Despite a vision to provide every PeaceHealth patient with safe, evidence-based care every time, our health system experienced significant patient flow bottlenecks and a disjointed throughput process. Patients were being turned away at the door. With the prospect of declining reimbursement over the coming years, we knew we had to address our disconnected process.
Our biggest chronic problem was ambulance diversion. At its height, it exceeded four hours per day – roughly the equivalent of losing two to three admissions daily – $6 to $12 million per year.
Although we could identify many of the causes – a lack of critical care beds, discharge delays, staffing issues – we couldn’t see the big picture. With little management oversight, no hard-wired ED surge or bed request processes, and no one held accountable, there was a disconnected view of patient flow.
Externally, the situation was eroding patient and physician satisfaction and eating into our contribution margins. Internally, we faced a much bigger problem: diversion was so ingrained, it had become part of our culture. There was a prevailing belief that the problem couldn’t be solved, so nobody tried.
A Catalyst for Change
Worsening statistics forced us to ask the hard questions. Were our current processes best practices? Did our diversion results support our mission as a tertiary center for our community? Were leadership and structures in place to support this goal? The answers led us to a universal recognition that became our catalyst for change: PeaceHealth’s current state was not consistent with its “every patient, every time” philosophy.
We used Kaizen methodology and value stream mapping to determine our desired future state. From there, people, process and technology united to make that future a reality. We formed the Patient Access to Care Team (PACT) with a mission to ensure patient access 100% of the time, along with matching bed capacity and staffing. To assist the team, we deployed McKesson’s visibility solution to provide a real-time view into patient flow and care processes.
The Power of Visibility
Our enterprise patient care visibility system is helping to provide our care team with visual care cues that were aggregated from clinical, ADT, housekeeping, transport, location and other systems. The graphical cues provided shared visibility into the status of patients and rooms on large, electronic white boards that we prominently displayed throughout the hospital.
Because we can quickly identify patients with critical lab results or orders pending, and view patient location, status and room availability, we can see when and why the hospital is nearing divert status and act accordingly. The knowledge has helped us enable the availability of service for “every patient, every time.”
A Connected Process Brings Results
Almost overnight, hidden beds became visible, and the need to reroute patients to other facilities virtually disappeared. We have maximized volume by identifying bottlenecks that delay treatment and extend average length of stay (ALOS). We’ve fundamentally overhauled our organizational culture, and rebuilt trust with patients, physicians and staff.
In the first two years alone, we realized significant process improvements and cost savings:
- $6.3 million in direct variable costs based on lower ALOS
- More than $4.5 million in contribution margin due to patient flow efficiency
- A dramatic reduction in ED diversion, from a monthly average of 183 hours to just 35
- The ability to accommodate two additional inpatient admissions per day
- Incremental increased inpatient and outpatient volumes, including higher surgical volume out of the ED, and consistent volume in stroke, heart and trauma services
In addition, the solution has helped frontline staff readily identify fall risk patients and reduce falls with injury by 17%. Our conservative estimate of the potential cost savings from fewer falls is $630,000 over two years.
Reconnecting with Our Vision of Serving “Every Patient, Every Time”
These positive changes have enabled us to recapture trust both inside and outside the hospital walls. Staff members are engaged and work as a cohesive team to sustain the gains and build on our improvements. Leadership accountability has given caregivers confidence that we will fix what’s important, and they are inspired to own the changes moving forward.
Our improvements in patient flow and access has buoyed our reputation in the community as well. Patients trust they’ll get the care they need when they need it, and physicians trust their patients will be admitted in a timely fashion. In addition, emergency management services trusts it can stay local and continue to transport patients to their hometown hospital.
PeaceHealth Southwest Medical Center Reports Improved Bottom Line with Patient Flow Results
- 81% initial decrease in ambulance diversion hours, and zero diversions since August 2010
- $6.3 million in direct variable cost savings based on lower ALOS
- 5.4% decrease in Medicare ALOS
- 7.7% decrease in non-Medicare ALOS
- 17% reduction in patient falls
- Estimated $630,000 in cost avoidance due to fall reduction
- Contribution to margin > $4.5 million