modeling space needs with excel - institute of industrial
TRANSCRIPT
Modeling Space Needswith Excel
Cardiac Cath Prep and Recovery
Session Description
Use Excel to model patient flow, wait times and space needs. Learn the
formulas and steps used to analyze a unit including what-if scenarios for
changing the mix of patients among ambulatory treatment, cardiac
catheterization and surgical prep and secondary recovery, and pre-admission
testing.
Objectives:
• Steps for analysis of resource needs• Excel formulas for modeling resource
utilization from patient logs• How to conduct what-if scenarios in
Excel• Ideas for decreasing patient waits
Process Used to Complete ATC/PAT/Cath Request
• Clarify request• Interview staff• Obtain volumes, processes and job descriptions• Enter volumes by date and time• Combine volumes to determine combined need• Write summary• Review draft summary with staff for accuracy and
gain acceptance• Develop presentation for Administration
Measure Clarification Worksheet
1. What question do you want answered? What are you trying to prove or what decision will you make as a result?
2. Who is going to review this information?3. Describe the process that is being
measured.4. What population is being measured (i.e.
inpatients, outpatients, or all patients)?
Measure Clarification Worksheet (continued)
6. What is the data source?
7. How will missing or conflicting information be handled? (For example, what will you do with a record that has missing or conflicting time?)
Pre Admission TestingAmbulatory
Treatment Center
Cath Lab
200
300
400
500
600
700
Jun-
99
Jul-9
9
Aug
-99
Sep
-99
Oct
-99
Nov
-99
Dec
-99
Jan-
00
Feb-
00
Mar
-00
Apr
-00
May
-00
Jun-
00
Jul-0
0
Aug
-00
Sep
-00
Oct
-00
Nov
-00
Dec
-00
Jan-
01
Feb-
01
Mar
-01
Apr
-01
May
-01
Month
Patie
nts
Pre Admission TestingAmbulatory Treatment CenterCath LabCath Lab
Patient Volumes
Staff Skills
Pre Admission TestingAmbulatory
Treatment Center
Cath Lab
One Year Staff Nurse Experience
Space NeedsHow much space?1. Patient Volume2. Space Needs per Patient
• Equipment• Minor Equipment• Major Equipment, Control Room • No Equipment• Procedure Table• Stretcher• Bed• Chair
• # of Visitors, MDs and Staff
•Before Invasive Procedure> Assessment> Education
•Outpatients•Prior to Day of Procedure•Clothed•Sitting•Week Days
PAT ATC
CL
Pre Admission Testing
Patient Signs In At Registration
Patient Waits In Lobby
Patient Registers
Patient Waits In Lobby
Registrar Walks Blue Card &Pregistration Forms to Pre Admission Testing
Secretary Stamps Forms, Enters Orders & Adds Forms Based On Orders
Nurse Takes Chart, Old Records & Patient for Assessment, Teaching & EKG
Pre Admission Testing
Patient Waits For 2nd Patient To Be Ready for Anesthesiologist
Anesthesiologist Assesses & May Write Orders
Nurse Logs Orders
Secretary Enters Orders
Nurse Gets Blood Tube Labels & Copies Chest X-ray Order
Nurse Draws Blood
Nurse Escorts Patient to X-ray
Nurse Calls Retail Pharmacy With Prescriptions
Nurse Logs Out Patient
Converting to electronic data
Aggregate
Copy Values
80th Percentile
80th Percentile
Compare Volumes, Schedule Capacity and Staffing
Patient Volumes
• Average: 26 patients each weekday• Range
– 15 patients the Friday before Memorial Day– 20 patients on the next lowest day– 33 patients per day on the highest day
• Volume does not correlate to day of week
Patient Volumes
• Patients seen from 8:30 – 5:00• From 10:00 – 4:00
– Average 3 patients being seen• Volume gradually decreases after 4:00
– Staffing does not
Average Utilization 48%, but…
Pre Admission Testing LayoutCongested Area
Rarely Used
Pre Admission Testing Patient Mix
• 97% pre-operative patients assessed by nursing and anesthesia
• 4 open heart surgery
• 6 of the 578 patients were seen outside of Pre-Admission Testing in addition
• 5 lithotripsy patients not seen by anesthesia
Pre Admission Testing Patient Throughput Times
• Patients arrive at Registration• Wait to see a Registrar
– Daily average ranged from 6 to 33 minutes• Registration
– Daily average ranged from 12 to 20 minutes
Pre Admission Testing Patient Throughput Times
Pre Admission Testing Patient Throughput Times
• Average patient in Pre-Admission Testing 47 minutes
• Ranged from 5 minutes to 1 hour and 50 minutes
What If?
•Invasive procedure> Conscious Sedation> Recovery Required
•Outpatients & Inpatients
•Gowned•Lying•Week Days•Specialized equipment & room
Cath Lab
Patient Prepped In Ambulatory Treatment Center Unless Know Will Be An Angioplasty, then on Cardiology
(Assessed, IV Cannula Inserted)
Groin Shaved in Holding Area (inpatients done on floors)
Patient to Cath Lab Room
Physician Paged
Cath
Leave Cath Lab Area from Cath Lab Room
Arrive in Ambulatory Treatment Center for Diagnostic Caths and on Cardiology for Angioplasties
Cath Lab
Cath Lab
Cath Lab Rooms
• 3 Cath Suites• Staging Area• Patients Leave Directly from Cath Suite
Sitting procedures
33%
Lying procedures
2%Preps38%
Recovery27%
Ambulatory Treatment Center Visit Mix
Ambulatory Treatment Center Prep
Assessment & Education
IV Cannula Inserted
Gown
Lab Draw
Procedure Area Requests
Chest X-ray, if ordered
Procedure Day if no Pre Cath Visit
Transport to Procedure
Ambulatory Treatment Center Prep
Assessment & Education*
IV Cannula Inserted
Lab Draw*
Procedure Area Requests
Chest X-ray, if ordered*
Procedure Day if no Pre Cath Visit
IV Cannula Inserted
Procedure Area Requests
Day if had a Pre Cath Visit*
Transport to Procedure Transport to Procedure
Gown Gown
Ambulatory Treatment Center Preps
•Before Invasive procedure> Assessment> Education
•Outpatients•Day of Procedure & Prior Day•Gowned & Clothed•Lying & Sitting•Week Days
Ambulatory Treatment Center Recovery
•After Invasive procedure•Outpatients•Day of Procedure, After Procedure•Gowned•Lying•Week Days
Cardiac Catheterization Recovery
• 31% of hospitals recover OP Caths in an ambulatory care area
• 15% recover in a PACU
• 82% recover in Cath
Ambulatory Treatment Center Lying Procedures
•Invasive procedure•Outpatients•Day of Procedure•Gowned•Lying•Week Days
Ambulatory Treatment CenterSitting Procedures
• Non-Invasive procedure•Outpatients•Day of Procedure•Clothed•Sitting•Week Days & Weekends
Ambulatory Treatment Center Patients
Staff
Ambulatory Treatment Center PatientsPeople
Ambulatory Treatment Center
• Preps undress and bed• Stretchers for transport• Beds cleaned before reused, daily• Treatment chairs not cleaned
before reused
Patient Throughput
Patient Throughput
Ambulatory Treatment CenterCapacity
• Hours/Day 14• Days x11• Hours 154• Spaces x14
» 2156• Downtime -5%• Capacity 2048
Ambulatory Treatment CenterUtilization
• Used 721• Capacity 2048
= 35%
Fewer Rooms Would Cause Waits
>27% Recovery patients>31% Preps>2% Liver biopsies>60% Pre cath visits and sitting procedures
AssessmentEducationClothedSitting
EquipmentEquipment
In summary
PAT ATC
CLOutpatientsWeek Days
InvasiveGowned
Lying
Pre Admission TestingAmbulatory
Treatment Center
Cath Lab
Pre Admission Testing
Ambulatory Treatment Center
Cath LabCath
Equipment
Sitting Procedures
Combining Patient Arrival Times and Time in Pre Admission
Testing or Ambulatory Treatment
Pre Op Short Stay Endoscopy
Cardiopulmonary Diagnostics
NeurodiagnosticsOutpatient Lab Work
Ambulatory Treatment CenterUtilization
40% of current Ambulatory Treatment Center patients could wait without causing negative
effects on others
Too much space?
Pre Admission TestingHow many Wait with X Rooms
0 18
26
64
0
10
20
30
40
50
60
70
9 8 7 6 5
Staffed Rooms 8:20 a.m. Until The Last Patient Leaves
Patie
nts
Who
Wou
ld H
ave
Wai
ted
1Out of 572
1%8
5%26
12%64
Pre Admission Testing Utilization•Pre Admission Testing Needs
Nurses Station SpacePC
Printer Fax
Phone Phone
Addressograph Log
ChartRack
registrar nurse
Potential Idea to Consider
• Replace Pre Admission Testing’s Office with a Nurses Station
• Benefits: Eliminate traffic congestion
Findings So Far:
• Pre Admission Testing, Ambulatory Treatment Center & Cath Holding Have Similar Needs for Staff Skills, Types of Rooms & Equipment
• Pre Admission Testing Needs More Patient Rooms & a Nurses Station
Potential Idea to Consider
• Combine Pre Admission Testing • & Ambulatory Treatment Center• Benefits: Less Total Space Needed
Maximum Rooms Needed for Any Day May 2001 if Pre Admission Testing and Ambulatory Treatment Center Were
Combined
05
101520
6:30
AM
7:30
AM
8:30
AM
9:30
AM
10:3
0 A
M
11:3
0 A
M
12:3
0 P
M
1:30
PM
2:30
PM
3:30
PM
4:30
PM
5:30
PM
6:30
PM
7:30
PM
8:30
PM
Time of Day
Max
imum
Roo
ms
Ever
Ne
eded
Max Needed 80% of the Days = 14
Potential Idea to Consider
• Schedule More Patients in the Morning & Late Afternoon
• Benefits: Decrease Space Needs At Peak
Potential Idea to Consider
• Schedule Caths
• Benefits:– Eliminate Patient Wait for
Cath, 1 hour average, – up to 4 hours– Free Up Room Space– Staff Know Who to Prep 1st
Pre Admission TestingPatient Signs In At Registration
Patient Waits In Lobby
Patient Registers
Patient Waits In Lobby
Registrar Walks Blue Card & Registration Forms to Pre Admission Testing
Secretary Stamps Forms, Enters Orders & Adds Forms Based On Orders
Nurse Takes Chart, Old Records & Patient for Assessment, Teaching & EKG
Patient Waits For 2nd Patient To Be Ready for Anesthesiologist
Anesthesiologist Assesses & May Write Orders
Nurse Logs Orders
Secretary Enters Orders
Nurse Gets Blood Tube Labels & Copies Chest X-ray Order
Nurse Draws Blood
Nurse Escorts Patient to X-ray
Nurse Calls Retail Pharmacy With Prescriptions
Nurse Logs Out Patient
New ProcessObtain Orders, Register, Stamp Forms
Patient Arrives, Chest X-ray if Needed
Assessed Clothed In Chair, Call Anesthesiologist Without Waiting For 2nd Patient
To Lobby with Pager
Paged to Holding Area
Gown, Insert IV Cannula, Shave, Pager to Visitor
Procedure
Recovery on Stretcher, Page Visitor
Summary
• Skills needed in Ambulatory Treatment Center, Pre Admission Testing & CathHolding are Similar
• Pre Admission Testing Needs More Exam Rooms
• Combining Pre Admission Testing & Ambulatory Treatment Center Requires Less Space Than 2 Separate Areas
• Process Changes Could Be Made To Reduce Space Needs
Potential Combined Space
• Preferably Adjacent To:– Anesthesia– Cath Lab– Special Procedures– Registration (if keep current process)
• Benefits: Minimize Anesthesiologist, Cardiologist, Patient and Registrar Travel
North Tower Lobby
South Tower Lobby
Cardio-pulmonary Diagnostics
Information Desk
Stairs/elevator
Currently IS,
Medical Library
Elevator/BR/phone
Recovery Room OR
Cath Lab
Special Procedures
Chapel
Registration
Pre Op Short Stay
Current Pre Admission
Testing
Ambulatory Treatment Center is currently not on the 1st floor
Lab
Area Patient Rooms Square Feet Pre Op Short Stay 2 with adjoining bath 24’ x 11’ = 264 ‘2
Door Door
Door Door
Sink
Sink
Chair
Stretcher
Stretcher
Chair
Door Door
Door Door
Sink
Sink
ChairStretcher
Stretcher
Chair
Door Door
Door DoorS
ink
Sink
Chair
Stretcher
Stretcher
Chair
Door Door
Door Door
Sink
Sink
ChairS
tretcher
Stretcher
Chair
8 rooms with 4 shared baths = 96’ x 11’
<-11’-> 3’ <-11’->
----11’------>= toilet
Medical Library/IS Network Engineers/IS Storage= ~110’ x 30’ = 3,300 ‘2
door
door
8 rooms with 4 shared baths = 96’ x 11’
8 rooms with 4 shared baths = 96’ x 11’
8’ hall
<-S Tower Lobby
Cath Lab SpecialProcedures
RN Station
RN Station is 6’ x 11’ log, fax, PC, & phone
Utility Rooms
2 Utility Rooms, Each 6’ x 5 ½ ‘
What Was Done
• Pre Admission Testing Office Remodeled
• Lab space was given to Pre Admission Testing providing 6 exam rooms
• Pre Admission Testing Process Revised• Not Combined with Ambulatory
Treatment Center
What Was Done
• Ambulatory Treatment Center’s patient mix was changed– Cath Prep and Recovery was removed– Non-invasive Cardiology Patients were
added
What Was Done
• Cath Observation Area Created
Questions?