Burmeister, David B., DO

Karper, Laurence P, MD

Kaufmann, Michael W, MD

Norris, Edward R, MD, FAPA, FAPM

Primelo, Ralph A, MD

Rifai, Muhamad Aly, MD

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of PsychiatryGrowing Organizational Capacity to Facilitate theStreamlining of Patients with Psychiatric Disordersin a Community Academic Health Network; AnEight Year ReviewEdward R. Norris MD, FAPA, FAPMLehigh Valley Health Network, edward.norris@lvhn.orgMichael W. Kaufmann MDLehigh Valley Health Network, Michael.Kaufmann@lvhn.orgDavid B. Burmeister DOLehigh Valley Health Network, david_b.burmeister@lvhn.orgMuhamad Aly Rifai MDLehigh Valley HospitalLaurence P. Karper MDLehigh Valley Health Network, Laurence.Karper@lvhn.orgSee next page for additional authorsFollow this and additional works at: https://scholarlyworks.lvhn.org/psychiatryPart of the Psychiatry Commons, and the Psychiatry and Psychology CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtNorris, E., Kaufmann, M., Burmeister, D., Rifai, M., Karper, L., & Primelo, R. (2010, November 10-13). Growing organizationalcapacity to facilitate the streamlining of patients with psychiatric disorders in a community academic health network; An eight year review.Poster presented at: The 2010 Academy of Psychosomatic Medicine (APM), Marcos Island, FL.AuthorsEdward R. Norris MD, FAPA, FAPM; Michael W. Kaufmann MD; David B. Burmeister DO; Muhamad AlyRifai MD; Laurence P. Karper MD; and Ralph A. Primelo MDThis poster is available at LVHN Scholarly Works: https://scholarlyworks.lvhn.org/psychiatry/3Growing Organizational Capacity to Facilitate the Streamlining of Patients with Psychiatric Disorders  in a Community Academic Health Network; an Eight-Year Review  Edward R. Norris, MD, FAPM, Muhamad Aly Rifai, MD, David B. Burmeister, DO, Laurence P. Karper, MD, Ralph A. Primelo, MD, Michael W. Kaufmann, MD Lehigh VaLLey heaLth Network • aLLeNtowN, PeNNsyLVaNiaBACkGROuND  This report describes a transformation process of quality improvement projects that Lehigh Valley Health Network (a three-hospital system with a total of 889 beds) has undertaken to improve psychiatric patient flow. Projects included medical floor transfers to inpatient psychiatric units, reducing length of stay on inpatient psychiatric units, decreasing ancillary testing, and improving psychiatric patient flow in the emergency department.MEtHODS   A combination of lean methodology and Kotter’s eight steps for change were used to develop standardization processes designed to improve access to care.RESultS  Even as volumes in all areas were increasing, the average waiting time of psychiatric patients on medical floors decreased from 10 hours to less than 5 hours. The average length of stay on the inpatient psychiatric unit decreased from over 10 days to 8.45 days. Ancillary testing on the inpatient unit was reduced by 29%. The average length of stay for psychiatric patients in the emergency departments (EDs) has trended down from over 13 hours to under 10 hours and the total ED length of stay has trended down from 4.8 hours to 3.28 hours.CONCluSiONS Using a collaborative change model (and increasing spheres of influence), psychiatric patient flow across the continuum of a premier academic community hospital became more cost effective.14.012.010.08.06.04.02.0AvERAGE YEARlY lOS DAtA200120022003200420052006200720082009 Med Floor tx (hrs)  inpt Psych lOS (Days)  ED Psych lOS (hrs)  ED lOS (hrs)1.61.41.210.80.60.40.20YEARlY PAtiENt vOluMESPSYCHiAtRiC EMERGENCY SERviCES (PES) PAtiENt WORkFlOW  iN tHE EMERGENCY DEPARtMENtStAGES OF CHANGE increase urgency Build the guiding team Get the vision right Communication for buy-in200120022003200420052006200720082009 Med Floor tx (1,000)  inpt Psych (10,000)  ed Psych (10,000) ed tot (100,000)  This graph demonstrates eight years of patient volumes of four pivotal measures including medical-surgical floor transfers to psychiatry in thousands of patients, inpatient psychiatry in tens of thousands  of patients, emergency department psychiatric patient volume in tens of thousands of patients, and  emergency department overall patient volume in hundreds of thousands of patients.  The Heart of Change, John P Kotter and Dan S Cohen 2002 Harvard Business School Press ANCillARY REDuCtiON FY 2009300025002000150010005000lABORAtORY tEStSDiAGNOStiC tEStSGRAND tOtAl Actual Performed target Maximum  This graph demonstrates the laborato-ry and diagnostic tests that were planned versus actually performed in fiscal year 2009 on the inpatient psychiatric unit. The purpose of ancillary reduction was to re-move unneeded tests to decrease length of stay and control costs.  This graph demonstrates eight years of data including three-year baseline and five-year active improve-ment for network concerns included rising times for medical-surgical floor transfers, inpatient length of stay, and psychiatric emergency department length of stay. The pivotal measures include medical-surgical floor transfers to psychiatry (Med-Surg Tx), inpatient psychiatry length of stay (Inpt Psych LOS), emergency depart-ment psychiatric length of stay (ED Psych LOS), and emergency department overall length of stay (ED LOS).  H (hours)  D (days) Empower action Create short-term wins Don’t let-up Make change stickPAtiENt WORkFlOW tO StREAMliNE MEDiCAl  PAtiENt tRANSFERS tO PSYCHiAtRiC uNitSMed-SurgStaffBed SearchConsultationPsychiatristsinpatientStaffPsychiatricEmergencyServicesPatient Psychiatry  inpatient unittRANSFER DiSPOSitiON DECiSiONS    iNFORMAtiON FEEDBACkPatient presents to the Emergency  Department with psychiatric  complaintEmergency Department Assessment and Medical Clearance• Medical Assessment• Physical Exam• Laboratory WorkupDecision for disposition  medically clearedReport to PESTarget period  to improvePrompt responseMultitasking  introducedDefine Patient  Load per PESPES information gathering  and reviewPES interviews the patientReal-time consultation  with a psychiatristDecision on disposition made• Admission to BH Units• Referral to other facilities• DischargeInsurance authorizationRegulatory and medical  record completionOptional assessment by a  psychiatrist for a level of careReferral to other facilitiesTarget period  to improveReasons for delay• Insurance auth • No BH beds• Transportation• Security•  Patient dual diagnosisMEDiCAl ASSESSMENt DElAY PES ASSESSMENt DiSPOSitiON DElAY2.6 5 7.5 10 12.5HOuRS2117_Ed Norris GOC Streamlining_Final.indd   1 10/28/10   8:58 AM

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Growing Organizational Capacity to Facilitate the Streamlining of Patients with Psychiatric Disorders in a Community Academic Health Network; An Eight Year Review

Growing Organizational Capacity to Facilitate the Streamlining of Patients with Psychiatric Disorders in a Community Academic Health Network; An Eight Year Review

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