Avoidable Day Text Pager - Collaborative Process: Improving Patient Throughput Utilizing an Avoidable Day Text Pager

Purpose:
The Actual length of stay (LOS) exceeded the Budgeted LOS at our hospital. Care management data confirmed ancillary services delays caused prolonged hospital days which impacted LOS. The avoidable day text pager would proactively/concurrently resolve barriers, improve collaboration and patient flow.

Significance:
An avoidable day/delay is a barrier in the timely delivery of services resulting in an unnecessary day in which the patient remains in the hospital. The hospital's financial database revealed the following: 2006 Budgeted LOS 5.58/Actual LOS 5.90; 2007 Budgeted LOS 5.85/Actual LOS 6.13.

Strategy and Implementation:
Care management data revealed focused area service delays from cardiology, radiology and surgery services. The directors of care management, surgery, cardiology and radiology examined ways to proactively address the delays. A pilot study utilizing the avoidable day text pager was initiated in December 2006. The Process: Care manager identifies a potential delay in service and sends the text page which includes the responsible service line manager and director of care management. The contents of the text page/email consist of the patient name/unit, procedure/testing being delayed, name/pager of the Care Manager. Within 30 minutes, the service line manager investigates the barrier/delay, intervenes with the testing department/unit to provide same day resolution, and notifies the care manager of the outcome. If the intervention is unsuccessful in producing same day resolution, an Avoidable day/delay is documented in the care management database to facilitate ongoing process improvement.

Evaluation:
The hospital's financial data from 2008-2010 revealed improved LOS and hospital days with the implementation of the avoidable day text pager. 2008 Budgeted LOS 6.20/Actual LOS 5.96. In addition, data collected from 2008-2010 evidence an 84%-92% same day resolution of barriers to care.

Implications for Practice:
Reducing the wait for services needed prior to discharge expedites flow, reduces patients' exposure to the hospital environment, and reduces LOS. An innovative process adaptable to other hospitals is reflective of best practice initiatives that will improve patient care within a healthcare system.