ahrq annual conference bethesda, maryland september 26-29, 2010 1
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AHRQANNUAL CONFERENCE
Bethesda, MarylandSeptember 26-29, 2010
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Ochsner Medical Center
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Intersections Hurricane Katrina’s crossroads
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Intersections Hurricane Katrina’s crossroads
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Intersections Hurricane Katrina’s submerged crossroads
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ED Crowding Output (admission delays) Throughput (non-lean workflow) Input (poorly engineered demand
management)
“Martha, I am not feeling too well.
Maybe we should go over to the ER
and get triaged!!”
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Solve this problem
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Cracking the code Implement lean workflow
Lean registration Lean triage
Create virtual capacity Door to Doc processing protects the most
precious resource…..the bed Rules based process
Match resources to demand Queuing Theory Grocery Store Math© for EDs
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Cost Analysis of LWBS Net revenue (for real current LWBS payor mix)
Outpatient facility net revenue @ $300/visit discharge (90% of visits )
Inpatient facility net revenue @ $5,000/visit admission (10% of visits)
Professional provider net revenue @ $125/visit all (100% of visits)
1% LWBS @ 50,000 visits = 500 visits
Lost opportunity net dollars for every 500 visits that LWBS
$135,000 facility outpatient revenue (450 pts x $300)
$250,000 facility inpatient revenue (50 pts x $5,000)
$62,500 professional revenue (500 pts x $125)
Cost of 1% LWBS at 50,000 volume = $447,500
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Requires a leap of faith (1) Unlocking old behaviors
No registration up front and no deep dive triage
Dramatically different workflow for staff Reduce scarce real beds to create more virtual beds??????
Patient perspectives “ I never got a bed!”
Privacy concerns
Physician issues No compensation benchmarks for this kind of work… and it is uniquely
different
EM MDs become internal customers…not comfortable position for them
Not every MD suitable for D2D, requires great risk stratification skills
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Requires a leap of faith (2) New roles to manage with odd job descriptions
Flow techs and flow nurses
Administrative issues “Only the uninsured leave”…..not so
Its not about the expense, its about the return (ROI)
Staffing paradigm shift MLPs and LPNs……may be perceived as threatening
Forget FTE hrs/visit……think cost/visit
Rules! Lean processing at registration and quick look
Intake beds must be protected at all cost…almost.
Accountability for the WR
Internal queuing always….not in the WR
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Joe Guarisco MD FACEP jguarisco@ochsner.org 504-842-4433
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