GAME IT Optimizing Patient Flow Dr Moza AlishaqPh

GAME IT Optimizing Patient Flow Dr. Moza Alishaq-Ph. D ED Quality Patient Safety Dr. Jameela Alajmi-MD, ED Infection Prevention & Control

Conflict of interest declaration I hereby declare no conflicts of interest in presenting this session today

Objective : - Ø Ø Definition of patient flow Why work in flow? Key concepts for improving flow Game it practical method to improve patient flow in healthcare system Ø Game it Team Reflection

What Is Flow ? The term ‘flow’ describes the progressive movement of people, equipment and information through a sequence of processes. In healthcare, the term generally denotes the flow of patients between staff, departments and organizations along a pathway of care.

What Is Flow ? David M. Paushter, M. D. , FACR

The 7 Flows • Flow of patients • Flow of clinicians • Flow of medications • Flow of supplies • Flow of equipment • Flow of information • Flow of process Everything Flows Continuously!

The consequences of poor flow are well known: Ø EDs becomes crowded, stressful and unsafe Ø patients are admitted as ‘outliers’ to wards that are not best suited to manage their care, which may mean they have worse clinical outcomes Ø ambulatory care services, clinical decision units, even catheter labs and endoscopy units may fill with patients waiting for ward admission Ø inpatients are shuffled between wards to make room for newcomers Ø staff are overstretched and routine activities slow down dramatically Ø clinical outcomes are measurably worse, particularly for frail older people, who suffer more harm events and may decondition due to extended periods in hospital beds Ø patients’ and carers’ time is wasted due to delays and slow care processes, and their experience is adversely affected.

Lean Applications to Healthcare: The Role of Value Stream Mapping In Patient Flow

Rapid Changes in Healthcare We need to continuously improve the quality of care delivered to our patient, we need to have framework for developing testing implementing changes Improvement tool to engage workers and leaders to Identify Waste process Standard Implement changes Assess results of change Review next step Repeat the process

Spaghetti Framework of Lean Process SFLP Maps staff & patient movement It helps on: Elimination of unnecessary waste Minimize delays Continuous improvement Value Stream Mapping (VSM) STEPS TIME Lean ACTION

VALUE STREAM MAPPING (VSM) Map each step process patient present to medical care from arrival until care completed Find Non-Value Added (NVA) wasteful steps for improvement Value-Added (VA) steps include any step that directly contribute to improvement of the patient medical care/experience. waste Any steps which does not provide value to the patient/family.

Lean Focuses On Reducing Waste To Improve Patient Flow Increase % Value Added Work and reduce Waste to Increase Throughput, Lower Cost and Improve Quality to de i v ro ei lu Va p tely a m ulti ts e w n ice /Patie v r e s or s omer t c t u s rod ur cu p e o s th Mc. Manus – Lean Healthcare – March 2012 – © LAI Ed. Net 18

STEPS TIME ACTION

Future Assessment Process ( Now current) Arrive at A&E Plan for Diagnosis Nursing Obs History & Examination & initial treatment Perform tests & imaging Requests Test & Imaging Senior specialist Review Plan definitive treatment 1 hour STEPS TIME ACTION Safe Ambulatory Care Process Now Possible Transfer to Appropriate specialist area including home with PT/OT/SS Home assessment at home

Lean Focuses On Reducing Waste To Improve Patient Flow Increase % Value Added Work and reduce Waste to Increase Throughput, Lower Cost and Improve Quality to de i v ro ei lu Va p tely a m ulti ts e w n ice /Patie v r e s or s omer t c t u s rod ur cu p e o s th Mc. Manus – Lean Healthcare – March 2012 – © LAI Ed. Net 18

Game it

Game it is of interest to anyone who is involved in: �Patient flow or bed management in a hospital �Receiving patients including A&E staff and ward staff �Discharging patients �Managing staff and resources �Training of nursing, medicine and management disciplines �Patient groups

Skills and Capacity Development: Game it helps to develop professional and personal skills such as: �Capacity Management �Patient flow management �Problem solving �Decision making �Communication �Interpersonal skills �Leadership

The expected outcomes are a better informed and engaged workforce leading to improved operating efficiency.

Game It …………… Back ground Information

Time for game it 1 minute-Select Observer 3 minutes-Roles & Responsibility card for each participants, and the observer read his/her responsibility 3 minutes-Patient cards & Patient Handover 5 Minutes-Prioritize patient between Physician, Incharge Nurse, Bed Manager 3 Minutes-Discharge Criteria Lounge by Discharge Nurse 2 Minutes Morning Bed Meeting by Bed Manager After The game it Done 5 Minutes General Manger to lead the Afternoon Bed Meeting

Game it Team Reflection