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Reducing Bed Turnover Delays

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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.

Reducing Bed Turnover Delays

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UTILIZING DISCHARGE INFORMATION FOR EVS STAFFING The discharge peak occurs between 3 pm-6 pm. This is also happens to be the peak admission time. It is crunch time! During the PM shift, 4-5 housekeepers are scheduled to

clean dirty bed on medical-surgical units and 1 housekeeper each for ICU, MBU, L&D, Main ED and ED Annex. The housekeepers also moved to different units to respond to stat clean calls. As you can see, 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.

1. At 2 pm, the day shift EVS supervisor checks with day charge nurse on potential DC numbers for the following shift.

2. At 4 pm the EVS supervisor starts rounds and checks with the charge RN for an updated DC list.

3. Housekeepers are shifted around to units based on needs for clean beds.

As you can see, this is a combined effort. Here are some additional ways we can assist EVS meet these goals. When a patient is discharged from the room…

1. Check for patient belongings before the patient leaves.

2. Remove IV tubing, O2 tubing from the machines.

3. Remove patient trays from the room.

4. Remove suction canister and tubing.

5. Empty out the commodes and urinals.

In Feb 09, our bed turnover times varied from 120-160 minutes. Since these new processes have been put in place we have seen a decrease in bed turnover time to 105 minutes in June. Our next goal is reduce bed turnover times to 90 minutes and eventually reach the benchmark goal of 55mts.

NEXT STEPS / PILOTS

Staggered housekeeper start times in ICU to 0630, 0700 and 0800. In addition, the responsibilities have also been reshuffled to best suit the need of patients and improve workflow. Pilot to extend to one medical-surgical unit in the coming weeks.

EVS supervisors will include the following information when prioritizing rooms cleans:

Number of scheduled discharges for PM shift. Number of open clean male and female beds on the unit.

Pre-assigning non-clinical EVS staff to a clinical area as back up for stat cleans. Example-Lab housekeeper will be back up for the 3N housekeeper when there are multiple cleans.

Reducing Bed Turnover Delays

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1 week study of bed turn over times Feb 09, 6N

4:48 0:00 19:12 14:24 9:36 4:48 0:00 1 2 3 4 5 6 7 8
4:48
0:00
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Time

DC Patients

Time of DCBenchmark Times

Benchmark Times

Time Bed cleaned 6N BED TURN 6/09
Time Bed cleaned
6N BED TURN 6/09
4:48 0:00 19:12 14:24 9:36 4:48 0:00 TIME 1 3 5 7 9 11 13
4:48
0:00
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TIME
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NUMBER OF PTS

13 15 17 19 21 23 25 27 29 31 33 35 37 39 NUMBER OF

TIME OF DCTIME BED CLEANED BENCHMARK TIME

TIME OF DC TIME BED CLEANED BENCHMARK TIME

TIME BED CLEANED

BENCHMARK TIME

Reducing Bed Turnover Delays

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Goals

   

2008

3 rd quarter goal for 2009

4 th quarter goal for

2009

Measure

Performance (Avg or median)

ED: Bed request to bed received

60

minutes

45

30

 

minutes

minutes

ED: Bed received to patient leaves

60

minutes

45

30

 

minutes

minutes

ED time of admission to transfer to unit

120

minutes

90

60

 

minutes

minutes

ICU: Bed request to bed received

60

minutes

30

30

 

minutes

minutes

ICU: Bed received to patient transfer

90

minutes

60

30

 

minutes

minutes

Bed Turn: Patient DC to patient DC in census

45

minutes

30

15

 

minutes

minutes

Patient DC to Room ready for next patient

120

minutes

90

55

 

minutes

minutes