Diary of a Recovering Transfer Center a Candid Look at What Went Wrong & Why Agenda

Diary of a Recovering Transfer Center A Candid Look at what went wrong & why Agenda

•Health System Overview •Focus on Two Campuses • Building our Transfer Center •Avanti Best‐practices •March 15, 2010 • Recovery

Diary of a Recovering Transfer Center Health System Overview Notable Achievements

• Nation’s second largest, non‐profit, secular healthcare system (beds) • Nation’s 16th largest, integrated healthcare network (revenue) •Service area of 7 million people in Long Island, Manhattan Queens, and Staten Island

• Recipient of National Quality Forum’s 2010 National Quality Healthcare Award

• Recipient of Healthcare Association of New York State’s (HANYS) Pinnacle Award

• Home of the largest ‘corporate university’ in the healthcare industry: The Center for Learning and Innovation

• Nursing school affiliations with 15 colleges and universities

• Recipient of J.D. Power and Associates’ Distinguished Hospital designation at Syosset Hospital

Health System Overview Geographic Region –Metro New York

Huntington Hospital Glen Cove Hospital

Syosset Hospital

Plainview Hospital Lenox Hill Hospital North Shore University Hospital

Nassau University Medical Center (affiliate)

Long Island Jewish Hospital Forest Hills Hospital Cohen Children's Medical Center The Zucker Hillside Hospital Southside Hospital Franklin Hospital

Staten Island University Hospital (North)

Staten Island University Hospital (South)

Health System Overview Health System Hospitals

Four Tertiary Hospitals: •North Shore University Hospital, Manhasset •Long Island Jewish Medical Center, New Hyde Park •Staten Island University Hospital (North Division) •Lenox Hill Hospital, New York Two Specialty Care Hospitals: •Cohen Children’s Medical Center •The Zucker‐Hillside Hospital Eight Community Hospitals: • Forest Hills Hospital •Plainview Hospital • Franklin Hospital •Southside Hospital •Glen Cove Hospital •Staten Island University Hospital (South) •Huntington Hospital • Syosset Hospital One Affiliate Hospital: •Nassau University Medical Center

Health System Overview Facts & Figures

2009 Operating Statistics: •More than 5,600 hospital & long‐term care beds • About 4 million patient contacts • 25,100 babies delivered • 278,000 inpatients treated • 137,000 ambulatory surgeries performed • 605,000 emergency visits • 817,000 home health visits • thousands of clinical research studies • thousands of community education programs Economic Impact: •Almost $5.7 billion annual operating budget •More than 42,000 employees (9th largest employer in New York City) •More than 9,000 physicians •More than 10,000 nurses •More than 3,200 volunteers

Health System Overview A Tale of Two Campuses Historical Context

Glen Cove Hospital

Syosset Hospital

Plainview Hospital North Shore University Hospital

Long Island Jewish Hospital Forest Hills Hospital Cohen Children's Medical Center The Zucker Hillside Hospital Franklin Hospital

HealthA Tale Systemof Two Campuses Overview Hospitals Today

North Shore LIJ •Beds* 870 470 • Employees 4,800 3,600 • Discharges 55,500 33,500 •ER Visits 51,600 67,500

* approximate number, excludes psych & rehab

A Tale of Two Campuses Services Today

North Shore LIJ • Cardiothoracic Surgery 99 •Adult Trauma 9 •Pediatric Trauma 9 • Neurosurgery 99 • Ophthalmology 99 •ENT 99 • Maxillofacial Surgery 9

A Tale of Two Campuses The Decision is Made

•Improved quality of patient care •Maintain edge in competitive market •Physician, patient satisfaction

A Tale of Two Campuses Get it done…

• Facilitate easy, quick transfer of medically appropriate patients to NSUH & LIJ •Improve communication •Improve productivity of staff •Ensure consistency: internal & external •Improve physician satisfaction • Aggregate data and referral patterns • Grow market share

A Tale of Two Campuses Avanti Best Practices Roadmap To Success

#1#1 -- RightRight PatientPatient FlowFlow ProcessesProcesses

A Division of TeleTracking ButBut we'rewe're buildingbuilding aa transfertransfer centercenter whywhy areare wewe workingworking onon PatientPatient Flow?Flow? Roadmap To Success

## 22 -- RightRight GovernanceGovernance

A Division of TeleTracking Roadmap To Success

## 33 -- RightRight StaffingStaffing && CompetenceCompetence

A Division of TeleTracking Roadmap To Success

## 44 -- RightRight PhysicianPhysician SupportSupport AA RespectedRespected MedicalMedical ChampionChampion

A Division of TeleTracking Roadmap To Success

## 55 -- RightRight TechnologyTechnology && ReportingReporting

A Division of TeleTracking Building our Transfer Center the sell…the concerns…the result “Everything is negotiable but success…” ‐ Rahm Emanuel

Building our Transfer Center The Sell…

• Executive Leadership •Clinical Leadership • Voluntary Physician Community •Site Leadership •North Shore & LIJ •Other Tertiary Facilities • Community Hospitals

Building our Transfer Center The Concerns…

• Executive Leadership • Attending to Attending •Clinical Leadership •Patient ‘Dumping’ • Liability • Voluntary Physicians

•Site Leadership •Loss of Autonomy •North Shore & LIJ • Favoritism •Other Tertiary Facilities • Resources • Community Hospitals

Building our Transfer Center The Result…

• Executive Leadership • Attending to Attending •Clinical Leadership •Some Residents, Fellows • Voluntary Physicians

•Site Leadership •Loss of Autonomy •North Shore & LIJ • Decentralized Model •Other Tertiary Facilities • Community Hospitals

Building our Transfer Center The Result…

Conference Call: ED NSUH Attending to Attending Floor

CEMS

Conference Call: ED LIJMC Attending to Attending Floor

Building our Transfer Center March 15, 2010 Decisions

• Staffing the transfer center(s) •Critical Care experience • Sufficient, round the clock coverage • Telephone Technology •Recording software •Adequate conference bridging •Transfer Center Software •Home‐grown vs. Off‐the‐shelf

Building our Transfer Center Decisions Made

• Staffing the transfer center(s) •Critical Care experience Some… • Sufficient, round the clock coverage Not ALL the time… • Telephone Technology •Recording software Volume… •Adequate conference bridging Thought so… •Transfer Center Software •Home‐grown vs. Off‐the‐shelf Home‐grown…

Building our Transfer Center Go‐live

•Soft launch •The bumps anyone would have •“I can’t hear you…” •The bumps only we would have • Algorithms are your friend •A paper log in 2010

Building our Transfer Center Other Thoughts

• Hiring the Right Staff •Transfer Center Software • Telephone Technology

Building our Transfer Center Recovery “Let’s bucket the issues and fix them from there…”

Recovery Recovery

• Staffing • Seek out additional, experienced staff • Educate incumbent staff •Competencies •Triage • Algorithm Practice

Recovery Recovery

• Telephone Technology •Do you want the Buick or the Cadillac? • Original product tested, tested, tested • Replacement

Recovery Recovery

•Transfer Center Software •Scrapped the ‘home grown’ • Outside software developer • Listening to the consultant, listening to the staff

Recovery Recovery

• Marketing

Recovery Other Thoughts

Combined North Shore LIJ Transfer Centers 2010 Call Volume

300 272 250 221 Calls 200 166 of

150 100 67 Number 50 0 Mar 15‐31 Apr May June

Total NSUH Before Go Live LIJ Before Go Live Linear (Total)

Recovery After Thoughts

•The buck stops here •One more delay wouldn’t have killed us • 80% may well be called success •Transfer Center & Patient Flow in the entire house •Future goals…

Building our Transfer Center Questions

• Presenter Contact Information

– Micki Lerch, MS, RN, CCRN, FACHE Avanti Patient Flow Consultant [email protected]

– Kevin S. Beiner, MBA Director, Health System Operations North Shore LIJ Health System [email protected]

Slides: www.modernhealthcare.com/teletracking