Discharge Planning Advisor

'Ideal Patient Day' gives heads-up on care

Schedule serves patient, not just staff

When Elmhurst Memorial Healthcare looked at improving patient throughput, one of the issues that surfaced had to do with housekeeping, which historically had deployed its work force in a way that did not serve the facility, says Matthew J. Lambert III, MD, MBA, FACS, FACHE, senior vice president, clinical operations. "We found that when we needed the most [housekeeping personnel], the fewest were there."

That problem, among others, was remedied with something called the "Ideal Patient Day."

"When a patient is discharged that is put in the computer, housekeeping is notified, and [staff] have a time frame in which they have to respond," he explains. "Rooms don't sit around empty."

However, the concept extends far beyond room turnaround, Lambert says.

"One of the things any physician or nurse will tell you is that in many hospitals, patients are basically diagnosed and treated at the convenience of the particular department that is doing whatever it's doing."

Patients can be resting, having lunch or seeing visitors, he continues, and someone will call and say, "We want to take Mrs. Jones to X-ray."

With the advent of the Ideal Patient Day, all patient activities must be scheduled in the computer, Lambert says.

"If physical therapy wants to see the patient, or radiology, they have to schedule a time, so [everyone involved] knows exactly what's going on with that patient for that day — within reason," he says. "Obviously there could be an emergency that would change that."

Know where your patients are

The new process has been very helpful, Lambert says. "Patients are getting to tests on time, tests are known about in advance. [Staff] no longer come up to the unit and say, 'Where is Mrs. Jones?' and hear, 'I don't know. She must be in X-ray.'"

Computerized screens much like those at airports, but not as large, show where the patient is and what is scheduled, he notes.

The three people who oversee the operations improvement program — Lambert, the chief financial officer, and the director of process redesign — spent a lot of time brainstorming solutions aimed at improving patient care, he says.

The Ideal Patient Day, for example, was an outgrowth of looking at how other industries do things, Lambert adds. "One of the things that piqued my interest was that if you have a package sent by Federal Express, you can get on the Internet and follow that package.

"I started thinking about that and said, 'FedEx treats packages more like people, and we treat our people more like packages. Why don't we take a look and try to figure out how to do that kind of tracking?'"

Using an airport metaphor, he says, it's like having someone in the control tower — the nursing unit — who knows what's going on.

Despite the obvious benefits, implementing the Ideal Patient Day has not been easy, Lambert says. "It has created a lot of controversy in our organization.

"What it has done is it has taken away the autonomy of the department and the individual," he points out. "Physical therapy has been very resistant to scheduling appointments. [Physical therapists] like to show up when they want to show up. The clinical nutritionist is also a little unhappy."

The goal of the initiative is to put control back with the patient, Lambert says, and to get across the message to hospital staff that "it isn't just about you and your timeframe. We have to make sure the patient is not pulled away in the middle of lunch."

While people understand this conceptually, he adds, it's difficult for them to accept that they can't do what they want, when they want.

"When hospitals are facing this issue of capacity, admissions, discharges, getting people in and out, there are no quick fixes," Lambert emphasizes. "You have to go in and look at all departments."

And, he adds, "you have to be ready to get in deeply, measure everything. We break down the ED experience from the time the patient walks in the door to [discharge], with about eight different points and established goals for each of them. We measure not just the overall experience, but each individual segment."

The information that is tracked and presented on a regular basis includes the following:

  • arrival to triage time;
  • triage to room time;
  • room to MD assessment time;
  • time from when patient is placed in room until nurse sees the patient;
  • admission order to bed assignment time;
  • bed assignment to transportation order time;
  • transportation order to depart from ED time.

"One of our major stumbling blocks was the transportation department — delays in getting a transporter," he says. "Now they all have time limits and expectations, and we deploy them to certain areas at certain times of the day."

Improving patient throughput and access to care requires an organizational understanding that there are no independent departments, Lambert points out. "If each department is seeking to maximize its own success, it's at the expense of others."