E.D. – T.V. A Simulation Capacity Analysis

1. E.D. – T.V.A Simulation Capacity Analysis Jamey Koontz Baylor Health Care System

2. Overview • Baylor Health Care System • The Model • Methodology • Current State Data • ED Layout • ED Figures • Results • Other Information - Staffing

3. Non-Profit Health Care System in North Texas 14 Owned, Leased and Affiliated Hospitals 11th Consecutive Year in U.S. News & World Report’s “America’s Best Hospitals” Celebrated 100th Anniversary Oct. 2003 Baylor Research Institute 93,324 Admissions 245,558 ED Visits 495,645 OP Visits 13,249 Babies Born 2,587 Licensed Beds 15,000 Employees 3,300 Physicians Baylor Health Care System

4. Baylor All Saints Baylor City View BUMC Baylor Heart/Vascular Baylor Garland Baylor Grapevine Baylor Irving Baylor Plano Baylor Waxahachie Our Children’s House BSH BIR

5. Methodology • A Process Flow Diagram was Developed with the Current Process • Data was Obtained from the 2005 MedHost Database • September – October 2005 • A 2005 Model was Developed as a Base Model • Scenarios Tested were Based off of Volume Projections and Future Assumptions and Renovations

6. Beds Main ED: 15 Trauma: 1 Treatment Area 2: 6 LWOT – 5% = 5 patients/day Admits – 16.5% = 18 patient/day Current State Data2005

7. Current State Data2005

8. Current State Data2005 Average LOS is 3.7 Hours

9. ED Layout

10. ED Figures Emergent & Imminent Patients LWOT Patient Patient

11. New Changes & Assumptions • 7.0 New Beds • 1.0 Trauma Bed • 6.0 Main Beds • Improve Triage Process • Old Time – 5 min New Time – 4 min • Bedside Registration – allows for process to occur simultaneously • CPOE/EMR – Reduce Patient Treatment Time • 2007 – 4.5% • 2008 – 10.0% • 2011 – 12.5%

12. New Changes & Assumptions • Lab POC Testing • Reduce TAT by 75% • 1.0 Additional Radiology Unit • Reduce TAT by 75% • 1.0 Additional CT • Reduce TAT by 60%

13. New Changes & Assumptions • Will Gain 120 Inpatient Beds by FY10 • Reduce Admit Length of Stay up to 2 Hours

14. New Changes & Assumptions 154 139 Average Daily Volumes • Future Fiscal Year Volume Projections were Calculated as Follows: • 2006 – 0% • 2007 – 2% • 2008 – 1% • 2009 – 4% • 2010 – 5% • 2011 – 5% • 2012 – 5% • 2013 – 5% • 2014 – 5% • 2015 – 5% 126 115 110 107 2009 2011 2013 2005 2007 2015

15. Results

16. Other InformationWhat Else Can You Do with All this Data??

17. BUMC Avg. Pt. Flow / Nursing Nurse to Patient Ratio 1:4.3 Total Staff to Patient Ratio 1:2.7

18. GARLAND Avg. Pt. Flow / Nursing Nurse to Patient Ratio 1:3.5 Total Staff to Patient Ratio 1:2.9

19. ALL SAINTS Avg. Pt. Flow / Nursing Nurse to Patient Ratio 1:2.6 Total Staff to Patient Ratio 1:2.1

20. Service Audits • The Service Audit is used to assist in evaluating the level of service and performance of the area. • It provides a standard of measurement and a means of determining areas where service needs to be improved.

21. Service Audits • Example Questions • Do personnel report on duty to receive daily assignments? • Each shift routinely resolves discrepancies before leaving? • Is the chart signed by the nurse after completion? • Are test results placed with the E.D. record prior to discharge? • Have the vital signs been charted on ALL patients’ records with time?

22. ED Modeling Tips • What is the Problem? • Capacity vs. Staffing • Charge Acuity System vs. Urgency Acuity Classification • Simultaneous Processes • Ancillary Capacity • ED Hold Issue • Service Audits

23. Questions Jamey Koontz Sr. Management Engineer Baylor Health Care System JameyK@baylorhealth.edu