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Ann E. Hanford, MA, BSN, RN | NYU Winthrop Hospital
Assistant Vice President of Capacity Management and Patient Flow Optimization
Her passion for automation and data led her to successfully implementing a stand-alone electronic ICU nursing documentation system in the early days of the healthcare “computer age.” Ann challenged and grew her organization’s IT department capabilities early on with the successful implementation of their first internet/web based healthcare application: an electronic admission request system on behalf of patients whose discharge plan included inpatient post-acute care. Ann was most recently instrumental in advancing electronic automation of patient care at her organization when she implemented her own custom inpatient scheduling system for all ancillary tests & procedures. Ann holds a Master’s Degree in Nursing Informatics from New York University along with a Bachelor of Science degree in Nursing.
P.S. Learn even more about Ann’s experience with achieving compliance with The Joint Commission’s patient flow recommendation in the Winter 2018 issue of Patient Flow Quarterly.
Introduction: Welcome to the Patient Flow Podcast, powered by TeleTracking. On today's episode of the Patient Flow podcast, we welcome Ann Hanford, Assistant Vice President of Capacity Management and Patient Flow Optimization at NYU Winthrop Hospital. Ann is a visionary who has successfully implemented a variety of web-based applications for NYU. Let's listen in.
Susan: Ann, I understand that the Joint Commission considers the following reasons essential to maintaining patient flow standards, so to decrease overcrowding, to provide timely care to patients through minimization of delays, and to maintain patient safety. When NYU needed to develop comprehensive documentation that would demonstrate that type of compliance, how did you use TeleTracking's reporting capabilities to establish goals, and who was part of the team that you brought together to do that?
Ann: One of the first things I did was run varied reports from TeleTracking just to see what our baseline was and then to start there to establish goals. And I used many different reports, bed tracking reports, transport tracking reports, pre-admission tracking reports, and some portal reports, as well. And so, when I saw what our baseline performance was, then I was easily able to establish goals, which we were to achieve and to set up an action plan.
Susan: The approach you took was extremely comprehensive. Let's just talk about some of the TeleTracking solutions that were a part of your plan and some of the metrics that you were able to achieve with those? Starting off with bed tracking. What type of action plan and metrics did you achieve with that?
Ann: Well, Susan, for tracking beds, what I did was really to establish what our goal would be, what our objectives would be. What I did was to use the institute for healthcare improvements, IHI's model for improvement. They really focused on establishing a global aim and a smart aim (meaning that your goal was specific, measurable, achievable, realistic, and timely). We concentrated on our smart aims, in particular. Our global aim was really to improve the efficiency of our bed-cleaning process, so the smart aim that we used was specifically to decrease our bed turnaround time. The way we did that was through decreasing our response time, because that's where we saw we had an opportunity.
In doing so, we set up an action plan. We used TeleTracking data from the reports. We educated and moticated the staff. We deployed the iPhone devices. We unzoned our high-volume bed cleaning demand time, and we also deployed the bed tracking dashboard. We educated the staff regarding what our goals would be and what they were set out to be.
Our outcomes really resulted in our request to end progress time on behalf of the bed cleaner, which was really our response time, for all intents and purposes, and that decreased by or at least improvement by at least 50% after our action plan was implemented. Also, our request to complete time, so the time from when a requester put in for a bed clean to the time it was completed, we saw and improvement in time of about 33% as a result of our action plan.
We’re very, very happy to see those outcomes and just continuously improve to get better and better. The bed turnaround time is one part of the patient flow process. It's one aspect that's extremely important.
Susan: Regarding PreAdmitTracking, how did you address that performance improvement priority?
Ann: The global aim was to really improve the bed placement time for new admitted patients. Our smart aim was to decrease our admission time to bed occupied time or our request to bed occupied time. How we specifically did that was specifically to decrease our bed request to assigned time but also our assigned to occupy time? How we did that is we deployed some best practices? We centralized our bed placement process. We were not centralized before.
Some services and some units were permitted to assign their own beds, so that was changed completely. We assigned on clean beds only. We had not been doing that. We had been assigning beds in dirty status and in progress status. We also assigned clean beds to patients when they were ready to move, so we had deployed the ready to move function and feature, and we hardwired that. We set an assigned to occupy goal. We also deployed the PatientTrackingPortal on every single patient care unit, and then we subsequently deployed them in each of our portals of entry and saw a great improvement with that. It brought transparency to the units, which I'll tell you about a little later.
We also transported patients timely once the bed was assigned, so that has also decreased our request to occupy time as far as an outcome goes. That has decreased by at least a 50% reduction in that time. Specifically, from request to occupy, I call it the part A, the request to assign, and part B is assign to occupy. Part A, we decreased request to assign by 60% and assign to occupy by 40%. We've had some great outcomes.
Susan: Those numbers are very, very impressive. I imagine, as an additional benefit, patient satisfaction has to be impacted by that. People are getting to where they need to be in a timely fashion.
Ann: We're starting to see some of our HCAP scores related to specific areas of patient flow starting to improve. What I'm going to be looking at more closely is, from our Custom Reporting Solution (CRS) data, are the ready to move to assigned times, because that's really best practice. I have been using our standard reports for this process, but as I delve more into CRS, because we just recently deployed that application. So as I start to build those CRS, those custom reports, I'll be able to look at that. We do only assign on ready to move, but I'm not able to measure that specifically just yet. With CRS, I will be.
Susan: The PatientTrackingPortal performance, how did you address that?
Ann: For the patient portal, our global aim was to increase the situational awareness on every single patient care unit, not only of the patient's location status, but also of their discharge status. The specific aim that we targeted was really to increase our pending discharges or identification of our patients who were pending discharge and to increase that compliance with that use of that function and feature.
Also, in addition to increased use of our projected discharge date and time. We did deploy a discharge readiness program at the same time. What that consisted of is we actually pended patients 24 hours in advance, and what was key there was that when we did pend a patient for discharge, we also notified them of their anticipated discharge, and that was key. We engaged them in their role and responsibility in their discharge plan in that ensuring that they had set up a transportation plan for themselves.
We also, quite uniquely, use the comments field in PreAdmitTracking to enter any pending test and procedures that the patient needed completion of so that they could be medically cleared for discharge and actually graduate to a confirmed discharge. What we used is we entered those pending tests in the comments section, and we actually exported that list to an Excel spreadsheet, which got distributed to the ancillary areas that were responsible for completion of those pending tests and procedures. Upon receipt, they would prioritize scheduling of the pending patients, and they would actually complete those tests and procedures early in the day so that these patients who were pended had an opportunity to be confirmed early in the day and actually depart earlier in the day. So that has been a great success.
As far as an outcome achieved, we've increased our pending compliance rate over time from probably an average of about 42%. We started at only 25% compliance, and we've gone to as high as 67% so far. We've also decreased our percent of discharges by 12 noon. That we have been able to double. Also, our median discharge time has decreased by 90 minutes, or about an hour and a half. Each of these outcomes achieved has really made a positive effect on our patient flow.
Susan: Finally, related to TransportTracking, how did you prioritize that, and what steps did you take?
Ann: Again, using the IHI model for improvement, we established a global aim for transport by improving the efficiency of the patient transport process. Specifically, our smart aim was really to increase the transport trip time. Where we saw opportunity was really, like EBS, to decrease the transporter's response time to the transport request. What we embarked on was an optimization process with TeleTracking, where we completely rezoned the entire physical plant. That resulted in transporters transporting patients more times laterally than vertically.So they were using elevators less often, and they were actually able to decrease their transport trip time, which was our goal, and become more efficient. Also, we had set goals for the transport staff. We had educated them. We motivated them. We also deployed iPhone devices for them, as well. We started a readiness for transport performance improvement project with a lot of the patient care units.
What transport was seeing was many cancellations, and that was definitely impeding their efficiency. As an outcome over all of that, we were able to decrease the transport request to completion time by about 33%. The good news was that we were able to accommodate an increase in volume without having to increase our FTE count. You mentioned patient experience before. What we look at specifically is our test to room transports.
Those have a very positive effect on patient experience. If you were ever a patient, like I have been myself, you never want to wait, especially if I have had a test or procedure performed, it's now completed, and I'm waiting to go back to my room. Those are your test-to-room transports. For those, we targeted those specifically to decrease the time it was taking our patients to get back to their room. That has positively impacted patient experience, because in that, patients have been more satisfied.
Next steps for us will be deploying the access management suite. In particular, the community access portal and also transfer center. I'm looking forward to that. More importantly, from what I'm hearing, the good news is that it sounds as if the community access portal and the access management suite and transfer center will be moving onto the continuum of care and actually looking into community placement, which I'm very excited about. I also have a background in not only critical care but also many years in case management, and I know that was always a challenging area, to have those patients depart timely and receive acceptances timely from post-acute care facilities. So I'm excited to see what evolves from a TeleTracking perspective in that way and seeing how I can leverage that portion of the application.
For my hospital in particular, we don't own post-acute care facilities that are part of our health system, so we always have to go externally. That is probably even more challenging than if you had an internal or within-network post-acute care facility to work with side by side. I'm actually looking forward to the community placement portion.
Susan: Any other goals on the horizon, or what are your next steps? You've had so much success so far.
Ann: I think a next step is just really to mature, probably CRS and our dashboards. They have been deployed fairly recently, and staff are still getting used to how to use them more effectively, so I think that will be our goal. In addition, moving on, then, to implementing transfer center as our next steps. We do about 1,000 transfers a year, so I'm looking to increase that. I've just actually put forth a business plan to do that to our senior leadership, and hopefully, that will happen very soon. Also, community access portal, because we do a lot of direct admissions. Physicians don't have an easy access or easy way of having their patients access our organization now. If I can make that even more streamlined for one patient, it'll be well worth it.
Outro: Thank you for listening to the Patient Flow podcast powered by TeleTracking. We take pride in bringing you insightful conversations with the leading experts in patient flow, as well as tips on industry best practices to help ensure patients get the right care in the right place at the right time.