Methods

1. Regional Transfers Complete Roll Out Begin Roll Out July ‘09 August ‘09 September ‘09 October ‘09 Incoming Call Strategy / Transfer Line Redesign Performance Improvement Initiative Philip J. Fracica1, MD, MBA, Kerri L Jenkins2, RN MBA andMichelle Hensley1, LPN Heartland Regional Medical Center1, St Joseph, MO; H3 Consulting LLC.2 www.heartland-health.com Our calling in life is life itself. H3 CONSULTING LLC The results of the Performance Improvement initiative include the following significant improvements: Introduction • Desired Outcomes Transfer Line: • Decrease Cost per Case and Revenue (elimination of ER charges and prevention of unnecessary tests and treatments) • Decrease LOS immediate workup. • Increase Patient Satisfaction • Increase local, regional and sub-specialty provider satisfaction. • Increase Core Measures Compliance (Best Practice Care) • Increase direct admission volume from regional facilities by incorporating the Hospitalist program and the transfer line. • Decrease Emergency Department departure Against Medical Advice and Left Without Being Seen rates. • Reduction in duplication of work done by ED for patients that have already been evaluated. • Increased ED Staff/Physician Satisfaction. Heartland Regional Medical Center had unsuccessfully attempted to redesign the transfer process for regional referrals for over 10 years. This presentation documents a successful performance improvement initiative that addressed this issue. • Regional Referral Transfer Volume (57% increase) • Regional Referral Provider Satisfaction • Local Medical Staff Satisfaction • Total inpatient census • Total inpatient payer mix • Increased total inpatient census (>200 additional admissions per year) • Call Center expenses (28% reduction in total expenses) • Improved Hospitalist Service and overall inpatient Patient Satisfaction (satisfaction of inpatients admitted through ED increased from <10th %ile to 77th %ile) • Hospitalist Service and overall payer mix and revenue • CMS “core measures” compliance with reduction in rework required • ED discharges against medical advice and patients left without being seen • Improved ED overcrowding/delays (40% reduction in hours over capacity, 10.5% increase in overall ED capacity) • ED throughput / ED patient satisfaction / ED capacity • ED Patient Satisfaction • Avoidance of duplication of ED services and charges • $1.3 million cost reduction through elimination of the waste of idle resources, waiting and processing through consolidation of services between switchboard, transfer line, patient placement and call center functions Methods The PASTE plus methodology was used which utilizes the following process: Solution Expansion of the Hospitalist program to allow 24x7 in-house coverage. This allowed transfer patients to be directly admitted to hospitalist thereby bypassing the ED. Change in call center staffing mix from clerks to LPNs who were able to transcribe verbal admission orders for direct admits. Redesign patient placement process to optimize value stream Call Center consolidation Analysis ED Overcrowding at 60,000 annual encounters (50% above capacity) Medical staff use of ED to evaluate and write holding orders for evening admissions. Multiple confusing routes for incoming calls, each with different processes Lack of Hand-off communication among referring facility, ED and inpatient staff Patients are accepted without notification of relevant responsible specialist Unclear ED Diversion policy Inefficient Mental Health admission and screening process Staffing and work flow inefficiencies among Switchboard, Patient Placement, Call Line and Transfer Line staff. Transition PASTE plus uses the PASTE approach supported by formal Six Sigma Black Belt support staff. Key elements of successful implementation included: Extensive outreach to Medical Staff within the organization as well as regional referring physicians Development of action plans with explicit deliverables and individual accountability. Support from key Medical Staff leaders. Sufficient Hospitalist Staffing to support the Transfer Line responsibilities Ongoing voice of customer assessment with all stakeholders to allow real time resolution of issues and process redesign to prevent recurrence. Problem Opportunity Statement: Improve access to the Integrated Delivery System through a coordinated standardized incoming call process that is more efficient and cost effective. • Desired Outcomes Incoming Call Strategy : • Increase Patient/Customer Satisfaction • Increase Internal Satisfaction • Increase local, regional and sub-specialty provider satisfaction. • Decrease the cost per Incoming Call. • Create a model that anticipates capacity to support preparation for Tele-Monitoring Services and potential CHIS revenue. • Decrease the volume of inappropriate Incoming Calls. • Ability to monitor Abandonment Rates and Avg Speed to Answer to meet Best Practice Benchmarks. • Decrease volume of inappropriate call transfers. Evaluation