Dana identified that each patient had a long wait time for admissions to the Sault Area Hospital (SAH) Assess & Restore Unit. When investigating this wait time, it was found that 100% of admissions to the SAH Assess & Restore Unit came from an SAH acute care inpatient unit. In 2015/16, 137 individuals were awaiting transfer to the Assess & Restore unit, which accounted for 1455 Alternate Level of Care (ALC) days waiting. Considering this information, the problem statement was defined as:
There is an average wait time of 10.6 Alternate Level of Care days a patient has to wait for admission to SAH Assess & Restore Unit from the SAH acute care inpatient unit.
Background / Current Conditions:
When collecting background information concerning the problem identified, it was found that in 2015/16, a total of 1455 ALC days were accrued based on patients waiting in-hospital for transfer to the SAH Assess & Restore unit. This accounted for 7.6% of all ALC days at SAH. Based on a conservative estimate of $1000/day, it costs $1,455,000 for patients to remain admitted ALC-AR awaiting transfer to this bedded level of rehabilitative care.
Beyond the financial implications, the current situation also significantly impacted overall patient flow throughout the organization and has adverse effects on a patient’s functional abilities. Individuals waiting in-hospital for transfer to the rehabilitation unit, occupy an acute care bed that could otherwise be used to pull patients from the Emergency Department.
Upon analysis of the background information it was decided that implementation of the Direct Access Priority Process (DAPP) at SAH would avoid unnecessary ALC days and prevent hospital-acquired disability. DAPP requires that targeted individuals are admitted to a bedded level of rehabilitative care directly from the community, bypassing Emergency Department and acute care in the process.
By creating a pathway that enables direct admission of high risk frail older adults from the community to an A&R unit bed, a goal to reduce ALC-AR days waiting at SAH without adversely affecting the patient experience may be executed.
By developing a referral process to access SAH A&R unit beds directly from the community it was possible to reduce the wait time.
the DAPP pilot process for a patient to access an SAH A&R unit bed directly from community was successful, as a result 10.6 ALC-AR days waiting were avoided
By implementing this pilot project, an admission to the SAH A&R Unit via the DAPP would result in approximately 100% reduction in ALC days waiting, equating to an estimated cost savings of $10,000/DAPP admission
Dana, Project Coordinator, from North East Specialized Geriatric Center used Lean tools, including an A3, Root Cause Analysis and Spaghetti Diagram to collect and analyze data concerning the identified challenge of reducing ALC days waiting in acute care for a bed within the Sault Area Hospital (SAH) Assess & Restore Unit. Once the problem was identified and data was analyzed a goal to address was outlined using Lean productivity tools and a pilot program was successfully executed.