PATIENT TRANSPORT - ONE HOSPITALS/ APPROACH TO … · SHS 2005 Patient Transport – One Hospital’s Approach To Improve Both Services and Productivity Jesse Moncrief Cengiz Tanverdi

SHS 2005

Patient Transport – One Hospital’s Approach To Improve Both Services and Productivity

Jesse MoncriefCengiz Tanverdi

SHS 2005

OUTLINE

BACKGROUNDGOALSAPPROACHANALYSIS

CHANGESIMPLEMENTATIONPATH FORWARD

SHS 2005

CHRISTIANA HOSPITAL

LEVEL 1 TRAUMA CENTEROVER 40,000 ANNUAL ADMISSIONSAVERAGE DAILY CENSUS OVER 600

SHS 2005

PATIENT ESCORT

CENTRALIZEDDIPATCHED & “DEDICATED” AREASRESPONSIBLE FOR

PATIENT TRANSFERSDISCHARGESOXYGENERRANDS

SHS 2005

PATIENT ESCORT

STAFF (FTE)MANAGERSUPERVISORS - 3DISPATCHERS - 9ESCORT STAFF - 75

TRIP VOLUMEANNUAL - 404,000WEEKLY - 7,800WEEKDAY – 1,300

SHS 2005

PATIENT ESCORT

REQUESTS FOR MORE “DEDICATED STAFF”AFFECTS PERFORMANCE OF OTHER DEPARTMENTSRESPONSE TIME COMPLAINTSPRODUCTIVITY PERCEIVED AS LOW

SHS 2005

PROJECT GOALS

ESTABLISH PATIENT ESCORT OPERATIONS THAT EFFICIENTLY RESPOND TO VARYING CHANGES IN WORKLOAD VOLUMEADJUST STAFFING LEVELS TO IMPROVE PRODUCTIVITY AND REDUCE DEPARTMENT OPERATING EXPENSES

SHS 2005

APPROACH

SUPPORT FROM ALL DEPARTMENTSIDENTIFY DEMAND PATTERNSIDENTIFY OBTACLESREVIEW DISPATCH PRACTICESDEVELOP NEW STAFFING ASSIGNMENTS AND DISPATCHING PRACTICES

SHS 2005

DEPARTMENTS INVOLVED

PATIENT ESCORTMANAGEMENT SYSTEMSRADIOLOGYREHAB SERVICES

HEART CENTEREMERGENCY DEPARTMENTCATH LABNUCLEAR MEDICINE

SHS 2005

DATA COLLECTION

TWO WEEK COLLECTION PERIODDISPATCH SOFTWARE DOWNLOADMANUAL LOGS FOR “DEDICATED” AREASSHADOWING ESCORT STAFF

SHS 2005

DATA ANALYSIS CHALLENGES

VOLUMEMANUAL LOGSDATA DOWNLOADMERGING MANUAL AND AUTOMATED DATA“VIRTUAL” WEEK CREATIONGROUPING TRIPSCREATING VISUAL PICTURE OF WORKLOAD DEMANDS

SHS 2005

CHRISTIANA TRIP/STAFFING DISTRIBUTION( MONDAY - FRIDAY )

0%

10%

20%

30%

40%

50%

60%

STAFFING TRIPS

PER

CEN

TAG

E

DEDICATEDDISPATCH

SHS 2005

CHRISTIANA PATIENT ESCORT WEEKDAY TRIPS

0

20

40

60

80

100

120

140

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23HOUR OF DAY

NU

MB

ER O

F TR

IPS

MONTUEWEDTHUFRI

SHS 2005

CHRISTIANA PATIENT ESCORT WEEKDAY TRIPS

0%

1%

2%

3%

4%

5%

6%

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23HOUR OF DAY

PERC

ENT

OF

TRIP

S

DEDICATEDDISPATCHED

SHS 2005

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23MON

TUE

WED

THU

FRI

HOUR OF DAY

CHRISTIANA PATIENT ESCORT DISPATCHED TRIPS

0-20 20-40 40-60 60-80

SHS 2005

0 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23MON

TUE

WED

THU

FRI

HOUR OF DAY

CHRISTIANA PATIENT ESCORT DEDICATED TRIPS

0-20 20-40 40-60 60-80

SHS 2005

CHRISTIANA DISPATCH STAFFING VERSUS TRIPS

048

121620242832364044485256606468727680

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

HOUR OF DAY

AVE

RA

GE

HO

UR

LY T

RIP

S

0

4

8

12

16

20

NU

MB

ER O

F ST

AFF

TRIPS STAFF

SHS 2005

CHRISTIANA DEDICATED STAFFING VERSUS TRIPS

0

8

16

24

32

40

48

56

64

72

80

88

96

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23HOUR OF DAY

AVE

RA

GE

HO

UR

LY T

RIP

S

0

4

8

12

16

20

24

NU

MB

ER O

F ST

AFF

TRIPS STAFF

SHS 2005

C L INIC A L 1 S T FLC L INIC A L 4 T H FL

EM ER DEP TL O BBY W HS

NURS ING UNIT O PO T HER 1 S T FL

O T HER L LS UP P O RT 1 S T FL

S UP P O RT L LW O M ENS BL DG

O T HER 5 T H FLC L IN

ICA L 1

ST F

C L INIC

A L 2N D F

C L INIC

A L 4TH F

C L INIC

A L LL

EMER D

EPT

L OB B Y CH

L OB B Y WH S

N U R S ING

UN IT

N U R S ING

UN IT

OTH E R

OTH E R 1

ST F

OTH E R L

L

PH A R MA C Y

SU P POR T 1S T F

SU P POR T 2N D

SU P POR T LL

SU R G, M

A P , MA P

WO

MEN S B

LD

OTH E R 2

N D F0 %

2 %

4 %

6 %

8 %

1 0 %

1 2 %

1 4 %

1 6 %

1 8 %

2 0 %

T O

F R O M

C H R IS T IA N A P A T IE N T E S C O R TT O / F R O M T R IP D IS T R IB U T IO N

SHS 2005

TRIPS TO/FROM CH RISTIANA N URSING UNITS (M ONDAY-FRIDAY)

0

50

100

150

200

250

300

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

H OU R OF D AY

NU

MB

ER

OF

TR

IP

TO IP N UFR OM IP N U FR OM IP N U TO IP N U

SHS 2005

CH R ISTIAN A TR IPS FR O M IP N U R SIN G U N ITS TO CLIN ICAL 1ST FLO O R

M O N DAY-FR IDAY

0%

2%

4%

6%

8%

10%

12%

14%

16%

0 1 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

H OU R OF D AY

6TH F L C -D(CH)6TH F L A-B(CH )5TH F L C -D(CH)5TH F L A-B(CH )4TH F L C -D(CH)4TH F L A-B (C H)3RD F L C -D (CH)2ND F L C -D (CH)2ND F L A-B(CH)

SHS 2005

CHRISTIANA PATIENT ESCORT TRIPS FROM IP NURSING UNIT TO CLINICAL 1ST

FLOOR MONDAY-FRIDAY

2ND FL A-B(CH)6%

2ND FL C-D(CH)9%

3RD A-B(CH)0%

3RD FL C-D(CH)6%

4TH FL A-B (CH)6%

4TH FL C-D(CH)12%

5TH FL A-B(CH)21%

5TH FL C-D(CH)15%

6TH FL A-B(CH)15%

6TH FL C-D(CH)10%

SHS 2005

CHRISTIANA TRANSPORTER TRIPS PER HOUR( Excludes ED Xray and Radiation Oncology )

0%

5%

10%

15%

20%

25%

30%

1 2 3 4 5 6 7 8 9

TR IP S PE R H OU R

PE

RC

EN

TA

GE

OF

OC

CU

RA

NC

E IN

G

D E D IC ATEDD ISP ATC H E D

SHS 2005

DISTRIBUTION OF CHRISTIANA TRANSPORTER TRIPS PER HOUR

0

1

2

3

4

5

0 2 4 6 8 10 12 14 16 18 20 22HOUR OF DAY

NU

MB

ER O

F H

OU

RLY

TR

IPS

25TH PERCENTILE75TH PERCENTILEAVERAGE

SHS 2005

REHAB SERVICES

SHS 2005

CHRISTIANA REHAB TRIPS BY HOUR OF DAYMONDAY - FRIDAY TOTAL

0

20

40

60

80

100

120

140

8 9 10 11 12 13 14 15 16

D ISPATC H EDD ED IC ATED

SHS 2005

CH RISTIAN A REH AB TRIPS BY H OUR OF D AY

0

5

10

15

20

25

30

35

8 9 10 11 12 13 14 15 16

NU

MB

ER

OF

TR

I

M O NTU EW EDTH UFR I

SHS 2005

8 9 10 11 12 13 14 15 16MON

TUE

WED

THU

FRI

CHRISTIANA REHAB TRIPS BY HOUR OF DAY

30-4020-3010-200-10

SHS 2005

HOURLY TRIPS TO AND FROM CHRISTIANA REHAB

0%

2%

4%

6%

8%

10%

12%

14%

8 9 10 11 12 13 14 15 16

HOUR OF DAY

PE

RC

EN

T

TO IP N UFR OM IP N U

SHS 2005

8 9 10 11 12 13 14 15 16MON

TUE

WED

THU

FRI

CHRISTIANA DEDICATED REHAB TRIPS BY HOUR OF DAY

20-2515-2010-155-100-5

SHS 2005

DEDICATED REHAB TRANSPORTER TRIPS PER HOUR

0%

5%

10%

15%

20%

25%

1 2 3 4 5 6

TR IPS PER HOUR

PE

RC

EN

T O

F O

CC

UR

AN

SHS 2005

DEDICATED REHAB ESCORTSTAFFING AND TRIP PATTERNS

0.0

4 .0

8 .0

12.0

16.0

20.0

24.0

6 7 8 9 10 11 12 13 14 15 16 17 18

AV

ER

AG

E H

OU

RL

Y T

RIP

S B

Y D

ED

ICA

TE

D

0 .0

1 .0

2 .0

3 .0

4 .0

5 .0

6 .0

NU

MB

ER

OF

DE

DIC

AT

ED

ST

D ED IC ATED TR IPS STAFF

SHS 2005

INITIAL OBSERVATIONS

# TRIPS INCONSISTENT BETWEEN STAFF# TRIPS OVERALL LOWER THAN EXPECTED“DEDICATED” STAFF NOT AS BUSYASSIGNMENT OF DEDICATED STAFF DOES NOT ELIMINATE DELAYSDEDICATED STAFF “SLOTS” ALWAYS FILLED

SHS 2005

INITIAL OBSERVATIONS

STAFF FINDING REASONS TO EXTEND CALLSSTAFF FINDING WAYS TO “DISAPPEAR”DELAYS TO FIND EQUIPMENT –INFREQUENTACTUAL TRANSPORT TIME FROM 3-5 MINUTES

SHS 2005

INITIAL OBSERVATIONS

DISPATCHERS NOT ABLE TO WATCH “BIG PICTURE”SIGNIFICANT VARIATION IN DEMAND BY HOUR OF DAY AND DAY OF WEEK

SHS 2005

CHANGES NEEDED

INCENTIVE TO TAKE CALLSSUPERVISION IN DEDICATED AREASFLEX DEDICATED STAFFADDITIONAL SUPERVISION TO MONITOR “BIG PICTURE’

SHS 2005

IMPLEMENTATION

INDIVIDUAL PERFORMANCE GOALSJOINT SUPERVISION FOR DEDICATED STAFFDISPATCHING DEDICATED STAFFDISPATCHERS ASSIGNED AREASRENOVATION OF DISPATCHER WORK AREAADDED 1 DISPATCHER

SHS 2005

IMPLEMENTATION

NEW DISPATCH CONTROL DESKRECOGNITION

SHS 2005

PATIENT ESCORT PRODUCTIVITY

0.0

0.5

1.0

1.5

2.0

2.5

3.007

/12/

2003

08/0

9/20

03

09/0

6/20

03

10/0

4/20

03

11/0

1/20

03

11/2

9/20

03

12/2

7/20

03

01/2

4/20

04

02/2

1/20

04

03/2

0/20

04

04/1

7/20

04

05/1

5/20

04

06/1

2/20

04

07/1

0/20

04

TRIP

S/H

OU

R

SHS 2005

CHRISTIANA PATIENT ESCORTON TIME PERFORMANCE

60

65

70

75

80

85

90

Jul-03 Aug-03 Sep-03 Oct-03 Nov-03 Dec-03 Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04

PER

CEN

T O

N T

IME

SHS 2005

TURNING POINTS

DEPARTMENTS USING DEDICATED STAFF SEEING ACTUAL WORKLOADSETTING # OF TRIPS PER SHIFTINCORPORATING GOAL IN PERFORMANCE STANDARDS

SHS 2005

PATH FORWARD

ESTABLISH APPROPRIATE STAFFING LEVELS FOR STAFF IN “DEDICATED” AREASDISPATCH ALL STAFF BY RADIO