V2kickoff dataancillary

Abbott Northwestern HospitalAbbott Northwestern Hospital

Emergency DepartmentEmergency DepartmentScope Definition StudyScope Definition StudyVisit TwoVisit Two

FreemanWhite FreemanWhite Emergency Department Emergency Department Consulting TeamConsulting Team24 March 201424 March 2014

What Separates FreemanWhite280+ Emergency Departments

Introduction to FreemanWhiteDevelopment of a Comprehensive Healthcare Consulting & Design Firm

A Focus on our ClientsBusiness Success

StrateStrategygy

Strategists

Strategic PlanningBusiness PlanningMarket Analysis

OperatioOperationsns

ProcessEnginee

rs

Operational AnalysisProcess

ImprovementStaffing Analysis

TechnoloTechnologygy

FacilitiFacilitieses

Low Voltage SystemsCommunications / ITMedical Equipment

Technology

Planners

PlanningDesignInterior

ArchitectureEngineering

ArchitectsEngineers

ED Consultin

gTeam

The Team

• FreemanWhite TeamJon Huddy, AIA, Managing Principal,

Lead Programming, PlanningChris Morales, AIA, Project Lead ArchitectJim Jepson, AIA, Senior ED DesignerKristyna Culp, MBA, Data and Process AnalystFreda Lyon, RN, MSN, NE-BC, ED Clinical Specialist

• Michaud Cooley EricksonGreg Trende, PE, Engineering Systems Analyst

Architectural, Engineering and Process Analysis Team

ED DesignFlexible Efficient Physical DesignSolution

Four Step Process to Success

The task of designing your physical environment is the opportunity to create the way that you will deliver care in the future.

AnalysisStrategiesPatientsOperations (lean)TechnologyFacilities

FutureVisionDefine lean Operations,Technology,And Customer Service Patterns

Project Scope DefinitionEarly Design Concepts

1 2 3 4

March 14March 24-25

April 10-11

April 22-23

May 20

Next Visit: March 24-25

Project Success

• “Care design that fits into the existing space”,• “No redesign within 5 years (Stands the Test-of-Time)”,• “Flexible design that adapts to changes in the marketplace”,• “Establishes a sense of community pride”,• “Efficient and beautiful”,• “A safe and comfortable healing environment”,• “A plan that accommodates family needs (family spaces)”,• “Good Ancillary support (buy-in from other departments)”,• “Great environmental systems (no need to think about

heating/cooling problems)• “Mix of specialty spaces combined with flexible general

spaces”,• “Need to focus on raising the level of care for stroke patients”• “Need consistent process that can manage surge capacity”

March 14, 2014

Current Likes

• Close to Imaging• Redundancy of treatment spaces• Current team profile (3 nurses + 1 provider)

March 14, 2014

Current Dislikes

• Good side (North ED) VS Poor side (South ED) “ Hawaii VS Bosnia”,• Storage Poor (need more appropriate storage for supplies and

equipment),• Some rooms do not work ergonomically,• Need to better accommodate older, sicker and larger patients,• Many rooms are not set up the same (need to have a universal layout),• Some bedside charting areas place the backs of staff to the patients,• Poor I.T. Access (need flexibility for current and future Technology),• Public access elevators in the middle of ED flow• Not enough patient toilets,• Noisy environment (little privacy), esp. in East work area• Charting areas not near patient care• Poor proximity to supplies, meds• No good, consistent space to wash hands• Mental Health situation unsafe• No grieving area

March 14, 2014

Comments/Issues/Concerns

• Little or no Peds volume (Peds hospital across the street),• Psych – 15% of volume is adolescent with 6-7 hour stays

average,• OBS (CDART) may move somewhere else, • Need improved supervision at walk-in entrance (assure public

and staff safety)• 55K annual volume for future benchmarking,• 22-25% of volume are ambulance patients,• North ED opens at 9:00 am-3a, East ED opens at 11:00 am-9p

or 11p• Behavioral Health is not in the Data set (look for A&R Consult)• Interaction of Heart Center Hospital pts• HVAC separate from Heart Hospital• Need Hot water and working sinks

March 14, 2014

Updated Data

• Behavioral HealthMental Health Designation =~7%ICD9 diagnosis codes=~9% 15% adolescentsIncludes Drug and Alcohol

• Imaging• Data by Day

Behavioral Health Volume 2011-2013

Behavioral Health Average Volume/Day/month 2013

Behavioral Health Average Volume/month 2013

Behavioral Health Average Volume/Day of the Week 2013

Behavioral Health Average Volume/hour 2011-2013

Behavioral Health Volume/Treatment Location 2013

Behavioral Health Disposition Percent 2013

Behavioral Health ALOS, D2X by Dispo 2013

Behavioral Health Arrival Distribution 2013

Behavioral Health ALOS, D2X by Arrival Mode 2013

Behavioral Health ALOS, D2X, 2011-2013

Ancillary Department Input

Ancillary Department Meeting

• What works?• What doesn’t?• New changes happening soon?

Behavioral Health

• Insufficient space for volume• No space • No designated room(s)• Have good relationship with ED• Would like Obs type option for MH• Not safe• A&R in close proximity to department• Have up to 3 staff on need space• Do telehealth assessments, need space.• Panic button per person• Check distribution of LOS

BioMed

• Will be replacing telemetry this year• Need to install AeroScout to find devices• New system allows staff to check on repair schedule• Incorporate space for minor repairs currently 20m walk to

work space• Need celling lifts in every room, most don’t have enough

room for portable lift

Integrative Med

• No space• Need alert in EDIS, use phone now• Sharps containers on both sides of room• Space in triage area for simple tx• Huge focus on this approach from donors, need to expand

Cardiology

• Quick TAT• Communication is good• Amb entrance to tx is issue, past elevators• EDIS is difficult when pt moves quickly from ED to CathLab

etc doesn’t accommodate quick moves

Cardiac Emergenc

Data Support

• Reporting and acquiring data is slick• Need more focus on quality

EMS

• Need smaller amb or bigger space (new trucks are much larger than older versions need more space

• Flow is rough• Garage holds up to 10 trucks• DC and Amb drop off in garage• Street to Entrance to treatment space• Decrease backing in, prefer drive through • Works stemi process• Transports always ready once EMS arrives• Communication is good

Endo

• Designated RN from ED for sedation • Adequate suction• Issue with communication of order• Most work is after hours• Would like a secure cart storage area for after hours

EVS

• Need space for water in and out• Finishes will be important• HK closets

Disaster Planning

• Communication for training is great• Decon shower is portable need built in• Decon equipment storage space need

Linen

• Need storage space for 5-6 carts• 1500-2000lbs linen/day (most 24h =500lbs)

Equipment services

• Room size • Bariatric eq needed• No consultation rooms• No quiet rooms• Transport process works well• Computers in each room• Need dirty room for equipment cleaning

Hospitalist

• Need overflow area for patients when admit process blocked with privacy for interviewing

• Need more stations for charting outside of doc area • Need ability to get accurate pt weight

Orthopedic Surgeon

• Imaging TAT, moving patient over and back• New space further from imaging• Variable assistance staff and equipment

Infection Control

• Need more isolation rooms and ability to surge for isolation• Sinks/handwashing• TLT in ED rooms (some)• Finishes work with Allina standards

IS

• Need data closet space!!! At max cap currently• Downtime for EPIC will be better in the future, decrease time• Looking at pt ed system• Moving to Tablets for providers• Moving to wireless phones• Portable xray• Bedside bar code• EDP order preference list

Lab

• Located in ED• Labels print in ED lab• Close to everything• Paging system works well• Room sq. footage ok but layout poor and poor ventilation• Closet size may not work for future volume• Need dirty sink for sample void• Need good wireless connect• Need to be close to tube• Phlebotomist in ED since 2006• Moving to bedside bar code system and label printer on cart

Materials Management

• Implemented centralized supply area• Need more space for bigger bins for 3 days worth of supplies,

currently have 1 day• Disaster supplies are across campus

Mother Baby

• Getting pt to appropriate space• Trying to share protocols• Far away from ED across street• Make sure >20wk pts are treated quickly• Need space for equip and supplies• Communication chain for postpartum pts

Rad

• Proximity good• Communication good• Poor prep/recovery area• Moving to bar code system for portable rad• Need to standardize supplies and equipment• Need to think in the future about using imaging prep area for

surge

Registration

• Communication with triage is good• But privacy is not• Some issues with EMR numbers as RNs arrive pts instead of

reg• Bedside reg difficult in small rooms

• Expanding financial counseling role to evenings and weekends will still go to bedside but need office

• Would like one reg booth to reg (family) when queue for bed forms

Respiratory

• Wireless phone system works• Always keep one Vent in the ED • Bipap unit not consistently stored in ED• No piped med air into ED

Security

• Communication with leadership• Secured perimeter but could be improved with better glass• Need perimeter lock down• Pt valuables are locked• Gun locker in place• BH suite needs to be together • Violence prevention in design• Need camera coverage esp BH• Securable psych rooms and/or flexible tx rooms• Radio coverage is difficult • Remote access for triage to buzz someone in• Panic devices need throughout• Lobby needs to be more visible• TLTs need to be close to phones??• Security needs to be in lobby visible• Need TVs in rooms

Trauma

• Need shorter distance to room from amb• Pt out within 30m is goal• Otherwise works

Telehealth

• Need space for mobile Telehealth carts will be wireless but also need data drops.

• Need area for medical staff to conduct tele health visits with other organizations/hospitals

• Area needs to have audio and visual privacy. there will be 2 -3 monitors for the MD to use for the visit. (1) to view the patient, (1) to document in the EHR and (1) for image viewing