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Prepared by (15pt Arial) [Insert name of presenter 15pt Arial Bold][Insert title]
[Insert Hospital name]
Month 200X (12pt Arial Bold)
Understanding the business of the hospital
22
Purpose of business of the hospital diagnostic Understand the performance of the hospital
Understand demand for hospital resources – inpatient beds, ED beds/treatment spaces
Understand capacity of hospital and existing capacity constraints
Understand where there is a mismatch in demand and capacity
Identify areas for drilldown analysis
Build understanding of the underlying issues and quantify the impact
Identify delays and reasons for delay
33
Metrics Analysis Data sources
Presentations% admittedNEAT allNEAT admitted to inpatient wardNEAT admit and discharge from EDNEAT non-admittedRepresentations within 24 hoursAverage length of stay Did not WaitLOS in ED >24 hours
ActivityMonthly trendBy hour of dayBy day of week
ED system – FirstNet, EDIS
HIE – ED visit table
Emergency Department business
44
NEAT Performance
45
50
55
60
65
70
75
80
% o
f pa
tien
ts w
ith t
ota
l tim
e in
ED
<=
4 h
ou
rs(C
AL
YT
D)
NEAT PerformanceNEAT Target
55
Length of Stay by Disposition
23.2%
51.3%
65.3%
36.1%
24.0%
28.2%
15.3%
8.0%
4.7%
25.4%
16.7%
1.8%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Admitted Transferred Discharged
% o
f p
rese
nta
tio
ns
LOS in ED<4hrs <8hrs <12hrs >12hrs
6
Patients with ED LOS > 24 hours
0
20
40
60
80
100
120
140
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Coun
t2010 2011
7
ED Length of stay increased in May
7
Data source HIE edvisit table 1/9/2012 – 31/7/2013
2
2.5
3
3.5
4
4.5
5
5.5
6
6.5
7
Av
LO
S in
Ho
urs
ED ALOS by day
88
Admitted and non-admitted LOS in ED
2
3
4
5
6
7
8
50
60
70
80
90
100
110
120
AL
OS
in E
D H
ou
rs
Ave
rag
e d
aily
pre
sen
tati
on
s
ED Presentations by admission status & ALOS
Not admitted Admitted Not admitted ALOS Admitted ALOS
Data source HIE edvisit table 1/9/2012 – 31/7/2013
9
Where do patients admitted from ED go next?
Ward 127%
Ward 221%
Ward 35%
Other Ward47%
1010
Patients staying in ED longer than 1 or 2 days
0
100
200
300
400
500
600
> 1 day > 2 days > 1 day > 2 days > 1 day > 2 days > 1 day > 2 days
2008 2009 2010 2011
Coun
t Specialty 5
Specialty 4
Specialty 3
Specialty 2
Specialty 1
1111
Triage nurse Ax
P/C or liaison with transit
nurse
Admin completes admission
P/C or liaison with acute coordinator
Transit nurse allocates
spot
Patient information entered into
EDIS & HOSPAS
Acute coordinator allocates
spot
P/C or liaison with nurse in
consults
Nursing Ax & Tx
Medical Ax & Tx
Patient waits in WR, ambo,
corridor, transit
Consults nurse
allocates spot
Pathology ordered
IT feed into Web DeLacy
Patient transferred to appropriate
area
Allied Health Ax & Tx
Patient presents to ED
Radiology ordered
Patient to be admitted directly to inpatient ward i.e.
MAU
Inpatient team assess
in ED
Decision to discharge or
admit
MASH
Inpatient Ward
Wardsperson delivers
referral to dept
ED doctors refer to
inpatient team
ED consultant utilises ‘right to
admit’ policy
Inpatient team Ax
patient in ED
Inpatient team accept
patient
Electronic ordering if possible
Paper request
completed – placed in slot
Patients booked for tests other than x-ray
Bloods and request
placed in chute
Triaged by pathology
Completed and electronic results
provided
Tests conducted and electronic
results provided
Patient prepared for
discharge
Doctor completes
D/C summary
Doctor completes med form
Patient departs the
ED
In-charge makes a bed
request
Admin staff to admission paperwork
Process to admit patient and allocate bed
Patient flow or AHNUM
notifiedBed allocated
JMO discusses patient with
SMO
Handover to inpatient
nursing team
Wardsperson transfers patient
EMU
CIN nurse AX and
treatment
CIN nurse orders
investigations
JMO
admit
admit
discharge
Map updatedBy acute
coordinator
Nurse
Doctor
Admin
Pathology
Radiology
Allied Health
Wardsperson
Wardsperson takes patient to radiology
Doctor clicks off on patient and finds Ax
space
Patient waits in CIN
Inpatient team advised of admission
SMO
Doctors handover at
change of shift
Print labels and deliver to
triage
Electronic request note to medical
records
Medical records transferred from chute to inbox on reg desk
Nurse posts discharge
time in EDIS comments
Admin update EDIS
and ATS
Reconcile process and
complete paperwork
Nursing co-ordinator
enters info into EDIS
Admin to bedside to
check info & private status
Patient signs forms if possible
EDIS & HOSPAS updated
Print MR1
Tracking system updated
Map the patient journey
1212
Understanding particular patient cohorts
0
0.5
1
1.5
2
2.5
3
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
Ave
rag
e T
ime
(ho
urs
)
Hour into Location
Paediatrics by hour into location
Av Daily Av time in location (hrs)
13
Metrics Analysis Data sources
Third door and other urgent admissions
AdmissionsSource of admissionDelays
ActivityMonthly trendBy day of weekReason for delay
PASBed management
Elective surgery
DOSA rateDay surgery rateCancellation on day of surgery NEST
ActivityMonthly trendPareto reasons for cancellation on day of surgery
ED system – FirstNet, EDISHIE – ED visit table
Planned medical admissions
AdmissionsDay procedure rateWaiting list – longest wait
ActivityMonthly trend
PASBed management
Inter-hospital transfers
Admissions% via EDDelays
ActivityMonthly trend
FirstNet, EDIS, PASHIE – ED visit & Episode table
1414
Pathways to Admission
1515
Metrics Analysis Data sources
Admitted patient
Day onlyOvernightAverage length of stayRSI
ActivityMonthly trendComparison to peer average and/or HRT benchmark
PASHIE –EpisodeHealth Roundtable
Specialty unit
NEAT by specialtyAverage expected admitsAverage daily dischargesAverage length of stayPatients with LOS >=21 daysRSIUnplanned readmissionsTime from consult request to patient review and report
Monthly trendBy day of weekDischarges by hour of day
PASHIE –EpisodeeMRMedical record review
1616
5
5.5
6
6.5
7
1000
1100
1200
1300
1400
1500
1600
1700
Jul-0
8
Sep-
08
Nov
-08
Jan-
09
Mar
-09
May
-09
Jul-0
9
Sep-
09
Nov
-09
Jan-
10
Mar
-10
May
-10
Jul-1
0
Sep-
10
Nov
-10
Jan-
11
Mar
-11
May
-11
Jul-1
1
Sep-
11
Nov
-11
Jan-
12
Av
LOS
in d
ays
Trend in overnight activity & ALOS
ON Discharges ON ALOS
1717
Long Stay Patients
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Episodes Bed Days
% L
ong
Stay
Pati
ents
> 20 days 14 -20 days 7 -14 days < 7 days
1061
37918
1818
1919
Performance – specialty units
2020
Interface with inpatient teams
Delays in inpatient teams coming to ED to review patients following referral by ED
Triage Into ED S/B RMO/Nurse
First test request
Referral to Snr
Referral specialty
team
Specialty team r/v
Bed request
Patient transfer
MedianMean
0:140:54
0:391:18
0:421:27
2:012:54
2:032:45
4:004:52
7:1810:00
3:554:22
2121
Metrics Analysis Data sources
Wards NEAT by wardAverage expected admitsAverage daily discharges% outliersAverage number of in ward bed movesAverage length of stayPatients with LOS >=21 days
Monthly trendBy day of weekDischarges by hour of day
PASBed managementHIE –Episode and Ward episode tables
ICU Average expected admitsAverage daily transfers outTheatre cancellations due to no ICU bed
Monthly trendBy day of weekTransfers out
HIE –Episode and Ward episode tablesOperating Theatre Management system
EMU AdmissionsAverage length of stayBeds occupied% NEAT
Under Emergency medicineUnder other specialties
HIE –ED Visit, Episode and Ward episode tables
2222
Time to bed request & depart by destination ward
0
100
200
300
400
500
600
700
800
0
2
4
6
8
10
12
14
16
18
Ward A Ward B Ward C Ward D Ward E Ward F Ward G Ward H
No
. of A
dm
its
Ho
urs
Time from triage to bed request and depart
Av Arrival to Bed Request Av Bed request to depart Admits
2323
Understanding daily demand
Ward A Ward B Ward C Ward D Ward E Ward F Ward G Ward H Ward I
2424
2525
2626
EMUTop 10 EMU Admitting Specialty EMU patientsEMU ALOS HrsEMERGENCY MEDICINE 1024 30% 14.5
COLORECTAL SURGERY 316 9% 19.8
GASTROINTESTINAL SURGERY 311 9% 20.3
ORTHOPAEDICS 1 240 7% 15.6
UROLOGY 190 6% 18.8
HEAD NECK ONCOLOGY 185 5% 17.8
NEUROSURGERY 166 5% 29.9
GASTROENTEROLOGY 121 4% 23.3
ORTHOPAEDICS 2 119 3% 15.7
NEUROLOGY 95 3% 30.9
2727
Metrics Analysis Data sourcesRadiology Time to first available
Turn around times (image available)Report availablePlain X RayCTMRIUltrasound
ActivityEmergency department Ward inpatientsIn hoursOut of hours
Radiology information system
Pathology Turnaround times for key testsTroponinFBCUEC
Emergency department patientsWard inpatientsIn hours, Out of hours
Pathology information system
Theatre CancellationsDemand in hoursLate startsBed days taken by patient waiting theatre(also see Elective surgery section)
ActivityMonthly trendEmergency / ElectiveSpecialty , DoctorDay of weekHour of day
Operating Theatre Management system, SurgiNet
Discharge DischargesDischarge delay reasons
Day of weekHour of day Pareto delay reasons
Bed BoardWhy am I still here Study?
Cost High volume above NEP by DRGHigh cost low volume above NEP by DRG
VarianceSpecialty , DoctorDRG
Casemix costing data
28
Delays to imaging
01:48
01:03
00:47
00:00
00:15
00:30
00:45
01:00
01:15
01:30
01:45
02:00
CT Bloods CXR
Tim
e (
ho
urs
:min
ute
s)
Who Owns the Timeline StudyRequest to test completed
29
Radiology Data
3030 Data source: HIE 1/1/2011 – 31/12/2011 Episode
31
3232
Theatre businessMetrics Analysis Data sources•Cancellations•Demand in hours -Operating time•Elective theatre schedule capacity•Emergency theatre schedule capacity•On time starts•Time from triage to theatre for all emergency and non DOSA surgery
•Surgery team overtime•Elective wait lists, not, ready for care, cases on per month and cases completed per month, cases removed (not operated on)
(also see Elective surgery section)
ActivityMonthly trendEmergency / ElectiveSpecialty , DoctorDay of weekHour of day
Operating Theatre Management system, SurgiNet
3333
0
50
100
150
200
250
300
350
400Ja
n-10
Feb-
10
Mar
-10
Apr
-10
May
-10
Jun-
10
Jul-1
0
Aug
-10
Sep-
10
Oct
-10
Nov
-10
Dec
-10
Jan-
11
Feb-
11
Mar
-11
Apr
-11
May
-11
Jun-
11
Jul-1
1
Aug
-11
Sep-
11
Oct
-11
Nov
-11
Dec
-11
Jan-
12
Feb-
12
Planned and other surgical separations
Other Surgical Planned Surgical Linear (Other Surgical) Linear (Planned Surgical)
3434
13.6
15.6 15.816.6 16.5
0
4
8
12
16
20
24
Mon Tue Wed Thu Fri
Hou
rs
Emergency capacity - new schedule
Week 1
Week 2
Week 3
Week 4
Av demand
3535
Voice of the Patient
Clin
ics
War
ds
Pat
ient
Flo
w
Pat
holo
gyED
Patient Journey
Con
sulta
nt P
hysi
cian
s
Imag
ing
depa
rtm
ent
The
atre
s
Alli
ed h
ealth
Com
mun
ity H
ealth
Why do I have to keep
telling my story?
3636
Planning diagnostics Start high level Identify areas of focus Emergency elective demand and capacity Drilldown by Specialty unit, ward Demand and capacity variances
– Time of day – Day of week
Substantiate and quantify root causes of issues Source the data Source the analysis expertise Data management plan