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Throughput Best Practices and Leading Indicators
Throughput best practices build a culture of effective communication that is focused on patient progression across the care continuum. Collaborative practices amongst care teams (i.e., nursing, transportation, and environmental services) deliver coordinated efficiency to the care environment.
BEST PRACTICES
Start discharge planning the day of admission to enable safe and efficient patient discharge supported by transparency and real-time visibility of discharge progress
Institute a 24-hour discharge prediction bundle to accurately predict discharges for the next day to create earlier access for waiting patients.
Multi-Disciplinary Rounds should include 24-hour predictions.
Identify 11am and 2pm discharges with contingent needs the day before.
Nursing/Case Management should conduct a 5 minute afternoon huddle to verify contingent needs are being met for early discharge.
Utilize PatientTracking Portal for the 24-hour charge nurse to charge nurse handoff.
Formalize reporting of yesterday’s discharge results during safety meeting or bed meeting.
Identify early discharges for the following day to ensure the Provider writes the order early to assist with earlier discharges and increased bed availability.
Communicate the patient’s Projected Discharge Date with the patient and family daily throughout the patient’s stay to avoid any potential delays in discharge.
Implement electronic whiteboard to enable situational awareness across multidisciplinary teams
Replace manual whiteboard with electronic Patient Tracking Portal boards to enable real-time display of critical patient flow indicators.
View Pending and Confirmed Discharges so that clinical and non-clinical staff have access to discharge information for planning for today and tomorrow. (EVS, Transport, Pharmacy, Case Management, PT/ OT, Lab, Radiology, etc.)
Configure real-time views to include but not limited to : Observation Timers, LOS, Pending & Confirmed Discharges, Milestones, Transfers, Assignments, bed status, and patient’s current location from Transport.
Utilize Precision Placement to ensure proactive throughput approach and improved timeliness of care
Each Unit places and updates Bed Assignment Priorities throughout the day to ensure proper use of beds. 3 priorities should be identified throughout the day.
Develop guidelines to ensure bed assignments are not changed unless medically necessary to avoid duplication and inefficiencies.
Nurses should utilize a No Delay Nurse Handoff/Report to improve the efficiency of patients arriving to their units.
All patients with a bed request should be converted to an inpatient/ observation status and placed in a virtual bed in the ADT system in order for the nursing unit to transfer the patient to their bed upon arrival.
Nursing should have the ability to discharge patients via an integration from their EMR to their ADT.
Create a planned surgical/procedure admit list, so that patient placement and nursing can pre-plan for surgical admissions throughout the day
Plan for surgical/procedure admissions by targeting units the day before, so that units can prepare for known admits. This may include transferring off- service patients and/or earlier discharges.
Activate the bed request when the patient arrives in the Recovery Area. Click RTM or use projected RTM and update accordingly for planned and actual readiness of the patient.
Develop clearly defined protocols that qualify a patient as Ready to Move (e.g. Anesthesiologist clears patient) to ensure consistency.
Identify one owner for the creation of the planned surgical list to ensure accuracy and consistency.
Improve transporter performance to align with hospital operations.
Centralize the Transport Department to deliver efficient and dependable transport service using an efficiency focused dispatch set.
Promptly cancel a transport request if transport is no longer needed (prior to being dispatched) to eliminate wasted time.
Complete transport requests where patient/item is dropped off to improve proximity matching.
Minimize delays to 5 minutes to prevent other patients from waiting for their care.
Utilize the return equipment feature, so that the transporter receives trip credit and is properly located and considered for the next job.
Establish and utilize realistic transport alerts to notify supervisors about actionable events and to ensure appropriate follow up.
Improve the service provided by patient transport to all departments by improving the efficiency of the department
Align priorities to support response time goals to hospital/departments.
Utilize notifications to inform sending/receiving areas that a job has been created/cancelled/delayed, or that a transporter is on the way to collect/ deliver a patient.
Implement auto transport to expedite patient flow.
Place manual transport requests within 10 minutes for admits/transfers having a clean assigned bed to decrease holding time.
Use appropriate staffing strategies to ensure appropriate transport coverage all hours of the day to deliver consistent/expected response to transport requests, such as:
Stagger lunch and break shifts.
Ensure appropriate staffing levels during peak demand.
Schedule overlapping shifts to maintain response times and service during shift changes.
Place Transport Request in progress when a transporter has patient, to ensure prompt bed cleaning requests and prevent a false dirty bed. 7. Ensure patient is ready for transport when request is made to reduce unnecessary delays.
POTENTIAL OBSTACLES & CONSIDERATIONS
Potential Obstacle: Delay in moving a clinically ready in- house transfer patient with a clean bed assignment.
Considerations:
Identify why the in-house transfer patient has not been moved: is it related to the hand off report, or is the nurse unable to receive the patient.
Institute a No Delay Nurse Report or automated process to ensure the report process is seamless with no delays.
Automate the transport request once the bed is assigned.
Ensure patient is ready prior to the transport request.
Potential Obstacle: Lack of consistent communication to family/patient when patient is to be discharged.
Considerations:
Provide consistent daily communication to patient and family around the projected discharge date.
Utilize whiteboards in patient’s rooms to document the patient’s discharge date.
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