| Authors: |
Devesh Dahale MS, MBA, CPHQ, CPXP; Lara McCall RN, BSN, CCM |
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Background: |
Patient flow is the movement of patients in the healthcare facility – involving medical care, physical resources and systems to identify and organize arrangements for relevant psychosocial needs of the patients upon discharge. (NEJM Catalyst, 2018). Our hospital’s specific patient flow related problems included excessive diversion hours which in turn resulted in excessive boarding hours in the ED – both problems adversely affecting patient care and experience as well as the hospital’s capacity to provide acute care services to the community. |
| Methods and Data Analysis: |
We heavily leveraged our EMR (Epic) to set up data collection systems focused on capturing barriers related to patient flow at various points in the patient’s journey. Extracted data from Epic in the form of reports helped us assess baseline performance in various metrics of interest. Analysis of the data revealed the magnitude of problems affecting flow. Accordingly, we designed appropriate PDSA (Plan-Do-Study-Act) targeted interventions to relieve those barriers, streamline the workflows and improve the process outcomes. Out of the four phases of patient flow (admission, treatment, disposition and discharge), the last two phases offered the biggest initial opportunities (low hanging fruit) to make the largest observable impact on patient flow. |
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Key interventions: |
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Results: |
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Conclusions: |
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| Authors: |
Donna L. Yost, DNP, MSN-CNL, RN, OCN, CNE; Devesh Dahale, Ms, MBA, CPHQ, CPXP |
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Background: |
Fall event data ending FY 2019-2020 for a 420-bed regional community hospital, found 292 inpatient falls including 10 significant injuries with inpatient fall events peaking in FY 2022 at 359 events. Inconsistencies found in risk screening revealed opportunities for standardization of assessment and application of interventions in fall prevention. |
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Purpose: |
To drive accountability by deploying best-evidenced based practices/risk assessment tools to reduce falls/falls with significant injury rates |
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Description: |
October 2021 – September 2025: EPIC® reports: data collection. Hester Davis® Fall Risk Assessment Screening Learning modules for staff. Fall events reporting: ‘Post Fall Huddle Sheet’ and electronic methods. High risk patients- yellow armbands, blue when multiple falls. Bed/chair alarms alerting patient movement. ICONs for high risk patients/banners for age 75/older on dash/story boards. Patient/family educational sheets, bedside table tents, electronic patient safety contracts. Policy revision: escalation algorithm/high risk patient’s age 75/older automatic high risk. Floor mats reduced fall w/injury, Shower Steps® socks decreased bathroom slippage. Whiteboards include visual Fall Tips®. Physical therapy: walkers and Sara Steady™ Interventions active for discharged patients. Nursing protocol for implementing Virtual Sitters. Calls to action: April/October 2024 and January 2025, strategical escalations |
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Conclusion: |
Falls have a narrow realm of care provider control with an unpredictable human factor which is difficult to guide and direct. Review of the data shows the positive impact process standardization and adaptation to events have on improving patient safety and outcomes resulting in 94 fewer falls in FY 2024-2025 than at project start in FY 2021-2022. |