Jon Huddy, President Huddy HealthCare Solutions ... - SALUS · Photos display Jon Huddy personal design experience as Director of FreemanWhite ED Design Team Resuscitation/Flex Room

Copyright2018HuddyHealthCareSolutions,LLC

Copyright©2018HuddyHealthCareSolutions

Allrightsreserved.Nopartofthispresentationpublicationmaybereproduced,distributed,ortransmittedinanyformorbyanymeans,includingphotocopying,recording,orotherelectronicormechanicalmethods,withoutthepriorwrittenpermissionoftheauthorJonHuddy,exceptinthecaseofbriefquotationsembodiedincriticalreviewsandcertainothernoncommercialusespermittedbycopyrightlaw.Forpermissionrequests,pleasecontactauthor:

JonHuddy,PresidentHuddyHealthCareSolutions3558Dobys BridgeRdFortMill,SC29715USA(803)[email protected]

www.huddyhealthcare.com


Maximising Emergency Department Capacity Through Comprehensive Design

www.huddyhealthcare.com

Jon Huddy, PresidentHuddy HealthCare Solutions


CompanyBackgroundTeamingwithHealthcareOrganizationsandDesignProfessionalsAroundtheWorld

DataAnalyticsandPredictiveModeling

OperationalAnalyticsandImprovement

MultiCampusandSystemAnalytics

Mergers,AcquisitionsandSatelliteCampuses

StrategicPlanningandMarketAssessment

ServiceLineUtilizationandSystemDistribution

StrategyLedFacilityMasterPlanning

ProjectScopingandPlanningSolutions

Copyright2018HuddyHealthCareSolutions,LLC PhotospurchasedbyJonHuddyfromoriginalphotographers.PhotosrepresentJonHuddypersonalexperienceasDirectorofFreemanWhiteEmergencyDepartmentDesignTeam

DeliveringtheExperienceofOver330EmergencyDepartmentProjectsEasternEurope,WesternEurope,MiddleEast,NorthAmerica,SouthAmerica,Australia


JonHuddy,AIA,NCARBPresident,HuddyHealthCareSolutions

• Leading– Teaming– Consulting• Teamedwithover200designfirms

• EmergencyDepartmentSpecialist• EDstrategicplanning

• Leanoperations

• Marketanalysisandutilizationprojections

• Scope/feasibilitystudies

• Architecturaldesign

• AuthorofTwoEDDesignbookspublishedbytheAmericanCollegeofEmergencyPhysicians

• EDsfrom2,000to200,000visits


EDUseRatesAcrosstheWorld(QuantityofEDvisitsper1000population)

6

EDVisits Population EDUseRate Year

SaudiArabia 15,000,000 24,580,000 610/1000 2006

Spain 25,000,000 46,160,000 542/1000 2008

Italy 30,000,000 59,100,000 508/1000 2009

UnitedStates 141,400,000 321,000,000 440/1000 2015

Israel 2,869,000 8,060,000 356/1000 2013

Canada 12,800,000 36,290,000 353/1000 2016

England 20,458,000 65,111,143 314/1000 2015-2016

RegionHalland(Sweden)

88,000 300,000 293/1000 2015

HongKong 2,000,000 7,072,000 283/1000 2011

Finland 1,320,000 5,313,000 248/1000 2008

Germany 12,000,000 82,270,000 146/1000 2007


Utilisation impactsinA&E/ED

7

• AgeingpopulationwilllikelyincreaseEDvisitsaswellasincreaseEDacuities,admissionratesandLOStimes.

• Toincreaseavailablecapacityyoueitherneedtolowervolumes(goodluck!),increasetreatmentspaces(increasedcapitalcost)ordecreaseLOS

IsraelPopulationGrowthbyAge

85+

65+



8



AustraliaPopulationGrowthbyAge

75+

65+



9



EnglandPopulationGrowthbyAge

75+




11



EnglandPopulationGrowthbyAge

75+


RoomUtilisation andNumberofExamRooms

• HistoricalEDtreatmentroomprogramming• Focusedonaverage“patientsperroom”overthecourseofayear

• Attempttosplitpatienttypesbyacuitiesandprogramexamspaceneedsforeachacuitylevel• Roomquantitiesnevermatchedactualneed

• RecommendedApproach:• Focuson“clinicalroomusetime”forspecificpatienttypes• Howlongpatientsneedtobe“inanexamspace/room”isthedefiningfactor• Complex“HuddyBinBMethod”


PatientSpaceCapacity:Operations+Facilities

1300to1700AnnualVisitsTyp U.S.Planning

AnnualCapacityofTreatmentSpace

1000Visits

2000Visits

3000Visits

4000Visits

5000Visits

0

Less

Cap

acit

y

Mor

e C

apac

ity

2800to3100AnnualVisitsUKProgramming


Resusc

ResuscitationRoom350to750annualvisitcapacity

Resuscitation/Trauma365AnnualVisits

750AnnualVisits

1300to1700AnnualVisits

SingleResusc(SmallED)

MultipleResuscitation

Typ U.S.Planning


1000Visits

2000Visits

3000Visits

4000Visits

5000Visits

0

Less

Cap

acit

y

Mor

e C

apac

ity




ResuscFlex

Resusc

ResuscitationwithFlexCapacityApprox 1000annualvisitcapacity• Additionalgasesallowfor

overflowutilizationduringsurgesthusincreasingannualcapacity

PhotosdisplayJonHuddypersonaldesignexperienceasDirectorofFreemanWhiteEDDesignTeam

Resuscitation/FlexRoom365AnnualVisits

750AnnualVisits1000AnnualVisits



MultipleResuscitationFlex-Resusc

Typ U.S.Planning


1000Visits

2000Visits

3000Visits

4000Visits

5000Visits

0

Less

Cap

acit

y

Mor

e C

apac

ity




ResuscFlex

PrivateRoom

Resusc

PrivateTreatmentRoomObservation:Approx 1100visitsUSStandard:1300to1500visitsFastTrack:2200to2600visitsUK:2800to3100visits

PrivateExam/Treatment365AnnualVisits

750AnnualVisits1000AnnualVisits



MultipleResuscitationFlex-Resusc

Typ U.S.Planning


1000Visits

2000Visits

3000Visits

4000Visits

5000Visits

0

Less

Cap

acit

y

Mor

e C

apac

ity




ResuscFlex

PrivateRoom

Resusc

PrivateTreatmentRoomObservation:Approx 1100visitsUSStandard:1300to1500visitsFastTrack:2200to2600visitsUK:2800to3100visits

PrivateExam/Treatment365AnnualVisits

750AnnualVisits1000AnnualVisits1100AnnualVisits




MultipleResuscitationFlex-ResuscCDU;orPsychiatric:8-12hr

Typ U.S.Planning

UKProgramming2200to2600AnnualVisitsStandardFastTrack;Peds


1000Visits

2000Visits

3000Visits

4000Visits

5000Visits

0

Less

Cap

acit

y

Mor

e C

apac

ity

400AnnualVisitsPsychiatric:18-24hr



ResuscFlex

FlexCapacity

PrivateRoom

Resusc

FlexCapacityRoom2000visitannualcapacity• Utilizedasaprivatetreatment

roomuntilcapacityisreachedorduringvolumesurge

• Alternativetohallwaystretchers

FlexCapacityRoom365AnnualVisits






Typ U.S.Planning

UKProgramming

1900AnnualVisitsFlexCapacityRoom

2200to2600AnnualVisitsStandardFastTrack;Peds


1000Visits

2000Visits

3000Visits

4000Visits

5000Visits

0

Less

Cap

acit

y

Mor

e C

apac

ity




ResuscFlex

UrgentCare

FlexCapacity

PrivateRoom

Resusc

UrgentCare/GeneralPractioner3300to3500annualvisitcapacity• Capacitybasedonhoursof

operation

UrgentCare/GP365AnnualVisits







Typ U.S.Planning

UKProgramming

UrgentCare/GP




1000Visits

2000Visits

3000Visits

4000Visits

5000Visits

0

Less

Cap

acit

y

Mor

e C

apac

ity




ResuscFlex

Rapid/Vertical

UrgentCare

FlexCapacity

PrivateRoom

Resusc

Rapid/Vertical/ProtocolSpacesUpto4000annualvisitcapacity• Accommodates80%ofpatients

in16hourperiod• 24houroperationincreases

capacitytonearly4000annually

PhotosdisplayJonHuddypersonaldesignexperienceasDirectorofFreemanWhiteEDDesignTeam

RapidCare/Vertical365AnnualVisits





4000AnnualVisits



Typ U.S.Planning

UKProgramming

UrgentCare/GP

24HourRapid/Vertical




1000Visits

2000Visits

3000Visits

4000Visits

5000Visits

0

Less

Cap

acit

y

Mor

e C

apac

ity




ResuscFlex

SuperTrack

Rapid/Vertical

UrgentCare

FlexCapacity

PrivateRoom

Resusc

SuperTrackUpto5000+annualvisitcapacity

SuperTrack +Subwait365AnnualVisits





4000AnnualVisits

5000+AnnualVisits



Typ U.S.Planning

UKProgramming

UrgentCare/GP

24HourRapid/Vertical

SuperTrack




1000Visits

2000Visits

3000Visits

4000Visits

5000Visits

0

Less

Cap

acit

y

Mor

e C

apac

ity




Amomentofsilenceplease……

TriageAsaPlacethatDelaysCare


CareInitiationA&EDepartment

RN

A&EDepartmentTriage

Inner/Results25

Inner/Results10

Inner/Results10

OverflowPublicWaiting

15

RedistributionofWaitingandCareInitiationPatientand

PublicWaiting60Seats

Consult Consult ConsultHealthBuildingNotes:• Triage• AssessmentPods• RapidAssessment&Treatment(RAT)• Chair-centric• See+Treat•MinorCare


RedistributionofWaitingandCareInitiation


CareInitiation:CombinationofCareSpaces


CareInitiation:CombinationofCareSpaces

ResultsWaiting Chair-Centric Stretchers PrivateSpaces ProcedureRoomsInitialAssessment


ResultsPending

PhotocourtesyDesignGroup,Columbus,OH;OhioStateUniversityWexner MedicalCenterEmergencyRoomRenovation


200,000VisitEmergencyDepartment• 18CareInitiationSpaces(4,500patients/space)

• 20ResultsPendingand20FamilyChairs

• 81,000Patients(40%ofpatientsin11%oftheircarespaces)

20 Patients20

Family


SimulationTestingtoForecastResults


LOSandSatisfactionImpactsofCareInitiationArea(CIA)

38

52

34 34

13

49

36 40 3747

62 63

97

0

10

20

30

40

50

60

70

80

90

100

Sep

'16 Oct'16

Nov'16

Dec

'16 Jan'17

Feb

'17 Mar

'17 Apr'17

May'17

Jun

'17 Jul'17

Aug

'17 Sep

'17

165Min

90Min

60Min

0Min

20Min

40Min

60Min

80Min

100Min

120Min

140Min

160Min

180Min

BeforeCIA DuringCIAImplementation

CIAandSuperTrackOperationsCompleted

DischargeLOSMinutes

CIAProcessImplemented(Feb‘17)

Periodofsomestaffacceptance(Mar-May‘17)

NewHighScore

Percen

tileSatisfactionScore

BeforeCIA CIAImplementation

CIAandSuperTrack


KeyMetricsAcrosstheEntireED



PredictiveModeling:OperationsandDesignV


ChallengeYourselfandYourTeams

• Newwaysofworking• Newworkflowpatterns• Usetheplanning“buildingblocks”inanewway• Increasecapacitywithinthesame,orevenless,physicalspace


Thank You

[email protected]

Jon Huddy, PresidentHuddy HealthCare Solutions

Documents

Jon Huddy, President Huddy HealthCare Solutions ... - SALUS · Photos display Jon Huddy personal design experience as Director of FreemanWhite ED Design Team Resuscitation/Flex Room