the art of ed patient flow

The Art of ED Flow

©2014 Sean Carney, LLC.Sunday, February 23, 14

ED Flow Hubs

IntakeThroughput

OutflowSurge CapacityFlow CatalystsInfrastructure

Patient Satisfaction

© 2014 Sean Carney, LLCSunday, February 23, 14

ED Patient Intake

Sunday, February 23, 14

Ambulatory

• Disrupt Triage

• Eliminate or Flow Gate

• Rapid Entry Only

• Keep vertical/vertical

• Consider segmenting the unscheduled lower acuity

• Protocols during delays

• Implement Kiosks/Greeters

• Consider Call ahead programs or mobile

© 2014 Sean Carney, LLC

ED Patient IntakeEMS

• Consider mapping EMS triage through main triage.

• Protocols

• Kiosks/Greeters

• Call ahead programs


ED Throughput


• ED Sub-system management

• Push/Pull concept

• Bilateral flow monitoring

• Shared targets

• Imaging, lab, EVS, Transport, Pharmacy bed control, etc.

ED Partner Relations


ED Cascading Communications• Agile ED Operations

• Regular quick standup-No sitting!! No more than 10 min

• Running the board

• Everyone participates

• What do you need from me to keep flow for every patient

• Administration attends, listens and fixes, has no direct role


Cascading Communications ED Team

• Cascades down from Agile Ops and continues through team

• Decentralized

• Running the board-target times

• Regular team rounding-what are we waiting for?

• Defining “done” at first patient interaction

• Identifying potential admissions at first patient interaction


ED Leadership Cascading Communications

• Facilitate Agile Ops and decentralized team communications

• Running the board

• Eliminate flow blocks

• Initiate escalation and decompression plans

• Responsible for Intake and Output targets


How to Eat The ED Elephant (please don’t really eat elephants)


Make The ED Smaller• Break the ED and staff up

into teams or functional areas

• Areas mirror each other in clinical operations and size

• Scalable based on studied ED patient demand

• Team owned and incentivized


ED Tracks Or Pods• Scalable by hour and day of week

• Breaths with predictable and non-predictable surge

• Mirror in capability and capacity

• Generalize ED beds, avoid specialty rooms.

• Stop saving code rooms use for patients be walked out quickly when needed


ED Output• Optimized Discharge Flow

• Identify “done” target

• Think flow constraints

• Pre-plan logistics

• Optimized Admission Flow

• Same as DC flow + early admission potential

• ETA to Admit Units

• Push and Pull Incentives© 2014 Sean Carney, LLC


Flow Catalysts


Flow Technology• Identify and implement technology via

ROI that can enhance flow or reduce staff tasks

• Real time flow monitoring systems

• Automate, automate, automate

• POC testing

• Kiosks

• Telemedicine

• mobile applications

• Smart rooms© 2014 Sean Carney, LLC


Flexibility in Flow• Flexibility

• Designated ED flow coordinators

• Scribes

• Task Shifting and Sharing

• Call Systems

• Cross training© 2014 Sean Carney, LLC


ED Infrastructure

ED PlanningDeveloping Cultural Sense of Urgency


ED Planning• Pertinent to

Operational Flow

• Functional Capacity

• Daily ED team logistics

• Defined roles and responsibilities


ED Team Design• Bonsai Teamscaping™

• Leverage data to allocate staff not “feel”

• Strategic resource usage

• Align functional capacity to demand by

• Hour of day

• Day of week

• Season

• ED flow should have consistent functional capacity based on demand need not on vacation, sick call, etc.


Designing An Urgency Culture

• First before you go

• Set Staff Up for Success

• Design Flow

• Staff led

• Standardized

• Scalable

• and Simply to follow© 2014 Sean Carney, LLC


ED Urgency Culture Shaping• Bonsai

Teamscaping™

• Hiring analytics

• Staff led collaborative flow design teams

• Staff ownership of processes and targets


Commander’s Intent

Incentivize your people, give them the latitude to do

the right thing. Lead by example so they will

maintain operations when your not forcing it.


ED Surge Planning


ED Decompression• ED focused standardized

scalable plans based on LOS and/or volume to make ED

• Temporarily bigger

• Temporarily faster

• Or both

• Objective is to regain smooth flow

• Example-Inside forward flow waiting areas to add capacity


ED Escalation System

• Facility wide standardized, documented escalation system based on ED LOS and/or volume

• Provides common language across facility

• Leadership line of sight to ED operations

• Layered escalation system


Patient Satisfaction


Patient Satisfaction • Patient Satisfaction Relates To LOS.

Simple

• Everything else is a workaround

• Greeter/Rounders

• Real time monitoring

• Communication strategies

• Service Recovery systems© 2014 Sean Carney, LLC


Thank You

www.seanmcarney.com@seancarney


http://www.seanmcarney.com




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art of ed flow2014 sean