Achieving Success for Naval Medical Center San Diego

Improving the performance of a medical center

 With a beneficiary population of over 1 million, including a majority of retirees and military personnel, the Navy has made San Diego, CA the place to be. 
But since the 1980’s, San Diego’s population has doubled, putting pressure on the city’s infrastructure. 
One sector finding itself spread thin is the area’s medical community. 
Hosting a large contingency of military and elderly patients, Naval Medical Center San Diego (NMCSD) was particularly strained. 
With a facility built in the mid-1980’s (when San Diego hosted only half of its current beneficiary population), NMCSD needed to update its facilities to yield to a growing and increasingly demanding population.

Challenge

The Tefen Business Consulting Firm was asked to evaluate the medical center’s emergency department to find opportunities to improve patient processing and alleviate capacity restraints. NMCSD’s largest opportunity for improvement lay with their handling of patient processing. In the ED, patients were registered before being triaged, which runs contrary to best hospital practices. 
Further, instead of sorting patients by seriousness of their condition, nurses ran a full history and physical for every incoming patient regardless of symptom severity. 
This extended the average triage time to about 20 minutes, well beyond the ideal two minute mark (ED wait time regularly exceeded 5 hours). 
As a result, the facility experienced a high level of LWBS, or “left without being seen” patients.
Each of these challenges allowed Tefen a clear directive toward improvement of the facility.

How Tefen Helped

Tefen’s team established five levers for improvement in the medical center’s ED performance, each containing a number of supplementary recommendations. The breakdown of Tefen’s suggested levers for NMCSD are as follows:

Lever 1: Operational Efficiency

• Expand fast track capacity to serve non-urgent patients (ED, UCC) for the 30,000+ patient volume
• Relocate and expand triage
• Consolidate registration forms, implement quick patient observation process, and register patients in exam room
• Establish patient management status board and redesign admissions process
• Implement operational improvements to POC lab, standardize unit processes, and establish 5S and materials management

Lever 2: Practice Pattern Standardization

• Identify major patient types
• Develop and standardize treatment protocols for the top volume patient types
• Front-load ordering of diagnostic test and procedures to triage

Lever 3: Layout & Facility Improvement

• Utilize Military Construction Program for new building projects
• Apply for Navy funding program
• Complete new construction or renovations
• Account for space planning before project begins
• Plan for 80,000 visits per year in new building
• Insert within new facility:
  • 120 sq ft exam rooms
  • 25-30+ exam rooms
  • 6+ trauma rooms
  • Larger fast track area
  • Dedicated ancillary support services
    • Satellite lab
    • Digital X-ray
    • CT scan

Lever 4: Staff Scheduling Optimization

• Characterize patient demand and patient census by TOD and DOW
• Implement staff schedules to maintain NTP rations with minimal overstaffing and no understaffing
• Minimize overtime requirements

Lever 5: Performance & Visual Management Systems

• Input measures on patient demand, severity, staff availability, space availability, and budget availability
• Measure average wait times, process times, LOS, NTP radio standards, practice variations, and reset rate
• Measure output surrounding LWBS, number of patients seen, number of patients admitted, overall patient satisfaction, and number of hours on diversion
• Enhance patient tracking board to accommodate more pertinent information

Performance Excellence Delivered

As a result of this diagnostic project with the Naval Medical Center San Diego, Tefen identified opportunities to streamline processes, resolve capacity restraints and improve critical key performance indicators (KPI’s) specifically within the hospital’s triage (discharge/admission) and ancillary support services sections in the emergency department.