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By Teressa Conley, RN, MBA, MSN, DPA
Chief Operating Officer, Siena Campus
St. Rose Dominican Hospitals
Vegas Area's Population Growth Strains Capacity
Visitors to Las Vegas know that it is like no other city in the world. As it has grown, so has St. Rose Dominican Hospitals (St. Rose), which has served the Southern Nevada area for 60 years. The region is synonymous with tourism, where every new hotel room is estimated to create two direct jobs and two indirect jobs. While the country's current economic downturn may have some impact, Clark County's population is projected to increase from 2 million people today to nearly 3 million people by 2020.
A member of Catholic Healthcare West (CHW), today St. Rose is a 511-bed network comprising three campuses: Siena, Rose de Lima and our newest facility, San Martin, which opened in November 2006. As the population around us has continued to boom, we have sought to maintain high-quality care while grappling with daily occupancy rates as high as 120 percent. Despite our best efforts, makeshift patient rooms divided by curtains in corridors are the norm rather than the exception.
A Centralized View of Capacity for Quick
Patient Placement
In 2005, St. Rose conducted a throughput analysis based on recommendations from the Advisory Board's "Breakthrough Capacity Management" research. The following year we implemented a consolidated operations center on our main Siena campus in order to centralize patient placement and staffing functions across all three facilities. Key to the center's success is McKesson's Horizon Enterprise Visibility™ enterprise tracking board solution, which we implemented in 2007 at all three hospitals.
Bed requests, bed assignments, patient movement and bed turns can all be viewed on large, electronic whiteboards in the operations center and throughout each facility. A daily census "dashboard" highlights capacity issues, staffing issues and transfer availability over a 24-hour period.
With this insight, we've been able to implement an ED transfer process whereby patients can be admitted to available beds with the right level of care at any campus. Now soon after arrival, we can offer patients in holding areas the option to stay where they are with no guarantee of a permanent room or immediately transfer to a private room at our new facility 15 minutes away.
St. Rose's Commitment to Collaboration
As with any implementation, the technology is only as good as the processes behind it and the adherence to them. In this case, patient flow can only be improved if everyone involved in the care process learns to rely on the electronic tracking boards and acts on the information that they see. They must also use the enterprise tracking board to enhance other forms of communication, not replace them.
At St. Rose, we encourage what we call COC, or "commitment to collaboration," over independent action. The enterprise tracking board helps drive organizational alignment by putting everyone on the same page. It also helps ensure process compliance by broadcasting visual reminders of staff accountability to each other and to the patient.
Sustained Gains from New ED Transfer Process
By centralizing patient placement and staff management, and cross-training operations center staff, we have been able to reduce the number of FTEs required for these functions from 30 to 11. Within two months of implementing the new ED transfer process in December 2007, we began efficiently transferring more than 200 ED admissions per month to a bed with an appropriate level of care within the network. The ability to make these transfers has helped the Siena campus maintain an average patient satisfaction score above 90% despite continually running at full capacity.
All of this has not gone unnoticed by our 41-hospital parent corporation. In July 2007, Horizon Enterprise Visibility was named CHW's "patient flow gold standard" based on the results here at St. Rose.
Teressa Conley, RN, MBA, MSN, DPA, is the chief operating officer at Catholic Healthcare West (CHW)/St. Rose Dominican Hospitals-Siena Campus. In 1990 she began holding senior nursing executive positions at hospitals throughout Southern California and has been with CHW since 2001. CHW is the eighth largest hospital system in the nation.
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