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Real Time Demand Capacity (RTDC) Approach

Identify

Barriers to

Accomplishing

Plans

Focused

Improvements

on Barriers

Real-Time

Matching of

Capacity to

Demand

Shift/Add

Capacity to

Address Large

Mismatches

Copyright © 2012 Institute for Healthcare Improvement

Months: 3 6 9 12 24

. . . .

Larger

Improvement

Projects

Hospital Bed Meeting:Its Role in Real Time Demand Capacity Management

This presenter has nothing to

disclose.

October 23, 2014

Session Objectives

Describe the key components of a hospital-wide

bed meeting

Make comparisons to participants’ existing bed

meetings

UPMC Then: Hospital Bed Meeting

Bed Czar

“keeper of the beds”

Surgical Unit“I am not going to fit”

“I need 2NA/1RN for E”

This Bed Meeting Format Led To:

Increase ED border hours

Long PACU stays

PACU holding post-op patients overnight

Off-service patients on every unit

But most of all, this process led to….

6

Sharing About Your Bed Meeting

Sharing Prework

At your tables, briefly describe your daily hospital-wide

bed meeting. (Include start time, length, participants,

objectives, and, in general, the format.).

What are the weaknesses?

Hospital Bed Meeting

Let’s take a look at a hospital (Gundersen Health

System) that took the leap

After watching the video, let’s discuss:

“What recommendations you would make to improve

their bed meeting?”

UPMC Now: Hospital Bed Meeting

A mandatory house-wide, interdisciplinary meeting held each morning to assess the status of capacity and demand by unit and develop plans when there is a mismatch. The meeting focuses especially on the next 6hrs.

It’s not about staffing

Key Participants at Bed MeetingInpatient Units

Case Management

Emergency Dept

PACU /CCL

Infection Control

Nursing Leadership

AOD

Transport

Cardiology

EVS

Hospital Bed Meeting

Recipe for Success

Hospital Bed Meeting

Standing start time

that does not vary

Consistent room,

large enough to hold

the entire group

Hospital Bed Meeting

Entire room must be able

to visualize each unit’s

huddle outcomes

Hospital Bed Meeting

Prior to start of bed

meeting…..units

have informal

discussions about

pending transfers

Hospital Bed Meeting

Each nursing unit must report the outcome of their unit huddle (to measure demand / capacity for the day) and any informal discussions

This information is entered onto a screen for all to see

Hospital Bed Meeting

Attendance at the bed

meeting is not optional

Calling information in,

texting or emailing

information is not

acceptable

Hospital Bed Meeting

Ancillary support departments’ attendance is equally important and expected daily

Problems can be solved on the spot with ancillary partners present

Hospital Bed Meeting

Consistent leadership

presence is essential

Hospital bed meeting

should be chaired by

nursing leadership

(Director level and

above) and Care

Management

leadership (Director)

Hospital Bed Meeting

Once all units have reported the outcomes of

their unit huddles meeting should begin

Important that everyone in the room can

visualize the spreadsheet with outcomes and

easily see where the issues will be

Hospital Bed Meeting

Unit

Available

Beds DC's

Transfers off

Unit

DC /Tsfs by

2pm

AdmissionS: ED,

ORs, CCL,

DIRECTS, etc

Transfers

from other

Units

Admits

by 2pm

Status at

2pm PLANS

12E 1 8 0 3 8 0 6 -2

11E 0 12 0 8 9 1 6 2

10E 2 6 1 1 9 0 4 -1

9E 4 8 3 5 7 3 4 5

0

0

0

Hospital Bed Meeting

12E – you are are at a minus 2

– You have predicted 8 discharges for today but

only 3 of them leaving by 2pm

– Of the 5 discharges leaving after 2pm – are

there any opportunities to put a plan into

place to move 2 of those discharges earlier?

Hospital Bed Meeting

10E – you are at a minus 1

– You predicted 6 discharges for today, but only

1 leaving by 2pm. Is there any opportunity to

put a plan in place to move any of the other 5

discharges up to a time before 2pm?

Hospital Bed Meeting

We have 17 discharges and transfers predicted to occur by 2pm and plans in place to try to get an additional 3.

It is important that the moment you incur any kind of barrier in getting your predicted discharges out, you need to escalate that barrier to the proper person

If we can get our 20 discharges by 2pm, the ED and the PACU should not have anyone waiting for beds.

Hospital Bed Meeting

Do any of the ancillary departments have

any issues that we need to be aware of

that might affect our patient flow today?

Let’s look at yesterday’s results.

Summary

The hospital-wide bed meeting is a key structure

for RTDC

Most hospitals will need to make changes to the

objectives and format of their existing bed

meeting when implementing RTDC

Observing your bed meeting with the steps of

RTDC in mind is a good learning exercise

24

Exercise

Identify and discuss at your tables two things you

would do differently in your bed meeting.