Module 2: Case Study
Case D: Moving the Needle: Managing Safe Patient Flow at Yale-New Haven Hospital
Changing the Response Management of hospital beds is a concern for most organizations. Yet, most approaches are based on static, unadaptable estimates in length of stay (Schmidt, Geisler, & Spreckelsen, 2013). Increased length of stay contributes to longer admission wait times for patients, leading to both patient and staff dissatisfaction, and increased cost for an organization. Hence, process improvement in this area would lead to value added change. However, change is difficult for most. Complacency and fear of the unknown can create resistance within an organization.
Joe Miller needs more information regarding the significant results achieved at YNHH. In addition, data from Jones Memorial Hospital needs to be translated to show what the results may look like if Jones Memorial Hospital moved
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To enable a positive change in discharge time, the physicians would need to be engaged and accountable for their part in the initiative. Environmental Services would need to be educated on how bed turnaround time affects patient flow and they can help make this initiative successful. Social Services and Case Management would be integral in the process. Assuring that barriers to patient discharges are addressed early. In addition, nurses would need education on this initiative and positive effects that would be seen as a result of its success. Nurses will have to prioritize to assure their care and responsibilities do not cause delays. Improved teamwork between centralized bed placement staff and unit staff would help assure smooth flow of patients. Administration needs to continue to be highly visible throughout the initiation of this change and on a continued basis to sustain the positive effects of the change (White & Griffith,
SGH has been plagued with patient quality issues, therefore SGH finds itself in a situation which is inherently antithetical to the mission of the hospital. The costs of healthcare continue to rise at an alarming rate, and hospital boards are experiencing increased scrutiny in their ability, and role, in ensuring patient quality (Millar, Freeman, & Mannion, 2015). Many internal actors are involved in patient quality, from the physicians, nurses, pharmacists and IT administrators, creating a complex internal system. When IT projects, such as the CPOE initiative fail, the project team members, and the organization as a whole, may experience negative emotions that impede the ability to learn from the experience (Shepherd, Patzelt, & Wolfe, 2011). The SGH executive management team must refocus the organization on the primary goal of patient
...what may or may not need to be changed. The charts describe a residents ADL’s, how long they can or cannot stand, and any other treatment goal progress.
Monitoring staff levels is an important factor. Also leveling the flow of patients in and out institutions could help to reduce wide fluctuations in occupancy rates and prevent surges in patient visits that lead to overcrowding, poor handoffs, and delays in care. Studies show that overcrowding in areas such as the emergency rooms lead to adverse outcomes, because physicians and nurses having less time to focus on individual patients. One study found that for each additional patient with heart failure, pneumonia, or myocardial infarction assigned to a nurse, the odds of readmission increased between 6 percent and 9 percent (Hostetter and Klein, 2013). All of which costs the hospital money.
The challenges that all acute care hospitals and facilities faces are the demand for highly specialized services has increased. The US population is constantly aging and the elderly tend to need more acute care services. Because many people lack health insurance, they tend to use emergency rooms in the hospitals as their source of care. The increase demand in acute care prompted hospitals to expand their facility
Hino, R. (2013, September 25). Hospital Strategic Plans Must Go Beyond the Status Quo. Retrieved from http://www.hospitalimpact.org/index.php/2013/09/25/p4358
Case Management Case management has become the standard method of managing health care delivery systems today. In recent decades, case management has become widespread throughout healthcare areas, professionals, and models in the United States. It has been extended to a wide range of clients (Park & Huber, 2009). The primary goal of case management is to deliver quality care to patients in the most cost effective approach by managing human and material resources. The focus of this paper is on the concept of case management and how it developed historically, the definition of case management, the components of case management, and how it relates to other nursing care delivery models.
The internal control breach that involved Massachusetts General Hospital missing records did turn up the regulatory and enforcement heat in the Health Insurance Portability and Accountability Act (HIPAA). The requirements of HIPPA provide clear guidelines that require all health care providers, in the United States, to give insightful protection of the private patient information. This protection should be done through physical, administrative and technical internal safeguards. The department of health and human resource service in the Office of Civil Rights (OCR) announced a massive penalty on Massachusetts General Hospital as a measure to enhance their security and privacy regulations (Paxson).
Long Term Acute Care Hospital With today’s technology and the specialized skills of doctors, nurses, and therapists, patients who need long term care for acute problems can obtain these services at institutions known as postacute care providers. One type of facility that falls under this title is the Long Term Acute Care Hospital (LTACH) (Munoz-Price, 2009, p. 438). This paper will discuss services provided by LTACHs, the role of the Chief Nursing Officer (CNO) in these facilities, and Medicare reimbursement effected by patient satisfaction surveys. For patients requiring longer acute care than what is generally given at an inpatient acute care hospital, the Long Term Acute Care Hospital is an option. To be admitted to an LTACH, patients are required to have “medically complex situations with a mean length of stay > 25 days” (Munoz-Price, 2009, p. 438 ).
According to the Centers for Disease Control and Prevention (CDC) (2012), the average time patients spend in the U.S. emergency department (ER) before they can see a doctor has increased to 25% between 2003-2009. The main cause of longer wait times (WT) in the ER is overcrowding. Overcrowding has been found to be closely related to both subjective and objective patient satisfaction (Miro’ et al, 2003). Longer wait times in the ED is such an important issue because its consequences are detrimental not only to the ER patients, but also to providers. As a health care provider, decreasing patients’ WT in the ED is essential, although challenging, to improve patient’s health outcomes and increase patients’ satisfaction. Although it is a very challenging issue to tackle, hospitals that have initiated some quality improvement (QI) strategies are experiencing some positive outcomes in that area of care. The outcomes are measured by decreased waiting times, improved patients’ clinical outcomes and increased patients’ satisfaction.
To provide appropriate care, long-term care admissions must be well thought-out and explicit tasks fulfilled prior to the patient’s arrival. There should be a smooth transition between facilities to promote continuity of care (LaMantia, Scheunemann, Viera, Busby-Whitehead & Hanson, 2010). If discharge planning is inadequate, patient safety and health can be compromised. For example, scheduled drug regimens, such as antibiotics and controlled medications, must be available within a timely manner. Most long-term care facilities do not support an in-house pharmacy. In addition, many pharmacies require original hard scripts before filling controlled medications. If admitting orders are inadequate or cannot be carried out within the appropriate time span, the admitting facility may be unable to meet critical needs. I have experienced this first hand on more than one occasion. The most recent o...
Nursing staff, Social Workers, and case managers play an important role in the discharge planning which also correlates with patient safety outcomes. Case managers and social workers work face to face with...
Thousands of nurses throughout the nation are exhausted and overwhelmed due to their heavy workload. The administrators do not staff the units properly; therefore, they give each nurse more patients to care for to compensate for the lack of staff. There are several reasons to why
...staff would not be required to put in the overtime to compensate for the lack of workers. Patients would no longer have to suffer the neglect of the staff because he or she was too busy. Making sure the patient gets the best quality care reduces the time spent for recovery. Reducing the time spent for recovery increases the organization’s finances. Providing a safe facility also reduces the expenses on the private hospital’s budget. Ensuring a patient is safe can reduce potential use of ongoing treatment and services. Hiring the appropriate nursing staff needed can save the organization money. Instead of cutting back on staff, more staff needs to be hired to fulfil the needs of the patient. In the economy today, private hospitals need to focus on the overall long term effects of each action opposed to quick reactions resulting in financial strain for the facility.
Low nurse staffing levels are an issue hospital-wide at St. Vincent Healthcare, particularly observed during my management hours with a House Supervisor. A responsibility of a House Supervisor is to ensure efficient utilization and allocation of nurses among the floors, so I have had the opportunity to thoroughly discuss and personally observe a variety of causes and consequences of low staffing with my preceptor. A primary reason for inadequate staffing appears to be due to finances; along with making patient safety a continuous priority, St. Vincent Healthcare must strive for good financial outcomes as well. There are certainly challenges that arise in maintaining a balance between providing adequate staff to deliver safe patient care and delivering services at lower costs. Other causes of low staffing are employee conflicts, management and/or leadership discrepancies, heavier patient loads/higher acuity patients, floating to other units, or decreased job ...
Nurse management in healthcare organizations can be a difficult task due to the many scenarios that must be addressed for the entire system to run smoothly. There are many parts to the system but none more important than the people that work each shift to give quality patient care: nurses and nursing assistants. A major problem for nurse management occurs when the operation runs on short staffing. Inadequate staffing, whether it occurs due to nurse shortages, hiring freezes, or call-outs, can be a difficult hurdle for nurse managers to overcome due to the increased stress occurring in nurses that must perform with a heavy workload. Possible causes for this problem include difficult working conditions and negative attitudes toward the organization--problems that could be caused by short staffing, in turn creating a snowball effect. The problem occurs on a healthcare unit managed by a nurse supervisor who guides nurses (LPN and RN) and certified nursing assistants (CNA) while completing patient care on a shift by shift bases. The problem is happening due to the ability to call out of work using sick time, the inability for managers to fix the cause of a short staffing problem, or the inability of the organization to recruit new employees and retain current employees.