creating flexible space out of existing space
TRANSCRIPT
Bakersfield Heart HospitalCreating Flexible Space Out of Existing Space
September 21, 20111:30pm to 3:00pm
Presenters• Michael Bell, MBA Vice President, Operations
Bakersfield Heart Hospital• Phillip Bahr, AIA Associate Principal
Cannon Design• Joseph Livengood, MD, FACS Acute Care Surgeon
Medical Center of the Rockies
Learning Objectives
• Identify patient entry point and flow characteristics unique to the Cardiac Hospital.
• Evaluate the use of a Flexible Care Unit to serve multiple patient care areas.
• Identify metrics for critical review when building a Flexible Care Unit.
• Explore an advanced concept for Flexible Care Design inspired by the Bakersfield project.
Bakersfield Heart Hospital
• Throughput Symptoms• 110% at capacity during peak hours• LWBS rate increasing• Transfer requests turned away due to “No
Beds”• ER patient satisfaction complaints
increase• Related to privacy and comfort• Inpatient holds hours increasing
• Vision of a team of physician and staff specialists “dedicated to fighting one disease – heart disease.”
• Physician Led - empowered physician leadership with significant decision making roles for technology .
• Patient Focused - reduce number of caregivers interacting with patients.
Effective: Clinically proven care provided at the right time and
way for the patient’s needs.
Efficient: Services provided are appropriate to the needs of
the patient while managing resource utilization.
Safe: Care provided that minimizes risk of harm to the
patient and staff
Patient Centered: Keeping the emotional, spiritual and physical well-being of the patient in the center of our care results
in a positive patient experience.
Hospital Origination and Vision
Facility Overview
• 47 private inpatient beds (including 10 critical care beds)• 3 operating rooms with complete facilities for heart and vascular surgery • 4 cardiac catheterization labs with 1 lab equipped for electrophysiology • 20 outpatient and recovery rooms• 8 bed emergency department • Technologically advanced cath labs• Over 228 employees in addition to the medical staff • Highly trained, caring clinical staff • Over 20 of the leading cardiologists and cardiothoracic and vascular surgeons
in Bakersfield
Floor Plans
DepartmentsSquareFootage
ClinicalOperating RoomCardiologyAdministrative & GeneralOperationsEmergencyRadiologyDietaryHousekeepingLaboratoryMedical RecordsRespiratory TherapyPharmacy
28,68512,19210,444
9,8069,6934,9714,6623,5781,5671,1721,1281,0711,031
Service OfferingsBakersfield Heart Hospital (BHH) is a 47-bed acute-care hospital providing care in:
• General Medicine• General Surgery• Hematology• Nephrology• Neurology• Medical Oncology• Pulmonary• Rheumatology• Thoracic Surgery• Vascular Surgery• Cardiology• Cardiovascular Surgery• Emergency Medicine• Interventional Radiology
Procedures Supporting Services InpatientOut
PatientCardiology
Diagnostic Angiogram X XAngioplasty X XDrug Eluting Stent X XIntravascular Ultrasound X XElectrophysiology Studies X XPace Maker Implantation X XAICD Implantation X XEcho Cardiography X XStress EKG X XUltra Sound X X
Cardiac SurgeryCABG on and off pump XValve Repair X
VascularPeripheral Vascular Angiography X XPeripheral Vascular Intervention X X
General Surgery X XMedical Procedures
Bronchoscopy X XEndoscopy X XAcute Dialysis X
Payor Mix Trend
Payor Mix (based on Admits, budget based on Net Rev) FY2009 FY2010
FY11 June YTD
Medicare 53.00% 59.4% 59.4%Medicaid 4.60% 4.4% 5.8%HMO 7.50% 2.4% 2.3%Commercial (Other, PPO, Blue Cross) 10.40% 13.5% 12.8%Self Pay 2.80% 3.2% 3.9%Medicare HMO 21.80% 13.6% 10.4%Medicaid HMO 1.40% 1.9% 2.1%Medicaid Pending 0.70% 0.7% 1.9%Medicaid Outsourced 0.00% 0.0% 0.0%Indian Health 0.00% 0.0% 0.0%Worker's Comp 0.50% 0.5% 0.6%Champus 0.20% 0.0% 0.7%
Patient Care Areas
• ED• OB/Gyn• Pre-op• PACU• SICU• CICU• NICU• TICU
• Step-Down• Telemetry• Surgical• Post-Trauma• Med/Surg• Women’s Care• Oncology• Orthopedics• Neurology• Rehab
Acuity-Adaptable DesignA patient space that accommodates the care of patients along a continuum of needs.
Universal Room DesignBuild a space that can accommodate all patients from ICU to Floor
Flexible Room DesignBuild a basic room and bring care to the patient.
Patient Care Areas
•ED•OB/Gyn•Pre-op•PACU•SICU•CICU•NICU•TICU
•Step-Down•Telemetry•Surgical•Post-Trauma•Med/Surg•Women’s Care•Oncology•Orthopedics•Neurology•Rehab
•ED•OB/Gyn•Pre-op•PACU•SICU•CICU•NICU•TICU
•Step-Down•Telemetry•Surgical•Post-Trauma•Med/Surg•Women’s Care•Oncology•Orthopedics•Neurology•Rehab
Staff Qualification
• ICU-Level ED Preop PACU ICU
• OR Spine Cardiac General Trauma ENT GYN Robotic EyeFloat Pool ??
• Floor Medical Cardiology Surgical TraumaWomen’s
Care
Pre-opPACU
Endoscopy
CathLab
EROBS
Thursday, 8pm
1 Call RN
1 Call RN
1 Call RN
1 Call RN
Foreign Body
AcuteCholecystitis
LAD
IntoxicatedConcussion
ManagerStaffCall SchedulePolicies
ManagerStaffCall SchedulePolicies
ManagerStaffCall SchedulePolicies
ManagerStaffCall SchedulePolicies
Peri-Operative Area
Pre-opPACU
Endoscopy
CathLab
EROBS
Peri-Operative Area
Foreign Body
AcuteCholecystitis
LAD
Intoxicated Concussion
ManagerStaffCall SchedulePolicies
ManagerStaffCall SchedulePolicies
ManagerStaffCall SchedulePolicies
ManagerStaffCall SchedulePolicies
2 Call RN
Procedural CallStaff- GO HOME
2 Call RN
1 Manager1 Staff Pool1 Call Schedule1 Policy Set
Thursday, 8pm
Pre-opPACU
Endoscopy
CathLab
EROBS
Peri-Operative Area1 Manager1 Staff Pool1 Call Schedule1 Policy Set
Procedural Call Staff- GO HOME
2 Call RN
• ER OBS Unit now staffed 24 hours• Off-Loads In-Patient Units• Minimizes Reimbursement Confusion
Universal Room Design
• Benefits• Simplified flow
• Detriments• Patient satisfaction• Difficult to staff• Expensive
Flexible Room Design
Traditional room design confines a patient to bed predisposing topreventable complications.
The Platform opens up the room to the patient, empowering mobility and improving outcomes.
Barriers to Flexible Design
• Operational Silos• ED• Peri-op• OR• ICU• Step-Down• Med/Surgery
• Staff Training• Flexible • Float Pool• Open Unit• Overflow
Cardiac• ED• Cath Lab• CCU• Telemetry• Rehab
• ED• CT• OR/PACU• ICU• Step-Down• Post Trauma• Rehab
• 60 minutes• 30 minutes• 3 hours• 3 days• 2 days• 4 days• 3 weeks
TimeTrauma
Slide Title?
Leadership Behind the Change
• Strong, committed management team
• Lean Process (along the entire serviceline)
Contact Information
• Michael Bell, [email protected]
• Phil Bahr, [email protected]
• Joseph Livengood, MD, [email protected]