ED DISPOSITION TIMEat St. Vincent Williamsport Hospital

Kiera BonebrakeTeam Leader

Abby BullerdickUser RepresentativeRachel Noyes

Administrator

Sara SimsUser RepresentativeLeah SteeleDesignerLindsey WaltzImplementer

LEAN Project• St. Vincent Williamsport Hospital• Critical Access Hospital• Problem with disposition times from Emergency

Department (ED) to In Patient unit (IP)• Disposition time: a measurement of the time when the

physician admits the patient from the ED until the patient is taken to IP unit

• Involves both the ED and IP, however our group’s focus is on the ED aspect

• Main Stakeholders: Patients, Trina Marlatt (CNO), Physicians, RNs, housekeeping, technicians, secretaries, and all other St. Vincent Williamsport Hospital employees

DefineProblem statement:

• The average time at St. Vincent Williamsport Hospital for emergency department (ED) disposition to inpatient admission is 94 minutes.

Background: • Prolonged disposition times and ED crowding compromises care quality, increases costs, and compromises community

trust. Furthermore, ED crowding will be measured by Centers for Medicare & Medicaid Services (CMS) under the Hospital Inpatient Quality Reporting Program initiative. By improving patient flow hospital-wide, this problem can be improved (McHugh, Van Dyke, McClelland, & Moss, 2011).

• The desired level of performance is 60 minutes or less. • Due to the prolonged disposition wait time, the following have occurred:

• Intergroup hostility between units has increased• A delay in patient care has developed• HCAHPS scores have decreased

• Current score of 54.8%• Target score of ≥70%

• There has been a projected loss in revenue to the ED.• According to Pines, Batt, Hilton, and Terwiesch, “A 1-hour reduction in ED boarding time

would result in $9,693 to $13,298 of additional daily revenue from capturing left without being seen and diverted ambulance patients” (2010, p. 331).

Measure: Current State Map

Measure

Analyze

Analyze

Improve: Future State Map

ImproveDeliverables• SAINT Handoff Reporting Tool • Time Data Collection Tool• Bed Placement ChecklistRecommendations• Inpatient RN should always be the one to

transfer the patient from the ED• Inpatient RN ensures PRN orders are obtained

from ED physician during patient handoff in the ED

• Inpatient RN will pick up patient from ED within 30 minutes of bed assignment confirmation

• If inpatient RN does not get patient within 30 minutes then ED RN will transfer patient to inpatient unit

Improve

Control

Control

Management and Leadership Principles•Delegation•“Defined simply as getting work done through others or as directing the performance of one or more people to accomplish organizational goals” (Marquis and Huston, 2012).

•Collaboration•“All parties set aside their original goals and work together to establish a supraordinate or priority common goal” (Marquis and Huston, 2012).

Conclusion• Going forward

• Data collection• Discover more areas of waste

• Implement SAINT tool and bed placement checklist• Continued interdisciplinary communication• Reinforcement of the process by leadership• Scheduling meetings at each interval of process implementation

to evaluate current state and make further improvements• Encourage staff communication