One of the unique features of Applied Management Systems (AMS) is our ability to match our staff to yours. Each of our staff are proficient in all the areas/departments that make up a hospital setting from materials management to the emergency department. Having our registered nurses and other trained professionals perform analyses in your emergency department, surgical suite, and inpatient nursing units is a win-win situation: our staff get to utilize their training, knowledge and administration and your hospital gets to benefit from the up-to-date skill set of our staff.
Patient care service engagements review the patient care model, workflow, staff scheduling, flexing strategies, and staffing targets. In addition to verifying staff assignments and targets for the patient care areas, the process identifies system issues that impede the overall effectiveness of the staff in providing quality care. These are all critical issues, given the financial, quality and patient satisfaction pressures of today’s health care environment. The process assesses the following key operating characteristics and provides appropriate recommendations for change:
- Staff-to-patient ratios
- General processes and systems
- Staffing strategies and daily staffing tools (staffing guides)
- Management structure
- Skill mix, shift length
- Paid hours per patient day targets
- Full time/part time/per diem mix
- Orientation resources
- Sitter resource utilization
For the Emergency Department, AMS assesses not only the patient throughput of the department, but also the hospital workflow of admissions (all the way up to the inpatient units and then some). We put ourselves in the patients’ shoes to get a feel for where patient satisfaction may suffer and where the process and hospital workflow could be improved. Data and statistics are analyzed to support our recommendations. Currently, there are some negative management indicators that are in the Emergency Department – long length of stay, low Press-Ganey scores, low morale, and a general sense that things do not run smoothly: this may come despite the hospital’s investment of some additional resources in the Emergency Department. Ancillary departments and patient care units are also reviewed for their impact on patient throughput and services in the Emergency Department.
For surgical services, the AMS operational assessment includes scheduling, materials management, pre-op, same day surgery and the post anesthesia care unit (PACU). AMS engages OR nursing, anesthesia and medical staff who utilize and interface with the surgical suite. The primary areas of focus are patient and information flow, room turnaround time, staffing, scheduling, communications, hospital organizational structure, materials management, and the day-to-day operation of surgical services.
AMS can analyze the following areas and recommend appropriate systems improvements:
- Facility utilization by room by day of week. This would include OR, same day surgery and PACU.
- Surgical services staffing and skill levels for both professional and support staff including Block Scheduling.
- Room turnaround procedures.
- Daily operations: patient throughput, materials systems, communication systems, etc.
- Case scheduling.
- Hospital organizational structure effectiveness.
- Efficiency of same day surgery and PACU.
- Quality performance analysis.
- Cost savings analysis.
- Hospital benchmarking comparatives.
Some Key Factors that are addressed in these evaluations are:
Identification of barriers to the effective delivery of patient care. This includes direct observation and/or flowcharting current processes and identifying bottlenecks and opportunities for improvement.
Review of patient throughput times. This would include a breakdown of patient throughput by component of care. The results will be compared to AMS’ hospital best practice benchmarks and recent surveys.
Development of staffing benchmarks for physicians, physician extenders, nursing and ancillary support staff by area based on acuity mix, patient throughput time and functions. This would include comparatives with AMS hospital best practice staffing benchmarks and development of detailed staffing plans by shift, skill, and day of the week for current and projected volumes.
Review of hospital bed management practices. The impact of inpatient flow (admission, discharge, transfer) on the Emergency Department and surgical suite will be measured. The number of beds available by specialty, acuity, day of week, time of day, unit, etc., will be determined.