“It’s a proactive approach, but we know in real time what is happening. We don’t have to be glued to a dashboard or census report to get the pulse of the hospital.”
—Kathy LeFrancois, RN, Director, Patient Flow and Nursing Resources, Sarasota Memorial Hospital–Venice, North Venice, Fla.Nov. 11, 2021, was a joyous day for Kathy LeFrancois, RN, and her colleagues as they gathered for the grand opening ceremony of Sarasota Memorial Hospital–Venice in North Venice, Fla. Anticipating 75% capacity, staff for the new 110-bed, full-service, acute-care facility was prepared for the opening. Almost immediately, however, the hospital would be over capacity.
“We saw firetrucks and ambulances coming through the parking lot, and we thought at first it was the county celebrating our opening,” says LeFrancois, director, patient flow and nursing resources. “But it was patients in need of care at the ER doors.”
Creative Solutions
Even though relief was on the distant horizon—a new five-story patient tower is set to open on the hospital’s campus in 2024, increasing capacity by 102 beds—the team needed to work within its existing reality.
“We had to create capacity through efficiencies,” LeFrancois says. “At the same time, we wanted to instill among our staff the importance of establishing a high level of care and making patients feel like they are important and not just being rushed in and rushed out.”
LeFrancois and the team were using many of the established processes in place at the 832-bed Sarasota Hospital 20 miles away and also part of the Sarasota Memorial Health Care System. But they needed to get even more creative to handle the volume at Venice, which was built to serve the growing south Sarasota County area. Some of the additional innovations Sarasota Memorial Hospital–Venice implemented include:
Strategic use of licensed practical nurses. One of the first decisions the team made was to place an LPN on the inpatient floors to focus solely on patients who were ready to be discharged. The LPN meets one-on-one with these patients to go over discharge instructions and provide education on their health conditions, allowing floor nurses to spend time on other patients.
The hospital now has three LPNs on the day shift working solely on discharges, a mid-shift LPN focusing on patient flow from the ER, and a night shift LPN who focuses on admissions and other patient flow needs.
Lightning rounds. Three months after opening, the Sarasota Memorial Hospital–Venice team established rounds in which the hospital’s LPNs go to the units first thing in the morning with the charge nurses and case manager. They flag any patients who are medically cleared and could go home before 1 p.m. The team also flags patients who potentially could be discharged but are being prevented from doing so because of the need for an MRI or other test.
Centralized discharge expediting. A dedicated discharge expediter, who works from a central logistics center at the Sarasota Hospital campus, receives notifications of these discharge barriers at both hospitals and the system’s freestanding ED in North Port and contacts the units at these facilities to ensure confirmed or potential discharge patients are priorities. Nurses on the lightning rounds also receive the notifications on their mobile devices and work to expedite the final care steps these patients might require prior to discharge.
Dedicated patient flow oversight. A patient flow coordinator was added to the Sarasota Memorial Hospital–Venice ED to review every admission and make sure clinicians are completing admission orders and recording required patient vitals. LeFrancois says establishing this role has been essential for streamlining patient flow.
“These coordinators have established relationships with both our hospitals’ teams, and they’re the first point of contact when a physician has a concern or a question about placement or when we’re looking at capacity transfers,” she says.
Door-to-car program. The hospital’s orthopedics program features valet appointments for patients with their physical or occupational therapists. On a patient’s discharge day, their final therapy appointment is the therapist helping the patient get into their family member’s or friend’s car to go home. This helps educate patients about how to safely move their healing bodies. These valet appointments have resulted in planned discharge times for some orthopedic patients.
“We have been able to plan that at least 50% of our orthopedic surgeries will leave the next day, so we can prep for either planned incoming surgeries or holds from the ER,” LeFrancois says.
Tech Ties It All Together
Supporting these innovative processes and teamwork is advanced technology that helps staff proactively manage discharge barriers and predict patient surges. LeanTaaS’ iQueue for Inpatient Flow allows the team at Sarasota Memorial Hospital–Venice to access the same information at the same time so they can effectively communicate discharge readiness and align on discharge priorities.
The hospital has set up notifications within the software about patient capacity, and when specific thresholds are met, automated alerts are sent via text and email to the appropriate staff.
“The software takes into consideration who is coming into the hospital and who is going out,” LeFrancois says. “It’s a proactive approach, but we know in real time what is happening. We don’t have to be glued to a dashboard or census report to get the pulse of the hospital.”
For at least the past six months, Sarasota Memorial Hospital–Venice has discharged 30% to 50% of its census each day before 6 p.m. This has created room for new patients earlier in the day, resulting in decreased ED boarding, fewer patients leaving without being seen, and a reduction in avoidable days and length of stay.
A goal initiated by the hospital’s capacity steering committee—to discharge patients within 403 minutes after they’ve been identified as needing no further care—has been far surpassed; the hospital’s current average is 327 minutes. Nearly 33% of patients are being discharged prior to 1 p.m.
When the new patient tower opens, LeFrancois and her team plan to operate with the same sense of urgency to discharge patients as efficiently as possible.
“That’s the culture we’re creating, and we’re going to stick with it,” she says. “We’ve proven it’s how we can be the most efficient.”
For more information, please contact Kayla Vasey, LeanTaaS, at kayla.v@leantaas.com.
“We saw firetrucks and ambulances coming through the parking lot, and we thought at first it was the county celebrating our opening,” says LeFrancois, director, patient flow and nursing resources. “But it was patients in need of care at the ER doors.”
Creative Solutions
Even though relief was on the distant horizon—a new five-story patient tower is set to open on the hospital’s campus in 2024, increasing capacity by 102 beds—the team needed to work within its existing reality.
“We had to create capacity through efficiencies,” LeFrancois says. “At the same time, we wanted to instill among our staff the importance of establishing a high level of care and making patients feel like they are important and not just being rushed in and rushed out.”
LeFrancois and the team were using many of the established processes in place at the 832-bed Sarasota Hospital 20 miles away and also part of the Sarasota Memorial Health Care System. But they needed to get even more creative to handle the volume at Venice, which was built to serve the growing south Sarasota County area. Some of the additional innovations Sarasota Memorial Hospital–Venice implemented include:
Strategic use of licensed practical nurses. One of the first decisions the team made was to place an LPN on the inpatient floors to focus solely on patients who were ready to be discharged. The LPN meets one-on-one with these patients to go over discharge instructions and provide education on their health conditions, allowing floor nurses to spend time on other patients.
The hospital now has three LPNs on the day shift working solely on discharges, a mid-shift LPN focusing on patient flow from the ER, and a night shift LPN who focuses on admissions and other patient flow needs.
Lightning rounds. Three months after opening, the Sarasota Memorial Hospital–Venice team established rounds in which the hospital’s LPNs go to the units first thing in the morning with the charge nurses and case manager. They flag any patients who are medically cleared and could go home before 1 p.m. The team also flags patients who potentially could be discharged but are being prevented from doing so because of the need for an MRI or other test.
Centralized discharge expediting. A dedicated discharge expediter, who works from a central logistics center at the Sarasota Hospital campus, receives notifications of these discharge barriers at both hospitals and the system’s freestanding ED in North Port and contacts the units at these facilities to ensure confirmed or potential discharge patients are priorities. Nurses on the lightning rounds also receive the notifications on their mobile devices and work to expedite the final care steps these patients might require prior to discharge.
Dedicated patient flow oversight. A patient flow coordinator was added to the Sarasota Memorial Hospital–Venice ED to review every admission and make sure clinicians are completing admission orders and recording required patient vitals. LeFrancois says establishing this role has been essential for streamlining patient flow.
“These coordinators have established relationships with both our hospitals’ teams, and they’re the first point of contact when a physician has a concern or a question about placement or when we’re looking at capacity transfers,” she says.
Door-to-car program. The hospital’s orthopedics program features valet appointments for patients with their physical or occupational therapists. On a patient’s discharge day, their final therapy appointment is the therapist helping the patient get into their family member’s or friend’s car to go home. This helps educate patients about how to safely move their healing bodies. These valet appointments have resulted in planned discharge times for some orthopedic patients.
“We have been able to plan that at least 50% of our orthopedic surgeries will leave the next day, so we can prep for either planned incoming surgeries or holds from the ER,” LeFrancois says.
Tech Ties It All Together
Supporting these innovative processes and teamwork is advanced technology that helps staff proactively manage discharge barriers and predict patient surges. LeanTaaS’ iQueue for Inpatient Flow allows the team at Sarasota Memorial Hospital–Venice to access the same information at the same time so they can effectively communicate discharge readiness and align on discharge priorities.
The hospital has set up notifications within the software about patient capacity, and when specific thresholds are met, automated alerts are sent via text and email to the appropriate staff.
“The software takes into consideration who is coming into the hospital and who is going out,” LeFrancois says. “It’s a proactive approach, but we know in real time what is happening. We don’t have to be glued to a dashboard or census report to get the pulse of the hospital.”
For at least the past six months, Sarasota Memorial Hospital–Venice has discharged 30% to 50% of its census each day before 6 p.m. This has created room for new patients earlier in the day, resulting in decreased ED boarding, fewer patients leaving without being seen, and a reduction in avoidable days and length of stay.
A goal initiated by the hospital’s capacity steering committee—to discharge patients within 403 minutes after they’ve been identified as needing no further care—has been far surpassed; the hospital’s current average is 327 minutes. Nearly 33% of patients are being discharged prior to 1 p.m.
When the new patient tower opens, LeFrancois and her team plan to operate with the same sense of urgency to discharge patients as efficiently as possible.
“That’s the culture we’re creating, and we’re going to stick with it,” she says. “We’ve proven it’s how we can be the most efficient.”
For more information, please contact Kayla Vasey, LeanTaaS, at kayla.v@leantaas.com.