At Arkansas Children's Hospital, the last five years have seen a radical improvement in patient flow and they have the numbers to support their success. As just one small example, time for outpatient arrival to registration is down to less than three minutes through a self check-in process. The self check-in also eliminated need for translators in the check-in process and allowed 45 percent of admitting staff to be reassigned to other job roles.
The technology revamp of the patient flow process has been led by Carol Graham, MHSA, RD, vice president of ambulatory care services, and David Higginson, ACMA, chief information technology officer. Their mission has been to use technology and facts -- not anecdotes -- to track and improve every aspect of flow. Now they have support staff, nurses, physicians and administration all using the same system and have between 16 and 28 timestamps tracked for every single patient visit with all the data availble in real time.
Looking back on their process and continuing improvement efforts, they've mapped the transition down to five steps:
Step 1. Desire to change -- Self explanatory, but without a desire to change, there will never be the support and embrace of new systems.
Step 2. Inject technology
- Through a coordinated effort, touchscreens and badge scanners connected to an electronic dashboard, patient records, bed availabilty, scheduling, etc..., were used to replace paper systems and the emergency department patient whiteboard.
- Touchscreens are outside of every room and used throughout the hospital.
- For registration, a Web-based dashboard was projected on the wall where the old whiteboard used to be to help streamline the change.
- Integrated into the system is an electronic "admissions scrubber" that helps the nurses focus on just what pieces of information they really need on the patient to update their accounts.
- State immunization database is integrated so nurses have shot records handy. Growth charts are integrated and automatic.
- These steps save several minutes per patient.
- Dashboard also keeps record of rooms available and doctors ready to see patients.
- Real bed reservations are visible everywhere in the hospital.
Step 3: Make change stick -- It took 18 months to convince the majority of the staff to transition to the dashboard. There are still a few laggards who are slowly being converted. The hospital has found that giving people funcationality in the system that makes their lives easier has been one of the best ways to entice people to use the system. For instance, the touchscreens are set up to allow staff to clock in and to reset their network passwords if they need to -- two functions that used to be more complicated; when reluctant staff engage the touchscreen system to clock in they also see some of the other funcations that are related to improving patient care, and eventually they make the move.
Step 4: Focus on facts, not anecdotes
- Data makes it possible to drill down and see where challenges remain or where there are anomalies.
- Adapt -- Several of the best ideas came during the implementation process.So data exists to debunk anecdotes and make data-driven decisions. This kind of information is available in real time during meetings.
Step 5: Move to micro-monitoring and micro-adjustments
- Samples are just that. There is no "typical" day in a hospital.
- Online appointment rescheduling is available to patients online.
- You have to look at data and continually look for places to make adjustments to improve flow.
For the future, one of Higginson's pet projects he would like to implement is to look at parking as part of the patient flow. In a perfect world, he'd like to see signage when patients arrive that shows them which lots have how many available spaces. Patients all can swipe some sort of electronic ID card to when they park so that the clinic then knows they are on campus and when they will be arriving. Having patients swipe into parking would provide one more timestamp. More timestamps help provide the data needed to make data-driven decisions on ways to improve patient flow.
Check out the slides and presentation overview, and also read about another patient flow process implemented at The Children's Hospital of Philadelphia.
Discuss:
- Where is your hospital in the process of using technology solutions to improve your patient flow?
- What area in your hospital has the greatest need for patient flow improvement?
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