Simple solutions cut admission wait time
Average wait time drops from 45 minutes to 12
If you don’t believe long wait times can lead to patient dissatisfaction, just ask Ellen Head, admissions director at Valley Children’s Hospital in Fresno, CA.
Two years ago, after a survey showed average admission wait time at the pediatric facility averaged from 45 minutes to as much as two hours, Head formed a task force to discover the root causes and how to solve them. The process improvement project was a success: Today the average time is 12 minutes.
Here’s how they did it:
Committee members included representatives of all those involved in the admissions process, both managers and staff in the admissions department as well as unit managers and charge nurses on the floor. "I wanted both management and those who had hands-on responsibility," she explains.
Next, the team began analyzing the admissions process by talking to staff to find out their perceptions of the problem. "We also begin recording how long patients waited from the time they came into admissions until they were in a bed on the floor," she says.
The team discovered the following reasons for the excessive wait times.
• Lack of bed availability. "Beds may not have been available because discharges weren’t happening quickly enough. Or, the bed had to be cleaned or set up by environmental services," she says.
• Inadequate communication to unit. "If the unit was not told a child had an infectious disease, for example, then he or she would have to be reassigned to another room rather than sharing it with another patient," she says. Such scrambling to find another vacant bed at the last minute would often "make the admission process come to a screeching halt."
• Inadequate information about the payer source. "Not knowing that prior authorization was required also held up the process," she says. If the payer representative happened to be at lunch or otherwise unavailable, the patient and parent would have to wait until authorization could be granted.
Because most of the root causes were based on gathering and dispersing timely information, the team decided to first concentrate on creating an automated admission notification form.
"Instead of making telephone calls back and forth from admissions to the unit and taking the chance of pertinent information being left out, we created a form that could be accessed from the units or the admissions office," she says.
In addition to patient demographics and diagnosis, symptoms, and treatment plan, the form also allows admission managers to note any communicable diseases that require isolation as well as what sized bed is needed. "We set the form up so that none of the fields can be left blank. That way we know all parties will have the information they need," she says.
Bedside check-in
By collecting as much information as possible in the pre-registration process, this automated form not only reduced redundancy but also allowed for bedside check-in of some patients. "[During pre-registration] we go ahead and create the armband and the stamping plate in addition to obtaining signatures and doing patient education," she says.
The actual registration process is then "invisible," explains Head. "We can pull the information from the computer and recode it as inpatient. But all the patient knows is that they can go straight from the education session to the room and bypass the physical admission office," she says. Internally, all the same things happen while the patients and their families remain unaware of the admissions process and thus perceive that things are moving much faster.
To improve communication among the unit, admissions, and the charge nurse, the admissions representative completes the electronic form and pages the charge nurse. "Now, the nurse is paged when the patient first arrives. Before, admissions would wait to make the call after the computer entry task was finished. But the nurse might have been busy, and the patient would have to wait," she explains.
When the nurse receives the page a special code denoting a patient will arrive in 15 minutes he or she calls admissions only if there is a problem. "Now we have an admissions representative, rather than a nurse, escort the patient to the floor, so the nurse isn’t interrupted and can concentrate on getting the bed ready quickly," she says.
Head explains that the team is still working on the issue of timely discharge. "Physicians are in their offices all day and then come to the hospital afterward to discharge patients. But we need the bed before that," she says.
Also, discharge may be delayed if parents aren’t notified of the physician’s plan beforehand. "Parents don’t have time to arrange transportation or finances," she says.
"We are talking with physicians about the discharge issue, but we didn’t want to wait for it to be solved before tackling admission wait time," she says. "Sometimes, with redesign, you just have to go ahead and make changes in the areas you have control over, rather than waiting for conditions to be just right on all fronts."
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