UK HealthCare Quality Design Brandy Mathews, RN, MSN Director, Capacity Command Center

1. UK HealthCare Quality Design Brandy Mathews, RN, MSN Director, Capacity Command Center 1

2. Our Charge • Financial analysis of patient movement and associated supply chain transport • In Scope • Adult inpatients at Chandler • Patient movement related to bed-to-bed transfers • Out of Scope • UK Good Samaritan, Kentucky Children’s Hospital, moves for testing or therapeutic services (e.g. OR, Cardiac Cath, etc.), and movement within a boarding unit or within the same room 2

3. Team Members • Sara Roberts, MHA – Team Leader • Bernard Boulanger, MD • Paula Chipko, RN, MBA • Leslie Cumming-Kinney, RNC, BSN • Patty Hughes, DNP, RN, NE-BC • Brandy Mathews, RN, MSN • Executive Sponsors: Jeff Norton and Teresa Centers 3

4. The Problem • “The Bed Shuffle” – Dr Rick Lofgren • Patients that are admitted to a location in Chandler Hospital are often subsequently transferred to another location(s) • Reasons for the shuffle • High bed occupancy and increased demand for inpatient beds • Challenges with geographical cohorting • The development of transitional units (virtual beds) • Semi private rooms • Level of care changes 5

5. The Problem • Unnecessary patient movement during an inpatient hospital stay has never been measured and its associated costs have never been quantified. • Each patient move consumes resources and requires significant re-work by multiple members of the care team. In addition, there is a potential impact on patient outcomes, patient and staff satisfaction, and the ability to facilitate admissions and transfer requests. 6

6. Methodology and Results • LEAN tools utilized • project scope • “go and see” • fishbone diagram • value stream mapping • process boundaries 8

7. Methodology and Results • Interviewed services with no measurable impact from patient bed moves • Patient Care Facilitators • Providers • Stock Clerks • Patient and Family Services • Customer Service • Interviewed services with measurable impact from patient bed moves • Core • Nurses • Nurse Techs • Patient Transport • Environmental Services • Capacity Command Center • Non-Core • Laboratory Services • Pharmacy • Dietary • Respiratory Therapy • Physical and Occupational Therapy

8. Methodology and Results • Interview Guide • Describe each step in their process of when a patient is moved or has been moved • Determine titles and pay grades • Determine what supplies are wasted per patient move (estimate cost)

9. Methodology and Results • Value Stream Mapping Process • Interview process was translated into Value Stream Maps • Process Time for Transport Tech is 35 minutes • At $10.95* per hour this step equates to $6.38 tial

10. Waste Identified • Missing chart, medication • Excess transport of patients • Time – MD, support services • Excess handoff • Additional room turn • Wasted supplies 12

11. Room Supply Waste: $30 per patient move Methodology and Results

12. Methodology and Results • Core Cost Per Patient Move • $59.69 • Labor $29.66 • Supply $30.03 *represents an average and excludes benefits and shift diff 14

13. Methodology and Results • Non-Core Cost Per Patient Move • $16.06 • Labor $11.84 • Supply $4.22 • Grand Total Cost Per Patient Move • $75.75 • Labor $41.50 • Supply $34.25 15

14. Methodology and Results • A sample of 124 patient bed moves taken by the Capacity Command Center indicate that 43.5% of patient moves are for reasons other than Level of Care adjustments or “Bed Shuffle” and are potentially avoidable • The percentage of moves related to lack of private room accommodations (patient initiated plus infection control and make appropriate bed for next patient) totals 16.1%

15. Methodology and Results • The initial PM data set included 14,959 adult Chandler inpatient discharges • Of the 14,959 discharges 9,217 or 61.6% had no patient moves* • 5,742 discharges or 38.4% had at least 1 patient move for a total of 9,492 moves* or 1.65 patient moves per patient with a move

16. Methodology and Results 18

17. Methodology and Results • In FY09, the “Bed Shuffle” was estimated to created 13,882 hours of inefficient labor hours, which translated into $213K or 6.67 FTEs, and $176K in wasted supplies, for a total of approximately $388K of cost (see detail on the next slide) • In FY09, if all rooms had private accommodations it is estimated that 5,138 hours of inefficient labor hours would have been avoided, which translated into $79K or 2.47 FTEs, and $65K in wasted supplies, for a total of approximately $144K of cost • *Source Chandler Hospital Financial Statement, period ending June 30, 2009 19

18. Methodology and Results Bed Moves per Year 11,779 If Avoided 100% Cost per Move $75.75 TOTAL $892,242

19. Methodology and Results • In general, as the number of patient moves increase so does the UHC LOS Index*. For cases with no moves the UHC LOS Index is 0.83 (17% lower than expected), however, for cases with 1+ moves the UHC LOS Index is 1.20 (20% higher than expected). • * UHC LOS Index = Observed or Actual ALOS / UHC Expected ALOS. • The red line 1.00 indicates when Actual LOS = Expected LOS.

20. Methodology and Results • For cases with no moves the UHC opportunity days* is (7,015) or (0.76) days per case, however, for cases with 1+ moves the UHC opportunity days is 9,678 or 1.69 days per case. The UHC opportunity days per patient move is 1.02 days . Cases 5,742 Opportunity Days 9,678 Opportunity Days Per Case 1.69 Patient Moves 9,492 Patient Moves Per Case 1.65 Opportunity Days Per Patient Move1.02 • * UHC Opportunity Days = (Observed ALOS – UHC Expected ALOS) * Cases

21. Methodology and Results • The opportunity days per patient move is approximately 1.02 days but has been demonstrated in two different patient populations to range from 0.94 days to 1.18 days and generally increases per move (see appendix) • Level of care moves may have a greater impact on opportunity days than non-level of care moves • *UHC OpportunityDays = (Observed ALOS – UHC Expected ALOS)* Cases 23

22. Methodology and Results • FY09 Inpatient Adult Chandler • Discharges 18,590 • ALOS 5.96 • 38.4% have at least 1 patient move • 7,139 patients will have at least 1 move • Patients with a move have an average of 1.65 moves per case • 11,779 patient moves • 5,124 estimated avoidable patient moves • UHC Opportunity Days (Range) • 0.65 per move  3,331 UHC opportunity days • 0.94 per move  4,817 UHC opportunity days • 1.02 per move  5,227 UHC opportunity days • 1.18 per move  6,046 UHC opportunity days • Potential Additional Adult Cases • 0.65 per move  3,331 UHC opportunity days  559 potential additional adult cases • 0.94 per move  4,817 UHC opportunity days  808 potential additional adult cases • 1.02 per move  5,227 UHC opportunity days  877 potential additional adult cases • 1.18 per move  UHC 6,046 opportunity days  1,015 potential additional adult cases

23. Methodology and Results $388,125 Total $212,616 Labor (55%) $175,509 Supplies (45%) 559 Potential Discharges

24. Conclusions • 38.4% of Adult Chandler patients move at least once and averages 1.65 bed moves per patient • On average, each patient move costs the enterprise $75.75 • 55% of this cost is related to labor inefficiencies generated by a patient move and 45% is related to wasted supplies • 43.5% of patient moves are potentially avoidable and account for an estimated $388,125 26

25. Conclusions • Overall, UHC opportunity days per patient move is 1.02, however is approximately 0.65 days per non level of care move, which impacts the ability to accept inter-facility transfers and new admissions • An estimated 559 potential additional discharges could be accommodated if these non level of care moves are avoided • 16.1% of patient moves in this study could be eliminated if all rooms are private avoiding an estimated $144K in cost 27

26. Recommendations 1. Reduce the Cost of a Patient Move Areas of process waste identified by this project team that can be improved via Lean Team Projects include: • Patient room supply waste • Develop standard process to ensure room supplies travel with the patient • Sending unit clerk submitting final transfer order • Enforce standard process to ensure the final transfer order is completed within the designated time expectation 28

27. Recommendations • Reduce the Number of Patient Moves • Stricter evaluation of the decision-making leading to a patient move • Involve IT to develop standard methodology that allows continuous evaluation of patient bed moves • Maximize the number of private rooms to decrease the cost related to patient moves • Future study • Further analysis to include Good Samaritan Hospital and the movement between facilities • Further analysis to include the Kentucky Children’s Hospital 29

28. Acknowledgements • Judy Applegate, Legal / Risk Mgmt • Theresa Crocker, Legal / Risk Mgmt • Barb Atkins, PT/OT/RT • Shari Fullenlove, RT • Barbara Bush, Laboratory • Bradley Cherry, Clinical Engineering • Adele Cummins, CEQS • Barb Latham, CEQS • Carla Hattendorf, Dietary • Kimberely Hite, Pharmacy • Tracy Macaulay, Pharmacy • Paula Hudson, IT • Tiffany Morgan, IT • Steve Patton, IT • Angela Rogers, IT • Donnie Johnson, Customer Service • Amie Hawkins, Patient Care Facilitator • Darcy Tekulve, Patient Care Facilitator • Emily Hiatt, Nursing • TamelaSallee, NCT • Rafell Parish, Patient Transport 30