42
SHS 2005 Patient Transport – One Hospital’s Approach To Improve Both Services and Productivity Jesse Moncrief Cengiz Tanverdi
SHS 2005
Patient Transport – One Hospital’s Approach To Improve Both Services and Productivity
Jesse MoncriefCengiz Tanverdi
SHS 2005
OUTLINE
BACKGROUNDGOALSAPPROACHANALYSIS
CHANGESIMPLEMENTATIONPATH FORWARD
SHS 2005
CHRISTIANA HOSPITAL
LEVEL 1 TRAUMA CENTEROVER 40,000 ANNUAL ADMISSIONSAVERAGE DAILY CENSUS OVER 600
SHS 2005
PATIENT ESCORT
CENTRALIZEDDIPATCHED & “DEDICATED” AREASRESPONSIBLE FOR
PATIENT TRANSFERSDISCHARGESOXYGENERRANDS
SHS 2005
PATIENT ESCORT
STAFF (FTE)MANAGERSUPERVISORS - 3DISPATCHERS - 9ESCORT STAFF - 75
TRIP VOLUMEANNUAL - 404,000WEEKLY - 7,800WEEKDAY – 1,300
SHS 2005
PATIENT ESCORT
REQUESTS FOR MORE “DEDICATED STAFF”AFFECTS PERFORMANCE OF OTHER DEPARTMENTSRESPONSE TIME COMPLAINTSPRODUCTIVITY PERCEIVED AS LOW
SHS 2005
PROJECT GOALS
ESTABLISH PATIENT ESCORT OPERATIONS THAT EFFICIENTLY RESPOND TO VARYING CHANGES IN WORKLOAD VOLUMEADJUST STAFFING LEVELS TO IMPROVE PRODUCTIVITY AND REDUCE DEPARTMENT OPERATING EXPENSES
SHS 2005
APPROACH
SUPPORT FROM ALL DEPARTMENTSIDENTIFY DEMAND PATTERNSIDENTIFY OBTACLESREVIEW DISPATCH PRACTICESDEVELOP NEW STAFFING ASSIGNMENTS AND DISPATCHING PRACTICES
SHS 2005
DEPARTMENTS INVOLVED
PATIENT ESCORTMANAGEMENT SYSTEMSRADIOLOGYREHAB SERVICES
HEART CENTEREMERGENCY DEPARTMENTCATH LABNUCLEAR MEDICINE
SHS 2005
DATA COLLECTION
TWO WEEK COLLECTION PERIODDISPATCH SOFTWARE DOWNLOADMANUAL LOGS FOR “DEDICATED” AREASSHADOWING ESCORT STAFF
SHS 2005
DATA ANALYSIS CHALLENGES
VOLUMEMANUAL LOGSDATA DOWNLOADMERGING MANUAL AND AUTOMATED DATA“VIRTUAL” WEEK CREATIONGROUPING TRIPSCREATING VISUAL PICTURE OF WORKLOAD DEMANDS
SHS 2005
CHRISTIANA TRIP/STAFFING DISTRIBUTION( MONDAY - FRIDAY )
0%
10%
20%
30%
40%
50%
60%
STAFFING TRIPS
PER
CEN
TAG
E
DEDICATEDDISPATCH
SHS 2005
CHRISTIANA PATIENT ESCORT WEEKDAY TRIPS
0
20
40
60
80
100
120
140
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23HOUR OF DAY
NU
MB
ER O
F TR
IPS
MONTUEWEDTHUFRI
SHS 2005
CHRISTIANA PATIENT ESCORT WEEKDAY TRIPS
0%
1%
2%
3%
4%
5%
6%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23HOUR OF DAY
PERC
ENT
OF
TRIP
S
DEDICATEDDISPATCHED
SHS 2005
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23MON
TUE
WED
THU
FRI
HOUR OF DAY
CHRISTIANA PATIENT ESCORT DISPATCHED TRIPS
0-20 20-40 40-60 60-80
SHS 2005
0 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23MON
TUE
WED
THU
FRI
HOUR OF DAY
CHRISTIANA PATIENT ESCORT DEDICATED TRIPS
0-20 20-40 40-60 60-80
SHS 2005
CHRISTIANA DISPATCH STAFFING VERSUS TRIPS
048
121620242832364044485256606468727680
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
HOUR OF DAY
AVE
RA
GE
HO
UR
LY T
RIP
S
0
4
8
12
16
20
NU
MB
ER O
F ST
AFF
TRIPS STAFF
SHS 2005
CHRISTIANA DEDICATED STAFFING VERSUS TRIPS
0
8
16
24
32
40
48
56
64
72
80
88
96
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23HOUR OF DAY
AVE
RA
GE
HO
UR
LY T
RIP
S
0
4
8
12
16
20
24
NU
MB
ER O
F ST
AFF
TRIPS STAFF
SHS 2005
C L INIC A L 1 S T FLC L INIC A L 4 T H FL
EM ER DEP TL O BBY W HS
NURS ING UNIT O PO T HER 1 S T FL
O T HER L LS UP P O RT 1 S T FL
S UP P O RT L LW O M ENS BL DG
O T HER 5 T H FLC L IN
ICA L 1
ST F
C L INIC
A L 2N D F
C L INIC
A L 4TH F
C L INIC
A L LL
EMER D
EPT
L OB B Y CH
L OB B Y WH S
N U R S ING
UN IT
N U R S ING
UN IT
OTH E R
OTH E R 1
ST F
OTH E R L
L
PH A R MA C Y
SU P POR T 1S T F
SU P POR T 2N D
SU P POR T LL
SU R G, M
A P , MA P
WO
MEN S B
LD
OTH E R 2
N D F0 %
2 %
4 %
6 %
8 %
1 0 %
1 2 %
1 4 %
1 6 %
1 8 %
2 0 %
T O
F R O M
C H R IS T IA N A P A T IE N T E S C O R TT O / F R O M T R IP D IS T R IB U T IO N
SHS 2005
TRIPS TO/FROM CH RISTIANA N URSING UNITS (M ONDAY-FRIDAY)
0
50
100
150
200
250
300
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
H OU R OF D AY
NU
MB
ER
OF
TR
IP
TO IP N UFR OM IP N U FR OM IP N U TO IP N U
SHS 2005
CH R ISTIAN A TR IPS FR O M IP N U R SIN G U N ITS TO CLIN ICAL 1ST FLO O R
M O N DAY-FR IDAY
0%
2%
4%
6%
8%
10%
12%
14%
16%
0 1 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
H OU R OF D AY
6TH F L C -D(CH)6TH F L A-B(CH )5TH F L C -D(CH)5TH F L A-B(CH )4TH F L C -D(CH)4TH F L A-B (C H)3RD F L C -D (CH)2ND F L C -D (CH)2ND F L A-B(CH)
SHS 2005
CHRISTIANA PATIENT ESCORT TRIPS FROM IP NURSING UNIT TO CLINICAL 1ST
FLOOR MONDAY-FRIDAY
2ND FL A-B(CH)6%
2ND FL C-D(CH)9%
3RD A-B(CH)0%
3RD FL C-D(CH)6%
4TH FL A-B (CH)6%
4TH FL C-D(CH)12%
5TH FL A-B(CH)21%
5TH FL C-D(CH)15%
6TH FL A-B(CH)15%
6TH FL C-D(CH)10%
SHS 2005
CHRISTIANA TRANSPORTER TRIPS PER HOUR( Excludes ED Xray and Radiation Oncology )
0%
5%
10%
15%
20%
25%
30%
1 2 3 4 5 6 7 8 9
TR IP S PE R H OU R
PE
RC
EN
TA
GE
OF
OC
CU
RA
NC
E IN
G
D E D IC ATEDD ISP ATC H E D
SHS 2005
DISTRIBUTION OF CHRISTIANA TRANSPORTER TRIPS PER HOUR
0
1
2
3
4
5
0 2 4 6 8 10 12 14 16 18 20 22HOUR OF DAY
NU
MB
ER O
F H
OU
RLY
TR
IPS
25TH PERCENTILE75TH PERCENTILEAVERAGE
SHS 2005
REHAB SERVICES
SHS 2005
CHRISTIANA REHAB TRIPS BY HOUR OF DAYMONDAY - FRIDAY TOTAL
0
20
40
60
80
100
120
140
8 9 10 11 12 13 14 15 16
D ISPATC H EDD ED IC ATED
SHS 2005
CH RISTIAN A REH AB TRIPS BY H OUR OF D AY
0
5
10
15
20
25
30
35
8 9 10 11 12 13 14 15 16
NU
MB
ER
OF
TR
I
M O NTU EW EDTH UFR I
SHS 2005
8 9 10 11 12 13 14 15 16MON
TUE
WED
THU
FRI
CHRISTIANA REHAB TRIPS BY HOUR OF DAY
30-4020-3010-200-10
SHS 2005
HOURLY TRIPS TO AND FROM CHRISTIANA REHAB
0%
2%
4%
6%
8%
10%
12%
14%
8 9 10 11 12 13 14 15 16
HOUR OF DAY
PE
RC
EN
T
TO IP N UFR OM IP N U
SHS 2005
8 9 10 11 12 13 14 15 16MON
TUE
WED
THU
FRI
CHRISTIANA DEDICATED REHAB TRIPS BY HOUR OF DAY
20-2515-2010-155-100-5
SHS 2005
DEDICATED REHAB TRANSPORTER TRIPS PER HOUR
0%
5%
10%
15%
20%
25%
1 2 3 4 5 6
TR IPS PER HOUR
PE
RC
EN
T O
F O
CC
UR
AN
SHS 2005
DEDICATED REHAB ESCORTSTAFFING AND TRIP PATTERNS
0.0
4 .0
8 .0
12.0
16.0
20.0
24.0
6 7 8 9 10 11 12 13 14 15 16 17 18
AV
ER
AG
E H
OU
RL
Y T
RIP
S B
Y D
ED
ICA
TE
D
0 .0
1 .0
2 .0
3 .0
4 .0
5 .0
6 .0
NU
MB
ER
OF
DE
DIC
AT
ED
ST
D ED IC ATED TR IPS STAFF
SHS 2005
INITIAL OBSERVATIONS
# TRIPS INCONSISTENT BETWEEN STAFF# TRIPS OVERALL LOWER THAN EXPECTED“DEDICATED” STAFF NOT AS BUSYASSIGNMENT OF DEDICATED STAFF DOES NOT ELIMINATE DELAYSDEDICATED STAFF “SLOTS” ALWAYS FILLED
SHS 2005
INITIAL OBSERVATIONS
STAFF FINDING REASONS TO EXTEND CALLSSTAFF FINDING WAYS TO “DISAPPEAR”DELAYS TO FIND EQUIPMENT –INFREQUENTACTUAL TRANSPORT TIME FROM 3-5 MINUTES
SHS 2005
INITIAL OBSERVATIONS
DISPATCHERS NOT ABLE TO WATCH “BIG PICTURE”SIGNIFICANT VARIATION IN DEMAND BY HOUR OF DAY AND DAY OF WEEK
SHS 2005
CHANGES NEEDED
INCENTIVE TO TAKE CALLSSUPERVISION IN DEDICATED AREASFLEX DEDICATED STAFFADDITIONAL SUPERVISION TO MONITOR “BIG PICTURE’
SHS 2005
IMPLEMENTATION
INDIVIDUAL PERFORMANCE GOALSJOINT SUPERVISION FOR DEDICATED STAFFDISPATCHING DEDICATED STAFFDISPATCHERS ASSIGNED AREASRENOVATION OF DISPATCHER WORK AREAADDED 1 DISPATCHER
SHS 2005
IMPLEMENTATION
NEW DISPATCH CONTROL DESKRECOGNITION
SHS 2005
PATIENT ESCORT PRODUCTIVITY
0.0
0.5
1.0
1.5
2.0
2.5
3.007
/12/
2003
08/0
9/20
03
09/0
6/20
03
10/0
4/20
03
11/0
1/20
03
11/2
9/20
03
12/2
7/20
03
01/2
4/20
04
02/2
1/20
04
03/2
0/20
04
04/1
7/20
04
05/1
5/20
04
06/1
2/20
04
07/1
0/20
04
TRIP
S/H
OU
R
SHS 2005
CHRISTIANA PATIENT ESCORTON TIME PERFORMANCE
60
65
70
75
80
85
90
Jul-03 Aug-03 Sep-03 Oct-03 Nov-03 Dec-03 Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04
PER
CEN
T O
N T
IME
SHS 2005
TURNING POINTS
DEPARTMENTS USING DEDICATED STAFF SEEING ACTUAL WORKLOADSETTING # OF TRIPS PER SHIFTINCORPORATING GOAL IN PERFORMANCE STANDARDS
SHS 2005
PATH FORWARD
ESTABLISH APPROPRIATE STAFFING LEVELS FOR STAFF IN “DEDICATED” AREASDISPATCH ALL STAFF BY RADIO
