By Kristen Godfrey. UC Davis Health has won gold stars for improving patient flow! How? By creating a program to address everything from reducing the time doctors spend walking from patient to patient, to decreasing the time patients spend waiting to be discharged.
The Patient Flow Program at UC Davis Health optimizes the electronic records system (Epic) build, leverages system data, and improves operational processes to drive patient flow improvements. The program encompasses projects touching all areas of health system processes and adapts to meet the needs of patients and operations. It includes admission, transfer, discharge, hospital capacity management, bed planning, environmental services (e.g., cleaning and disinfecting), transfer center, and transport.
Three years ago, UC Davis Health started at Level 1 in the Patient Flow category for the Epic Gold Stars program. Through the Epic Refuel Program, UCD Health achieved a Level 9 overall rating in August 2020. By January 2021, Patient Flow maintained 9/10 Gold Stars based on the 2021 Patient Flow category criteria. As of August 2021, Patient Flow achieved a 10/10 Epic Gold Stars rating and over 20 Patient Flow Gold Stars items.
Some highlights from the Patient Flow Epic Gold Stars include:
- The Epic Daily Huddle Dashboard is used in the Executive Huddle to provide hospital leadership with trending data on a wide range of areas. Over 40 components and 110 dashboard badges have removed manual reporting workflows for nursing supervisors, bed planning, the emergency department, perioperative services, transfer center, case management, and more. The dashboard results in up-to-date, actionable information at any moment throughout the day. The Epic Daily Huddle Dashboard brings real-time data for the first time to UC Davis Health. Christine Williams RN, MS, CNS, executive director of Patient Care Services, said, “Having real-time and trending data available in the 7 Capacity Management Dashboards, currently available, enables constant decision making and optimization of patient movement workflows to improve efficiency and create capacity.”
- The Patient Flow Daily AM/PM email sends a real-time snapshot of data from Epic twice daily. The daily email feature replaced manual phone calls and data entry for nursing supervisors, resulting in a time savings of 60-90 minutes per shift. That is a total average time savings of 912.5 hours per year. In addition, it replaced the use of manual spreadsheets for Patient Flow, when nursing supervisors would perform a manual workflow twice daily using a pencil, paper, and plenty of erasers. Joleen Lonigan RN, MSN, NE-BC, FACHE, executive director of Patient Care Services, said, “The Epic generated dashboard can generate a snapshot in time to distribute to our operational leadership team. The new dashboard provides a streamlined standard process to support organizational communication.” The new Epic dashboard removed this tedious workflow and took Patient Flow to the next level.
- Patient cohorting ensures that the same type of patients are grouped in a unit and saves physicians time rounding on patients. Increased cohorting saw a 75.2% increase in Hospital Medicine Service cohorting in several pilot units from January to September 2021.
- Discharge reception area enhancements help improve patient flow by providing a place where patients who are ready for discharge but are waiting on something before going home, such as a ride, medical equipment, medications from the pharmacy, or a variety of other services facilitated by the discharge nursing team. The Epic team worked with Patient Flow Management Center Director Jennifer Erickson to eliminate phone calls and paper workflows. The patient flow team created an automated Epic workflow for nursing to identify eligible patients and aid the discharge nursing team in identifying those patients quickly. These changes resulted in a 55% volume increase in patients utilizing the Discharge Reception Area. This aids in completing discharge by 2 p.m., which allows for more efficient planning and turnover. Previously the discharge process was conducted using phone calls and paper.
UC Davis Health prides itself on leading innovation through technology. As a Center for Excellence in Digital Health, its goal is to deliver exceptional patient and care team experiences and to utilize inclusive, human-centered design and workflow redesign. The Patient Flow Program allows UC Davis Health to provide world-class care to patients more quickly and efficiently, while also meeting operational needs and the needs of care teams.
Enabling responsive workflows helps reduce physician and care team burnout by reducing administrative burden. In addition, delivering self-service data access and enabling data democratization allows UC Davis Health to provide a best-in-class data experience. Because of the hard work of everyone involved (Epic IT applications team, the Patient Flow Oversight Committee, Patient Flow leadership, and the Patient Flow project team), UC Davis Health is one step closer to becoming the first choice for patients and healthcare professionals throughout Northern California.
The Patient Flow team is led by executive sponsors Brad Simmons; J. Douglas Kirk, MD; Christine Williams, RN; Jeffery Wajda, DO; Jennifer Burger; and Toby Marsh, RN; and includes project team members Christine Williams, RN (Patient Flow Champion), Joshua Maisner (Epic Patient Flow Services), Dee Dee Walsh (Grand Central/Prelude/Case Management & Patient Flow Application Manager), and Joliene Martinez (Grand Central & Patient Flow Analyst), and an oversight committee composed of health system and IT leaders.
Epic IT application analysts also completed 150 projects over the last two and a half years to support the program. Without these remarkable and diligent individuals, the Patient Flow initiative would not be possible.