Reducing Bed Turnover Delays

Page 1

Chapter 8. Improving Hospitalwide Patient Flow at Northwest Community Hospital Barbara Weintraub, R.N., M.S.N., M.P.H., A.P.N., C.E.N., F.A.E.N.; Kirk Jensen, M.D., M.B.A., F.A.C.E.P.; Karen Colby, M.S., R.N., C.N.A.A.-B.C. Reducing Bed Turnover Delays Bed turnover process is defined as the time between a discharged patient leaving his bed and the bed being cleaned for a new patient. Lengthy bed turn over delay was identified as a barrier to timely patient placement. A housekeeping task force has been closely observing, studying various processes involved in a bed turnover. Since Feb. 2009, various pilots and changes have been implemented to reduce delays. STAT CLEANS Stat cleans are called when a patient (in ED, OR, Direct etc) is waiting for a clean bed on a unit. Multiple phone calls took place between housekeeping, floor, capacity coordinator and sending dept to see if the patient can be transferred. This called for a change in process for improvement. 1. All stat cleans (for inpatient beds) are to be text paged to pager#0051 (EVS supervisor). 2. If the housekeeper cannot arrive for the stat clean within 15 minutes, the EVS supervisor will inform the charge nurse of the delay. 3. Upon completion, the housekeeper notifies the clean bed (for stat cleans) to capacity coordinator. Instructions to send the page using the NCH phone directory has been emailed to your Clinical Coordinators. If you need additional information please ask the PM shift EVS supervisor or the Capacity Coordinator.

PROCESSING ACCURATE DC TIMES IN INVISION The ADT census sheet also serves as the communication tool to notify the housekeeper of rooms that need to be turned over (cleaned). Any delay in updating the ADT log, causes delay in room cleans. A DC passport was trialed on 6N to improve this process. 1. RN hands a DC passport (with pt label and room number) to the patient along with the DC papers. 2. The patient is instructed to hand it to the volunteer/staff member who is wheeling them down for DC. 3. The staff wheeling the patient down writes the time of DC on the passport and places it in the bin at the front nurses station. 4. The unit secretary uses the information on the passports to update the ADT sheet. 5. The housekeeping gets timely information on dirty beds. This passport has been rolled out to 3N, 6N and 7N successfully. The other floors will be adopting the passport shortly.

the responsibilities have also been reshuffled to best suit the need of patients and improve workflow. Number of open clean male and female beds on the unit. Housekeepers are shifted around to units based on needs for clean beds. our bed turnover times varied from 120-160 minutes. Remove suction canister and tubing. This is also happens to be the peak admission time. When a patient is discharged from the room… 1. Main ED and ED Annex. 3. it is crucial for housekeeping to utilize available DC information at this time so that they can rearrange staffing based on bed availability and needs. In addition. Remove IV tubing. NEXT STEPS / PILOTS Staggered housekeeper start times in ICU to 0630. Pre-assigning non-clinical EVS staff to a clinical area as back up for stat cleans. 1. As you can see. The housekeepers also moved to different units to respond to stat clean calls. Remove patient trays from the room. As you can see. this is a combined effort. 0700 and 0800. In Feb 09. EVS supervisors will include the following information when prioritizing rooms cleans: Number of scheduled discharges for PM shift. 4. It is crunch time! During the PM shift. Example-Lab housekeeper will be back up for the 3N housekeeper when there are multiple cleans. 2. At 4 pm the EVS supervisor starts rounds and checks with the charge RN for an updated DC list. Our next goal is reduce bed turnover times to 90 minutes and eventually reach the benchmark goal of 55mts. O2 tubing from the machines. At 2 pm. Empty out the commodes and urinals. Check for patient belongings before the patient leaves. . 2. Pilot to extend to one medical-surgical unit in the coming weeks. MBU.Reducing Bed Turnover Delays Page 2 UTILIZING DISCHARGE INFORMATION FOR EVS STAFFING The discharge peak occurs between 3 pm-6 pm. 4-5 housekeepers are scheduled to clean dirty bed on medical-surgical units and 1 housekeeper each for ICU. 5. Since these new processes have been put in place we have seen a decrease in bed turnover time to 105 minutes in June. 3. Here are some additional ways we can assist EVS meet these goals. L&D. the day shift EVS supervisor checks with day charge nurse on potential DC numbers for the following shift.

6N 4:48 0:00 19:12 Time 14:24 9:36 4:48 0:00 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 DC Patients Time of DC Time Bed cleaned Benchmark Times 6N BED TURN 6/09 4:48 0:00 19:12 TIME 14:24 9:36 4:48 0:00 11 13 15 17 19 21 23 25 27 29 31 33 35 37 NUMBER OF PTS TIME OF DC TIME BED CLEANED BENCHMARK TIME 39 1 3 5 7 9 .Reducing Bed Turnover Delays Page 3 1 week study of bed turn over times Feb 09.

Reducing Bed Turnover Delays Page 4 Goals Measure ED: Bed request to bed received ED: Bed received to patient leaves ED time of admission to transfer to unit ICU: Bed request to bed received ICU: Bed received to patient transfer Bed Turn: Patient DC to patient DC in census 2008 Performance (Avg or median) 3rd quarter goal for 2009 4th quarter goal for 2009 60 minutes 60 minutes 45 minutes 45 minutes 90 minutes 30 minutes 60 minutes 30 minutes 90 minutes 30 minutes 30 minutes 60 minutes 30 minutes 30 minutes 15 minutes 55 minutes 120 minutes 60 minutes 90 minutes 45 minutes Patient DC to Room ready for 120 minutes next patient .

Sign up to vote on this title
UsefulNot useful