CLIENT: Orange Regional Medical Center
CASE STUDY
Middletown, NY
Fully understanding the problem allows us to develop solutions that focus on the root cause. Sometimes it is difficult for staff to see what is happening beyond the confines of their reality. In this case, the emergency department (ED) was very crowded with patients waiting for inpatient beds. The ED believed they needed more treatment space, but root cause analysis helped us see that the real need was for inpatient beds.
SERVICE: Transformation
EXECUTIVE SUMMARY
METHOD: Throughput Analysis
Initially focused on redesigning their emergency department (ED), Orange Regional Medical Center (ORMC) engaged Array Advisors to map the current and future state process. It became clear that there were some downstream bottlenecks causing the ED to be overwhelmed with patients.
Challenge The emergency department (ED) is experiencing daily holds. Currently, observation patients are sent to any available bed in the hospital. Staff fears that this bed assignment paradigm may be causing the back-up in the ED. Array looks to provide clarity around the impact of improving flow in the ED and cohorting observation patients.
The ORMC team was interested in seeing if they could increase ED capacity by adding holding beds for admitted patients waiting in the ED for an inpatient bed. We used a simulation model to test the effect of implementing the future state patient flow. Holding beds appeared to alleviate the problem, but we did not believe they were the best use of capital and they clearly did not solve the root cause of the issue. We recommended ORMC perform a study of the inpatient and observation patient interaction to determine if inpatient bed capacity was the root cause.
Solution
We hypothesized that moving observation patients, who were currently being treated
After developing a future state work flow focused on separating the very sick patients from the less sick patients in the emergency department (ED), Array worked to determine how a dedicated observation unit would impact current crowding in the ED.
reduce the number of holds in the ED.
in inpatient beds, to a cohorted unit would create capacity for admitted inpatients and
Array’s modeler developed a second simulation model to study the utilization and bed need of all inpatient units. The model also demonstrated the effect of treating observation patients in a dedicated unit, rather than inpatient units. The models provided the ORMC team with visuals, helping them see the impact of adding an observation unit. This also helped them determine the best use of their capital dollars.
PROJECT HIGHLIGHTS
2
SIMULATION MODELS: 1 ED, 1 INPATIENT
30
OBSERVATION BEDS NEEDED TO REDUCE ED HOLDING
6
RAZ POSITIONS ADDED