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Collaboration, coordination keys to 11 a.m. discharges, length of stay

Throughput is one category of PIP performance and it combines two measures: success with 11 a.m. discharges and length of patient stay. Each measure has its own goals and together they account for 10 percent of PIP.

"Getting the right patient into the right bed at the right time is how we define throughput," says Victor Morris, MD, associate chief of staff, and vice president, Physician and Patient Access.

"Discharging patients at 11 a.m. and decreasing length of stay involves many, many moving parts," he points out. "Success requires team effort and commitment."

Dr. Morris says that the Q3 PIP scores reflect how seriously employees have taken these i nst ituti on al goals. At almost 24 percent , 11 a.m. dis c harges exceeded the maximum for the quarter and, at 5.12 days, length of stay was just shy of maximum of 5.1.

11 a.m. discharges In the past three years, departments have learned to develop and use data to see what is holding back efficiency. Once a problem is identified, teams coordinate to correct the bottleneck.

For example, Environmental Services (EVS) determined that once a patient was discharged, it took aides about one hour to clean the room for the next patient. They closely studied those rooms where it took more than an hour to see what the problem was.

Adjusting curtains or getting supplies often requires a ladder and finding that ladder slowed them down. Now all EVS carts carry ladders, allowing EVS associates to stick to their schedules.

"In 2007, we discharged only 9 percent of our patients by 11 a.m.," observed Dr. Morris. "For the past few weeks, we have consistently hit 26 percent discharges and this eases pressure on the patients being admitted from our Emergency Department and the PACUs."

Length of stay Dr. Morris is the first to point out that length of stay is a challenge in a hospital where its transfer center, Y-Access, last year admitted nearly 4,000 additional patients — many of whom required longer lengths of stay because of the complex nature of their illnesses. In June, YNHH accepted more than 360 transfers and more than 400 in July.

"Yale-New Haven is a respected destination hospital because of the level of expertise we offer in treating extremely ill and injured patients," said Dr. Morris. "We are able to consistently and safely handle this kind of volume because so many teams work out ways to free up the right beds and keep the process moving efficiently."

For example, Patient Transport looked hard at its data that showed that it was taking transporters longer to move patients. On close inspection, they discovered that a change in state law was slowing them down. When picking up a patient, patient transporters could no longer unhook oxygen from the wall; only a nurse or respiratory therapist could. Transporters worked with nurses and respiratory therapists to streamline the process and regain their efficiency.

Some areas have excelled at decreasing length of stay such as the Psychiatric Hospital, which is reducing LOS for some of its patients by developing relationships with skilled nursing and long-term acute care facilities when it is appropriate. Dr. Morris also praised the work of care coordinators throughout the hospital — particularly in the Adult Emergency Department where they effectively screen patients and send appropriate candidates to an observation unit or return patients to their homes once nursing care has been arranged.

"To be successful with 11 a.m. discharges and reducing length of stay requires the participation of all employees," said Dr. Morris. "Safe patient care does not relax and it does not take vacation so we need round-the-clock commitment to these institutional goals. Employees have helped us make dramatic improvements and will continue to improve in these two important areas of safe patient care."

 
Yale-New Haven Hospital news release
ynhhpublicrelations@ynhh.com

Yale-New Haven Hospital is a nationally recognized, 1,541-bed, not-for-profit hospital serving as the primary teaching hospital for the Yale School of Medicine. Yale-New Haven was founded as the fourth voluntary hospital in the U.S. in 1826. Today, the hospital's two New Haven-based inpatient campuses include Yale-New Haven Children's Hospital, Yale-New Haven Psychiatric Hospital and Smilow Cancer Hospital. YNHH has a combined medical staff of about 4,500 university and community physicians practicing in more than 100 specialties. YNHH's York Street campus and associated ambulatory sites are Magnet-designated by the American Nurses Credentialing Center.

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