Implementation of an Acute Floor Operating Model and Analytics Dashboards

Customer

Tallaght University Hospital (TUH) is one of Ireland’s major academic teaching hospitals. With 562 beds, 16 theatres and 20 critical care beds – the 3,000 staff treat over 410,000 patients per year. Over 52,000 patients per year attend TUH’s Emergency Department.

Problem

Adopting an Acute Floor operating model to improve patient flow

The Paediatric Emergency Department (ED) service based in TUH transitioned to a new building freeing up space to expand the capacity for the Acute Medical Unit (AMU) and the Acute Surgical Unit (ASAU) services. In order to ensure this new capacity was utilised optimally, TUH decided to adopt an Acute Floor operating model. The main implication of this was to bring unscheduled services under a single governance model. These included the ED, AMU, ASAU and the ARAU (Age Related Assessment Unit). MedModus were asked to facilitate the development of the Acute Floor operating model.

Solution

Operational standards, metrics and governance

MedModus recommended and applied a four-step approach to the project:

  1. Operational Standards: There were multiple documented SOPs in existence which described the operating model of individual services. Many of these were out of date, lacked clarity and cross service agreement. MedModus facilitated agreement on single set of operating standards for the acute floor. This includes inter service referral guidelines, transition of care policy, service opening and closing times, key metrics, and the Acute Floor Governance model.
  2. Metrics and dashboard: In order to track service delivery against these agreed standards two improvement dashboards were designed. The first provided a near real time picture of the status of patient flow through the acute floor. This dashboard shows the number of patients in each service compared to agreed capacity, the number of patients per each pathway step e.g., awaiting Doctor review, awaiting Decision to Admit (DTA), referred to ASAU, etc. The second dashboard, to be used in monthly service review meetings shows trends in patient volumes stratified by complaint type, age, acuity, etc and trends in patient journey times.
  3. Governance: The acute floor operations and clinical management team were coached in how to run more effective (data driven action focused) service review meetings using the analytics dashboards.

Results

N

The process of getting cross service agreement on operational standards improved the quality of conversation and level of collegiality between service teams.

N

The metrics focus on the critical few measures that influence patient flow as well as providing drill down and stratification of data so as to identify the complaint type or pathway step that is contributing to delays in flow.

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