Title : Room ready rumble wrestling with turnover times
Abstract:
In an effort to enhance patient care and operational efficiency, a new room turnover process was implemented for patients being admitted from the emergency department. This initiative aimed to decrease length of stay, improve productivity, enhance patient experience, eliminate waste, and foster teamwork. Key changes included the establishment of standards for Inpatient Nursing, Environmental Services (EVS), Transport, Bed Placement, and the Emergency Department (ED). A multidisciplinary four-day Rapid Improvement Event (RIE) was conducted, engaging key stakeholders from the Emergency Department, Transport, Environmental Services, medical/surgical units, informatics, and various leaders, utilizing a Lean approach. The primary objective was to enhance operational efficiency and patient care processes. During the event, the current state was carefully mapped, and a comprehensive gap analysis was performed. This process identified significant waste within the current system, along with root causes, potential solutions, and anticipated outcomes. An initial target state was subsequently developed. To validate the proposed changes, a small test of change was implemented on two medical/surgical units during the RIE. This phase aimed to uncover any immediate issues and refine the approach. Following successful tests, new standard work protocols were established. The newly developed standard work was then piloted on two inpatient medical/surgical units to ensure its effectiveness and to identify any additional barriers prior to a broader, system-wide implementation. The pilot phase confirmed the viability of the changes, paving the way for a comprehensive rollout aimed at improving overall healthcare delivery and operational efficiency. The process was redesigned to enable parallel actions rather than sequential tasks, reducing delays. Discharge information is now entered into EPIC within 5 minutes, nursing staff strip beds immediately upon discharge, and the ED updates the SBAR within 30 minutes, which is then checked by inpatient nursing prior to patient arrival. Automatic triggers for EVS and transport ensure timely room cleaning and patient delivery. This sequence allows patients to arrive as room cleaning finishes, significantly reducing the mean time from discharge to room occupancy. The new process promotes standard work across many areas, ensuring consistency and adaptability to personnel changes. It emphasizes collaboration, with each department understanding and contributing to the overall efficiency. For instance, nursing strips the room to expedite EVS cleaning, and EVS cleans beds in situ to avoid unnecessary delays. This collaborative approach has streamlined room turnover, enhancing overall hospital efficiency and patient care.
Key improvements include:
- Discharge Order to Bed Assignment: Reduced 68 minutes, a 29% improvement.
- Bed Clean and Ready to Patient Leaving ED: Reduced 7 minutes, a 16.3% improvement.
- Clean and Ready Bed to Patient Occupy: Reduced 9.5 minutes, a 16.5% improvement.
- Dirty Bed to Occupy: Reduced 70 minutes, a 24% improvement.
- Patient are moving from the ED 50 minutes faster.
- In 6 months, this saved 384,200 minutes equating to over 6,400 hours of reduced ED wait time
From May 2024-August 2024, there has been a steady decline in the median minutes required to complete all tasks. This period demonstrates a consistent and significant reduction in task completion times, reflecting enhanced operational efficiency.
