rounding in the ed what goes around comes around beaver...
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Rounding in the Emergency DepartmentWhat goes aROUND comes aROUND:
Excellence Starts with You!Jamie E. Hendrix, RN, BSN
Director of Emergency Services Beaver Dam Community Hospitals, INC. (Beaver Dam, WI)
Richard Tovar, MD, FACEP, DBAMT Infinity Health Care Medical Director
Beaver Dam Community Hospitals, INC. (Beaver Dam, WI)
What’s Right in Health CareSM | Evidence to Outcomes
Presentation Objectives
1. Participants will learn how they can leverage themselves and their teams to achieve customer service excellence.
2. Participants will learn the essential steps to take in transforming their department and to get desired results.
3. Participants will learn how implementing essential tactics such as patient and staff rounding will help them to achieve desired results in customer and staff satisfaction.
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Beaver Dam Community Hospitals, INC.
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What’s Right in Health CareSM | Evidence to Outcomes
Beaver Dam Community Hospitals, INC.
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What’s Right in Health CareSM | Evidence to Outcomes
It’s Not About Us, It’s About the Patients.
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What’s Right in Health CareSM | Evidence to Outcomes
Our Charge:
Overhaul the ER.
Conduct an image campaign.
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How Do You Start?
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What’s Right in Health CareSM | Evidence to Outcomes
Beaver Dam Community Hospitals, INC. Emergency Services Department Vision
The ED will be a “Center of Excellence” for urgent and emergent care.
High Quality Clinical Care
Prompt and High Quality Service
Personalized Care
Non-judgmental
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What’s Right in Health CareSM | Evidence to Outcomes
It Starts with You
What goes aROUND comes aROUND.
What does this mean anyway?
– To make a complete change or reform.
– (idiomatic) To complete a cycle of transition, returning to the point of origin.
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It Starts with You
Ask yourself:
Do I make customer service my first priority?
Do I role model what I expect of others?
How would I like to work for me?
What kind of leader am I?
Am I a “winner or a whiner”?
Am I an owner or a renter?
It begins with self reflection!!
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Making the Vision Reality
Staff Ownership/Accountability• Accepting the past and looking to the future.
• Owning your part of the past.
• Accept don’t defend.
• Being willing to change.
• Asking yourself, “Have I been more in to me than the patients/customers”?
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What’s Right in Health CareSM | Evidence to Outcomes
It’s Not About You, It’s About the Patient . . .
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Making the Vision Reality
TransparencyBe open and honest about current state, assessments, expectations, and actions needed for improvement.
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What’s Right in Health CareSM | Evidence to Outcomes
Making the Vision Reality
Perception is Reality . . .Is the lady pictured old or young?
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Don’t be too Quick to Judge Others . .
Your assessment may be way off!
Your assessment may be way off!
Click here to play video clip
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Moving Forward
• Complete the past and move forward.
• If you keep one foot in the past and one in the future you will never move forward.
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Making the Vision Reality
Shared Vision & Goals
• Goals related to Customer Satisfaction, Turnaround Times, and Volumes established.
• It is not about us, it is about the patients. Patients are the center of all we do, it because of our patients that we are employed.
Clear Expectations• Patient Rounding is
required every 30 minutes
• Technical/Clinical Skills
• Customer Service Skills
• Teamwork/Communication
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Making the Vision Reality
Teamwork
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Making the Vision Reality
Essential Components of Management Team:
• Shared goals
• Collaboration
• Partnership
• Trust
• Respect
• Support
• Open Communication
• Managing up
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Making the Vision Reality
You can do anything with the right amount of TEAMWORK!
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Making the Vision Reality
Teamwork• Teamwork established with other
departments• Partnership with Medical Staff• By working together and focusing on
the patients not ourselves, we created a pull verses a push effect.
• Behavioral standards established and enforced.
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What’s Right in Health CareSM | Evidence to Outcomes
Making the Vision a Reality
Teamwork• We clearly defined the 3 aspects we were
looking for in each team member.
Clinical /Technical Teamwork/Communication Customer Service
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Making the Vision Reality
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What’s Right in Health CareSM | Evidence to Outcomes
Making the Vision Reality
Make sure you have the right people on your team.
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BDCH ES Team Members
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What’s Right in Health CareSM | Evidence to Outcomes
BDCH ES Team Members
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Making the Vision Reality
Accountability
• Hold staff accountable for expectations related to care, service, teamwork and communication.
• Use feedback from customer concerns, patient satisfaction surveys, and clinical documentation including timelines.
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What’s Right in Health CareSM | Evidence to Outcomes
Making the Vision Reality
Accepting Change
• If you want to get what you have always gotten, then keep on doing what you have always done.
• You can’t control what happens to you.
• You can however, control your response or attitude toward what happens to you.
• When you control your response, then you will be mastering change verses letting it master you.
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Changing the Way We Do Things . . .
TraditionJust because we have been doing things this way
for years, doesn’t mean it makes sense.
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Making the Vision Reality
The best way to know how you are doing, and what needs to improve . . .
Measure, Measure,
Measure!!!
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Making the Vision Reality
Measurement
• We measured and analyzed the following feedback on a monthly basis. All information gathered was used to make and evaluate process changes.
- Customer satisfaction ratings*Individual provider*Shift*Department
- Direct customer feedback- Turnaround times/metrics - Volumes
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What’s Right in Health CareSM | Evidence to Outcomes
Change- It Starts With YOU
• “Leaders establish the vision for the future and set the strategy for getting there; they cause change. They motivate and inspire others to go in the right direction and they along with everyone else, sacrifice to get there.” –John Kotter
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Leading Change
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Making the Vision Reality
Thoughts on Change:
You can change anything if you do following:
1. You clearly decide what it is that you're absolutely committed to achieving
2. You are willing to take massive action
3. You notice what is working and what is not.
4. You continue to change your approach until you achieve whatever life gives you along the way. - Anthony Robbins
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Making the Vision Reality
Communication
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Making the Vision Reality
Communication
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Making the Vision Reality
Communication
• Share the results of your efforts with members of the team.
-consistency
-transparently
-acknowledge positive
-change processes as needed
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What’s Right in Health CareSM | Evidence to Outcomes
Rounding
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Rounding—Physician style
• Rounding is performed on patients for 3 reasons:
– Customer service/guest relations
– Quality improvement
– Enhanced reimbursement
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Rounding—Physician style
• Physician Electronic Medical Record (EMR)– Order entry/chart documentation
• Requires a minimum of 3 separate rounding times with the patient/family– Initial contact– Update on ED throughput– Discharge
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Rounding—Physician style
Initial contact:
• Patient is greeted by the physician/physician extender
• Initial exam performed
• Diagnostic and treatment plan explained
• Emphasis on estimated waiting time for throughput presented if possible
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What’s Right in Health CareSM | Evidence to Outcomes
Rounding—Physician style
Update:
• Any delay in diagnostic tests, consultations, etc., given as update to patient AND family
• Partial results shared with patient and family
• Reassessment of throughput time
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Rounding—Physician style
Snap shot of EMR serial exam documentation:
• Repeat exam time snap shot
• Serial exam for abdominal pain snap shot
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Rounding—Physician style
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ED Observation
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Rounding—Physician style
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Serial Exams
What’s Right in Health CareSM | Evidence to Outcomes
Rounding—Physician style
Discharge:
• Summary of diagnostics/treatment
• Estimated time to discharge or admission
• Always ask “any other questions or concerns??” at the termination of visit
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Rounding—Physician style
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ED Course
What’s Right in Health CareSM | Evidence to Outcomes
Rounding—Physician style
• Feedback to all physicians and physician extenders on a monthly basis
• Positive and negative customer service and quality benchmarks are shared with each provider on an ongoing basis
• Several physicians have increased their guest relation scores with feedback
• With positive results, renters become owners
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Rounding-Physician Style
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Press Ganey Rounding Scores
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74
82
16
69
81
15
75
83
17
74
82
0
10
20
30
40
50
60
70
80
90
2006 - 2007 1st 6 months of rounding 1st Quarter 2008
Doctors courtesyDoctor took Time to ListenDoctor informative Re: treatmentDoctors concern for comfort
What’s Right in Health CareSM | Evidence to Outcomes
Average Turn Around Times for MD
12.75
66.25
53.5
0
10
20
30
40
50
60
70
Provider "X"
Min
utes
In Bed / Initial Contact Initial Contact / Care Complete In Bed / Care Complete
Rounding—Physician style
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Rounding-Nurse style
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What’s Right in Health CareSM | Evidence to Outcomes
Rounding-Nurse style
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Rounding-Nurse Style
What is nurse rounding?
• Nurses spend more time at bedside.
• Patient knows who the nurse is.
• Questions are answered.
• Patient and family informed of delays.
• Comfort needs are met.
• Rounding is documented.
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What’s Right in Health CareSM | Evidence to Outcomes
Rounding-Nurse style
• Each patient is seen by the nursing staff every at least 30 minutes.
• Nursing staff use the AIDET format when rounding.
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AIDET
A- Acknowledge
• Address patient by name. • Make the patient feel welcome and as
though you expected them.• Use eye contact.• Use welcoming and positive body
language.
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AIDET
I- Introduce
• Tell the patient your name, title, and credentials.
• As you get more comfortable with rounding, share more information such as:–Skills, experience, certifications–Manage up coworkers and other
departments
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AIDET
D- Duration
• How long is the expected wait?• How long will test, or procedure take?• How long will results take? • When will the doctor or next caregiver
come in?
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AIDET
E- Explain
• Tests/procedures
• Discharge and medication instructions
• What you are doing, why, and what your thought processes are
• Answer questions
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AIDET
T- Thank
Remember that HealthCare is consumer driven. Patients have choice and they have chosen to come to your hospital. Thank them for choosing you.
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What’s Right in Health CareSM | Evidence to Outcomes
Rounding
How to start:
• Provide facts about current state.
• Make expectations clear.-every patient-every day-every time
• Find a way to measure results.
• Follow up on noncompliance.
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Nurse Rounding Results
Press Ganey Rounding Scores By Percentile Ranking
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83 83
56
8590
55
8287
54
8693
0
10
20
30
40
50
60
70
80
90
100
2006 - 2007 1st 6 months of rounding 1st Quarter 2008
Nurse took time to Listen
Nurses attention to your needsNurses informative re treatment
Informed about delays
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What’s Right in Health CareSM | Evidence to Outcomes
BDCH Outcomes
CommunityGrowthPerformancePeopleQualityStakeholder Satisfaction
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What’s Right in Health CareSM | Evidence to Outcomes
Stakeholder SatisfactionEmergency Room Press Ganey Overall Percentile Scores
0
10
20
30
40
50
60
70
80
90
100
2006 July 2, 2007 -Dec 31,2007
4th Quarter2007
1st Quarter2008
Standard OverallStandard NursesStandard MD's
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What’s Right in Health CareSM | Evidence to Outcomes
Stakeholder Satisfaction
Patient Satisfaction by Volume
83.7
88.5
81
82
83
84
85
86
87
88
89
National AverageBDCH Average
National Average for ED's with 20,000 - 29,999 visits per year
BDCH ER AND UC with 24,261 visits
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Stakeholder Satisfaction
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Beaver Dam Community Hospital, Inc. Press Ganey - Emergency Services 2006 - 2008
73.178.680.9 81.7
85.786.483
8885
0
10
20
30
40
50
60
70
80
90
100
Overall Facility Rating Overall Rating of Care Likelihood of Recommending
Perc
entil
e R
anki
ng
20062007Jan1 - June 2008
What’s Right in Health CareSM | Evidence to Outcomes
People
• New ER Physician Group hired.
• ER RN Vacancy Rate reduced from 33.03% in 2007 to current rate of 3.13 YTD%.
• Charge Nurse and Tech. positions added for evening and weekend (high volume) hours.
• Clinical Nurse Manager hired to increase the skill level of nursing staff.
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Performance
Average Turn Around Times Arrival to Discharge Emergency Department
141136
131135
40
60
80
100
120
140
160
June 2006-June 2007 July 2, 2007- Dec. 31,2007
4th Quarter 07 1st Quarter 2008
June 2006-June 2007July 2, 2007- Dec. 31, 20074th Quarter 07 1st Quarter 2008
GOAL-120
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What’s Right in Health CareSM | Evidence to Outcomes
Performance
Beaver Dam Community Hospital Med Flight Ground Times
24 24
64
1917
32
0
10
20
30
40
50
60
70
Regional ER to Med Flight Call Med Flight Ground Time Med Flight Call to Arrival at UWHC
20062007
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Performance
Average Time Spent in US Emergency DepartmentsArrival to Discharge 2007-2008
Nat. Average TAT
Wisconsin Average TAT
BDCH Average TAT
0
50
100
150
200
250
300
National average TAT 240Wisconsin average TAT 182BDCH average TAT 130
In Minutes
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What’s Right in Health CareSM | Evidence to Outcomes
Growth
Number of Emergency Services Visits
22405
24261
13487
8918
15002
9259
0
5000
10000
15000
20000
25000
30000
Urgent Care Emergency Department Accumulative
2006
2007
70
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Excellence Starts With You!
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What’s Right in Health CareSM | Evidence to OutcomesEmergency Services72
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Conclusion
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What’s Right in Health CareSM | Evidence to Outcomes