Case Study: Inspira Health Network ED Observation

CLIENT:

Inspira Health Network CASE STUDY

Vineland, NJ

Executives make data-driven capital spending decisions with help from healthcare consultants.

Executive teams investigating the future must make critical decisions regarding the future of healthcare delivery now. New facilities’ designs should meet the fluctuating demands of the future, with little need for major renovation.

By offering strategic decision support, we can measure the outcome of incorporating universal resources and collocating similar departments, helping lay the framework for sustainable design.

CHALLENGE

EXECUTIVE SUMMARY

Provide the executive-level team with high-

Inspira Health Network, a regional healthcare provider that operates multiple

level decision support around emergency

ambulatory and acute care facilities, engaged Array to assist in a departmental space

department capacity, and present options

allocation study for their new greenfield hospital. The emergency department (ED)

that minimize capital spending.

and observation unit were key departments in this study.

Currently, staff direct patients who arrive to the ED to either the main ED or the

SOLUTION

observation unit, where they spend time in a bed before being either admitted or discharged. We received high-level data regarding the patient acuity distribution,

Strategic Decision Support

average length of stay, and patient arrival rates. Using these readily-available figures,

Array used discrete event simulation

our Healthcare Systems Engineer developed a strategic model to explore the impact

modeling to produce a high-level, decision

of utilizing flexible beds shared by the observation unit and ED. The model helped us

support resource. Building a model with

analyze three options for patient throughput, which we presented to the executive

readily available data, including average

team:

length of stay, patient mix and arrival rates,

1.

enabled the swift turn-around of a tool that

(41 main ED; 16 observation)

answered one strategic question, “Should we use a universal resource for observation and the emergency department?” The model helped the executive team see the results of various scenarios in a quick, concise manner so they could make a strategic, data-supported decision.

PROJECT HIGHLIGHTS

Continue with the current state model and build 57 rooms

2.

Reduce the number of main ED beds from 41 to 36, but continue treating observation patients in a separate area with 16 beds, for a total of 52 rooms

3.

Reduce the total number of beds to 52 and use flexible beds for both the main ED and observation unit

Applying the information gleaned from the model results, the executive team quickly made a strategic decision that resulted in an estimated $1.8M savings.

$1.8M Estimated Cost Reduction

3

Bed Allocation Models Tested

4%

Observation Patients

CLIENT PROFILE Inspira Health Network Vineland, NJ

Process Strategic decision making comes early in a project when there are still many unknown variables. When examining the process and exploring options, it is important to ask questions with the correct level of detail. To assist our client with making a strategic

Inspira Health Network, a charitable

operational decision, we focused on the high-level steps associated with patient

nonprofit organization, is the leading

stays in the ED and observation unit.

southern New Jersey.

Delivering the full continuum of primary, acute and advanced care services across more than 100 locations, Inspira is an integral part of the community. The

Current State

network of healthcare providers in Move to Observation Unit

Patient Arrival

41 Beds (57 Total Beds)

www.inspirahealthnetwork.org

Figure 1: Current state process map showing how patients move through the ED and observation unit.

Future State

multi-specialty health centers.

Discharge

Move to Main ED

network comprises three hospitals, a comprehensive cancer center, and several

Admit

16 Beds

Triage Patient

Triage Patient

In the current state (Figure 1), the

Move to Flexible ED high-level process Bed

Admit

begins with patient arrivals.

Discharge Patients then move to triage, where they are sorted into either the main ED or the Patient Arrival

52 Beds

observation unit. After their stay, patients are admitted or discharged. While this process seems much simpler than one would expect from an ED, it is all the detail we needed to answer a strategic question, “Should we create a hard separation between

TOOL

Future State

the ED and the observation unit?�

Admit

Move to Main ED

Triage Patient

Move to Observation

Patient Arrival

Discharge

52 Beds

Figure 2: Future state process map showing how the main ED and observation unit share resources, allowing them to flex as the census grows and shrinks.

We proposed a new future state workflow (Figure 2) to our client that involved an ED

Strategic Decision Support Every day, we make choices. They can be trivial, only affecting a small group; they can also be more critical, affecting many aspects of an organization. Our

adjacent to the observation unit, where beds could flex as necessary. In this scenario, patients arrive to the ED and are triaged, just as they do in the current state. The change occurs in the pool of resources available for the main ED and observation unit.

In this proposal, 52 beds make up the two departments. As the census in each varies, the size of the units can flex back and forth, as seen in Figure 3.

trusted advisors can assist with your next

ALOS Distribution

strategic decision so that you can see the Utilizing proven techniques, we provide a range of custom analysis options that focus on your specific need.

9:36:00 Observation

Emergency Department

8:24:00

LOS (Hours)

impacts of your options before choosing.

10:48:00

7:12:00 6:00:00 4:48:00 3:36:00 2:24:00 1:12:00 0:00:00

ESI 1 Admit

ESI 1 Discharge

ESI 2

ESI 3

ESI 4

ESI 5

Category Min

Median

Max

Figure 3: Relationship diagram showing the proposed space interaction between the ED and observation unit (left). Length of stay distribution shown for each acuity level (right).

Page 2 | Case Study

TRANSFORMATION

Data The strategic question focused on determining the number of bed resources needed to support two separate, but adjacent departments. We developed our data request with the high-level process in mind: patients arrive, are treated, and leave the system. Therefore, we were only really concerned with the total length of stay for each patient over a six-month period. This data was specific enough to help support a strategic decision, and health systems already collect it.

Our Healthcare Systems Engineer developed the simulation model, keeping in mind that this was a high-level process requiring very little detail to answer the desired question. We developed three options using the simulation model, with the ultimate goal of reducing bed count, if possible: Continue with the current state model and build 57 rooms (41 main ED; 16 observation) 2.

Reduce the number of main ED beds from 41 to 36, but continue treating observation patients in a separate area with 16 beds, for a total of 52 rooms

3.

our clients: improve the quality of our work, increase our efficiency, and motivate our staff to reach for success. At Array, we are establishing a culture of continuous improvement at all levels of our organization. We seek to empower team

Simulation

1.

Our core mission is the same as that of

Reduce the total number of beds to 52 and use flexible beds for both the main

members to be agents for good change.

We begin all endeavors by considering process before exploring solutions. Our team can guide your organization through pre-design, ensuring clear goal-setting; target outcomes; process analysis and design; and decision support. Our Lean-led approach to project definition provides a clear path to the right project before you begin to design.

ED and observation unit Array developed and tested these scenarios to answer a specific question in a short amount of time, leading to rapid results and quick decision-making.

How can we ensure effective resource utilization?

Every aspect of the healthcare industry relies on resources, including staff, equipment and space. It’s imperative that organizations utilize tvheir resources effectively. Our skilled and experienced consulting team can help your organization develop a strategy for utilization optimization, ensuring that every resource is providing the highest value while improving process flow.

Figure 4: Results graphic depicting wait times for each scenario.

Tools used: Adjacency, Capacity & Utilization Assessment, Data Analysis, Data Visualization, Process Mapping,

Solution The results, shown in Figure 4, helped Inspira see that they could reduce the total

Simulation Modeling

number of bed resources by five only if they moved to a model with adjacent units that could flex when appropriate. If chosen, this option saves them $1.8M and approximately 5,000 SF.

52 Flex Beds

5,000 SF Reduction

$1.8M Savings

Cast Study | Page 3

DISCOVERING YOUR HEALTHCARE SOLUTIONS TOGETHER We are innovators who specialize in the areas your system seeks out to leverage its valuable operational and facility resources. Array Advisors has the expertise and skills to reach beyond your milestones and provide you the decision support you need.

OUR SOLUTIONS

OUR SERVICES

We are dedicated to improvement.

How can we assist you?

Problem-solving and forward-thinking

We are Array Advisors, your trusted partners in Strategy Development, Organizational

individuals lead our efforts, which focus on your unique place in the healthcare delivery spectrum. Our knowledgeable staff can help you solve strategic business problems and develop a method to improve efficiency and utilization.

Transformation, and Facility Informatics. The challenges you face are not unique, but your solutions should be. Through a partnership of Strategy and Transformation we help you achieve and sustain. Our process begins by understanding your current operations and clearly defining your system’s goals before generating options. We employ a variety of integrated methods tailored to your strategic challenges, such as process mapping; operational planning; and healthcare real estate portfolio optimization, to help position your organization for future success.

MEET YOUR ADVISORS

Informatics Building Information Model management (BIM) is an enabler of most other technology trends in the Architecture, Engineering, Construction, Operations (AECO) industry, including but not limited to: sustainable design, offsite fabrication, LEAN construction, and energy efficient operations. Carefully considering how best to leverage virtual/digital representations of physical buildings can provide significant returns on innovation throughout the entire lifecycle of your facilities.

Strategy The need for healthcare real estate portfolio optimization has never been greater.

With the acceleration in mergers and acquisitions, as well as the evolution of clinical models, healthcare organizations must continuously evaluate their physical assets and maximize the value they derive from them.

Transformation Transformation and lean methods are very useful when focusing on operational process improvement. By bringing all constituents together and giving them the tools to experiment and test new ideas, current state barriers can be identified and transcended.

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Published: MAY 2016