The ABC of Lean Thinking
New Admissions and Bed Coordination Center to handle unscheduled admissions to UH, MCHC and CVC
(Nov./Dec. 2008)
Thanks to the hard work of a lean team, a new Admission and Bed Coordination Center (ABC) will be the conduit for all unscheduled admissions to University Hospital, the Maternal Child Health Care Center and the Cardiovascular Center.
Each year, about 60 percent of our admissions—or 45,000 people—are unscheduled admissions. These patients come to U-M through a variety of routes, including the Emergency Department, other hospitals and referring physicians, UMHS clinics and even directly from patient homes.
“This translates to about 60 to 80 patients a day,” says Carrie Dawson, M.S., B.S.N., R.N. That’s 60 to 80 patients every day who arrive here needing to be screened clinically and financially. Dawson and Debra Vasher, ABA, are co-managers of the new ABC.
ABC merges staff from three different departments (the current bed manager, Access/Transfer Center and the Admitting Bed Desk), and partners closely with Cardiovascular access staff and others to accomplish a seamless, single point of entry for unscheduled admissions, a centralized queue of patients earmarked for inpatient beds, and round-the-clock support and ease of patient flow.
The lean team: (bottom from left) Sheri Moore, Jennifer Gegenheimer Holmes, Ramona Ward, (top from left) Pam Chapelle and Debra Vasher worked on an 11-month lean project to streamline the process of coordinating unscheduled admissions to the Health System. (Not pictured: Jim Goulet, Judy Brant, Jon Fairchild, Kathy Gold, Priscilla Mazurek, Jean Shlafer, Kathy Wade, Dave Wesorick, Teresa Snider, Michelle Donnelly, Jennifer Miller, Mark Lowell, Michelle Begby and Mark Pearlman).
ABC has three different staff roles:
- Patient flow coordinators, a hybrid of the former bed manager role, expedite patient placement and ease intra-unit transfers 24/7.
- Admission triage coordinators coordinate hospital-to-hospital transfers and conduct financial and clinical screening of all unscheduled admissions.
- Admission triage assistants partner with both coordinator roles to ensure accurate patient admission and placement data and also manage our Discharge Concierge Service.
Public Relations and Marketing Communications is now partnering with ABC to improve its intake process for external referring physicians through M-LINE, the Health System’s referring physician service.
To handle this load in the most efficient way possible and to make the best use of resources to accomplish this goal, process owner Jennifer Gegenheimer Holmes, R.N., M.H.S.A., C.E.N., director of operations for the Emergency Department, led an ABC lean team on an 11-month journey to address critical issues for the Health System. They looked at the lack of consistent clinical and financial screening processes, and unacceptable or unpredictable wait times for unscheduled admissions from all sources.
“It’s like trying to turn around a huge ship,” says Dawson. “But we’ve made it, and we’re going in the right direction.”
Vasher agrees. “I see many departments wanting to partner with us to make changes and improvements. I’ve seen barriers broken down and lines of communication open up. I’m really happy to be part of this innovative process as we move forward to improve processes and communication throughout the Health System.”
“Lean methodology provided us with the tools to tackle long-standing issues,” says Holmes.