Hospital OffLoad Process Improvement Team

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Hospital Off-Load ProcessImprovement Team

• February 23, 2007

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Project Team

• Team Members
• Jennifer Higgins
• Traci Acton
• Benjamin Abes
• Mariellen Shields
• Janet Quinn
• Paul Hellriegel
• Team Leader
• Shared responsibility

• Team Facilitators
• Eileen Briscoe
• John Norton
• Sponsor
• Deputy Director
• H. C. Hansen

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Define Phase

• Problem statement
• Lee County hospitals are not off-loading EMS
  patients in a timely manner. This results in
  fewer ambulances available for response at any
  given time. It also results in more available
  units having to move around the County to provide
  coverage.
• Justification for project
• Lee County EMS and hospital partners are losing
  opportunities for faster return to available
  status of ambulances and more timely processing
  of patients to admission or release. The effort
  to better manage these resources will pay
  monetary benefits to both.

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Project Impact

• County objective
• Project will prove a savings in unit availability
  hours and manpower. Quicker off-loads will allow
  ambulances to turn around quicker and be
  available for calls, thus potentially reducing
  response times allowing LCEMS to meet the
  benchmark response time of lt 8min 59sec. To
  become more knowledgeable about hospital
  processes and assist hospital partners in
  streamlining the ED intake process. The
  estimated savings is 350,000 using 140/hr of
  unit utilization hour.
• Project goal
• EMS patients should be off-loaded 90 of time
  within 15 minutes of arrival at the hospital and
  within 30 minutes 100 percent of the time.

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Project Scope

• In scope
• All Lee County EMS ambulances.
• Out of scope
• All other transport agencies in Lee County.
• Hospitals in other counties.

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Process Flow Chart

• Please see hand-out.

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SIPOC Diagram
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Measure Phase

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Measure Phase

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Analyze Phase Destination
Coordination
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Analyze Phase Turn Around Times in
ER
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Analyze Phase Available Beds in ER
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Analyze Phase

• Root Causes Found
• Destination Coordination Ambulance clumping at
  ERs
• Available beds at ERs
• Hospital Turn Around Time Hospital boarding
  patients in ER

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Improve Phase Solution
Prioritization Matrix
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Improve Phase Solutions Implemented

• Transportation Destination Coordinator contact
  prior to transport. Transportation Officer must
  be a paramedic
• EMSystems update by hospitals.
• Lee Memorial Hospital ER nurse finding bed space
  prior to EMS arrival.

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Improve Phase

• Pilot ran from February 1st to February 14th
• The only facility implementing all three
  solutions was Lee Memorial Hospital
• Shift Command took on the role of Transportation
  Officer

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Improve Phase

• Results
• Pilot proved a statistically significant
  reduction in the average off-load times for Lee
  Memorial Hospital.
• A decrease in the variation (range).

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Improve Phase

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Improve Phase
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Improve Phase
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Improve Phase
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Improve Phase
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Improve Phase

• Recommendations
• Team to review results with Process Owners and
  hand off (2nd week in March).
• Pilot demonstrated significant reduction in
  range.
• Recommend that process used in pilot be continued
  with Lee Memorial as normal part of operation.
• Recommend that process used in pilot be
  implemented on an incremental basis in all other
  hospitals within county.

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Control Phase

• Process owners
• EMS Shift Commanders
• EMS Transportation Officer

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Control Phase

• Process data to be reported via weekly reports
  from Public Safety Information Resources.
• Data will be in Microsoft Excel format.
• Reports will be input to worksheets which are
  formatted to calculate timelines.

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Control Phase
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Control Phase
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Control Phase
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Hand-off Issues (Parking Lot Issues)

• Hand off should not present any unforeseen
  difficulty.
• Following recommendations will require workload
  adjustment for Shift Commanders or addition of an
  EMS Transportation Officer.
• Future projects will be decided by management
  with recommendations from Six Sigma Steering
  Committee.

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• Questions?