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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


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


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

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


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

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

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

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