSets
Undifferen
tiatedSepsis
BiPap/Intu
bation/
Vent
Shortness
ofBreath
Feb-16*
GIBleed UnknownDKAAug-
15*
Subarachn
oid
Hemorrha
ge
Post
Cardiac
Arrest
EndofLife
Dec-15*
Status
Epilepticus
EC3Pathway 49.2% 15.4% 11.5% 9.9% 8.1% 7.6% 5.3% 2.6% 1.6% 1.2% 1.1%
2,546
794
595514
421 391276
133 84 61 57
-5.0%
5.0%
15.0%
25.0%
35.0%
45.0%
55.0% EC3PathwaysUtilized
Multipleperpatientpossible2/16/2015- 2/28/2017
n=5,872
%ofT
otalEC3
StatusP
atients
*Dateorderset started
DepartmentofEmergencyMedicine
DiseaseSpecificOrderSets
DepartmentofEmergencyMedicine
LengthofStay&CostAnalysis
DepartmentofEmergencyMedicine
LengthofStay
MedianHospitalLOS MedianICULOSPreEC3 PostEC3
EDtoMICU 6.00
ED toEC3 toMICU 7.00
ED toEC3 toFloor 4.00
PreEC3 PostEC3
ED toMICU 2.00
ED toEC3 toMICU 3.00
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
ED:MICU ED:EC3:MICU
Med
ianICULO
S
PatientPathway
PreEC3
PostEC3
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
ED:MICU ED:EC3:MICU ED:EC3:Floor
Med
ianHo
spita
lLOS
PatientPathway
PreEC3
PostEC3
DepartmentofEmergencyMedicine
CostComponents
Cost
Radiology
X-ray
CT
MRI
Ultrasound
Pharmacy Nursing LabTestsAncillarySupport
RT
PT
OT
SpeechLanguagePathology
OtherTests
EKG
EEG
Echo
DepartmentofEmergencyMedicine
EC3CostComparison
$0.00
$1,000.00
$2,000.00
$3,000.00
$4,000.00
$5,000.00
$6,000.00
$7,000.00
$8,000.00
1 2 3 4 5 6 7 8 9
Cost
LOS(days)
EC3CostComparison
ED:EC3:MICU
ED:EC3:Floor
Pre-EC3:Baseline
DepartmentofEmergencyMedicine
ED
ICU WARDWithin24hours
- 4xlongertogettoICU
- O.R.Death3.07
Molina2014
WARDàICUtransferisalsoassociatedwithincreasedmortality
AnOpportunity
DepartmentofEmergencyMedicine
• 7.5AttendingFTEs
• 7PAFTEs
• 40NursingFTEs
• DedicatedRT
IncrementalFTEs
DepartmentofEmergencyMedicine
• Transitionzonebetweenacuteresuscitation
andongoingcriticalcaredelivery
• Needs-basedtreatmentvsgeography
–RightCareRightNow
• Timesensitive,nottimelimited
ED-ICUinterface
DepartmentofEmergencyMedicine
Scope
DepartmentofEmergencyMedicine
• Internalaudit– Needsbasedassessmentofcurrentstate
• CriticalCareAssessment
– Siloed
– Specificspaceforspecializedcare
• EmergencyMedicineAssessment
– EmergencyCriticalCareemergingspecialty(care/education/research)
– Currentstaffingmodel
– Currentphysicalplant
Roadmap
DepartmentofEmergencyMedicine
StaffingModel
Attending1 Attending2
PA/Fellow/ResidentA PA/Fellow/ResidentB
PA/Fellow/ResidentC PA/Fellow/ResidentD
EC3BedsideRNx4(2:1)
EC3TeamLeadRNx1(1:1)
RespiratoryTherapy
Pharmacy
MedicalProvider
Nursing
Ancillary
24Hours
Laboratory
DepartmentofEmergencyMedicine
ImplementationPlan
DepartmentofEmergencyMedicine
EC3:LogisticsandPatientFlow
EMS/Triage
ResusBay
EC3
DefinitiveCare ICU Ward Discharge
PalliativeCare
MainEDPatientSelection
Pushvs.Pull
90-120min
LOS11hrs (2-50hrs)
CollaborativeDisposition
DepartmentofEmergencyMedicine
RibbonCutting– Feb2015
DepartmentofEmergencyMedicine
• Defects
• Overproduction
• Waiting
• ExcessProcessing
• Transporting
• Inventory
• Motion
• NotUsingTalent
EightWastesofHealthcare
Grunden andHagood.Lean-LedHospitalDesign.CRCPress;2012:13-14
DepartmentofEmergencyMedicine
CostImpactofLEAN
SavingsOverTime
HigherUpFront
Investin
Personnel/LEAN
Leadership
Process
Improvement
Reduces
Cost/Increases
ValueOver
Time
Returns
DepartmentofEmergencyMedicine
IntensityofEDServicesIncreasing
DepartmentofEmergencyMedicine
• CCadvisorygroupformedin2012–– MedicaldirectorsandunitrepresentativesfromallinpatientadultICUs
• Agreeduponbasictreatmentprotocol/strategyformostcommonadmissions– Sepsis
– Cardiacarrest
– RespiratoryFailure
– GIBleed
– Anticoagulationreversal
– SAH
CollaborativeModel
DepartmentofEmergencyMedicine
• IntroductiontoMichiganMedicine
• DefineLEAN
• LEANTools
• PressuresAffectingEmergencyCare
• DemonstrativeCasePresentation
• Summary/Wrap-Up
Outline
DepartmentofEmergencyMedicine
• Engageallworkers
– Frontline,MiddleManagement,AdminLeadership
– AllJobFamiliesAffectingPatientExperience
• Empowers
• FostersTeamworkAcrossJobFamilies
• FrequentlyUncoverLargerSystemsIssues
• Leaders’primaryjobistogrowmoreleaders
People
DepartmentofEmergencyMedicine
Quality• ValuenotVolume
• HospitalAcquiredInfections
• MedicalErrors
Flow• IncreasingVolumes
• SickerPatients
• LackofPCPAccess
Financial• RisingCosts
• DecreasingReimbursement
• CapitatedPayments
• AccountableCare
• RepurposingExistingSpace
EmergencyCareSystemStressors
DepartmentofEmergencyMedicine
PhysicalSpaceInsufficienttoMeetCurrent&
ForecastedDemand
DepartmentofEmergencyMedicine
FullScaleMock-up
DepartmentofEmergencyMedicine
MultidisciplinaryTeams
DepartmentofEmergencyMedicine
•ExecutionoftheUMHSStrategicPlantodouble adulthighcomplexitymarketshare (from6%- to12%)willamplifythe
demandforemergencycriticalcareinoursystem
•Theemergencycaresystem,init'scurrentstructure,isnotpreparedtorespondtothesechallenges.
HealthSystemStrategicPlan
DepartmentofEmergencyMedicine
Roadtrips
DepartmentofEmergencyMedicine
DepartmentofEmergencyMedicine
DepartmentofEmergencyMedicine
Centralized,commonlyused
items
Rarelyusedbutcritical
proceduralitems
DepartmentofEmergencyMedicine
MichiganMedicine- Facts&Figures
DepartmentofEmergencyMedicine
DepartmentofEmergencyMedicine
GoldenTickets
DepartmentofEmergencyMedicine
LessonsLearned
DepartmentofEmergencyMedicine
StorageSpace/Technology
DepartmentofEmergencyMedicine
FullScaleMock-up
DepartmentofEmergencyMedicine
ValueStreamMapping
DepartmentofEmergencyMedicine
DepartmentofEmergencyMedicine
• file:///.file/id=6571367.12173219
DepartmentofEmergencyMedicine
Fiberoptic video
imagecanbe
displayedonmultiple
HDscreensaround
RESUSbay
DepartmentofEmergencyMedicine
DepartmentofEmergencyMedicine