Weekend Services: The Patient is Here, So Why Aren't We?

Session
Emergency Services / Patient Throughput

Authors
Michael McVicker
Managment Engineer Fellow
University of Michigan Health System

Brendon Weil
Lean Coach
University of Michigan Health System

Description
Are patients given appropriate access to services on the weekend to facilitate their care and discharge? You may find the answer surprising.

Follow the University of Michigan Health System in its journey to understand weekend service availability and the steps it took to begin improving access to care.

Abstract
The project began as an examination of increased patient length of stay. Statistical anomalies were identified, such as significantly higher LOSs for Friday admits compared to Monday for many DRGs. From this analysis, leadership opted for further examination.

First we identified the staffing levels of all major ancillary services by day of the week and their service response times. We discovered an average 4% reduction in hospital census during the weekend compared to a 61-80% reduction in staffing. Next we queried major stakeholder groups and services on perceived contributors to unnecessary patient days due to minimal/non-existent weekend coverage. 16 services were perceived to be the largest contributors and were placed under more stringent analysis to determine if LOSs were higher for weekend stay patients. Eight yielded statistically relevant results with increases of 0.6 to 1.7 days and were prioritized based on process deficiency and impact volumes. For those chosen, separate process improvement teams were created in order to determine staffing and process needs as well as appropriate service standards and benchmarking protocol. Teams are expected to present improvement opportunity findings using Service Level A3s to Senior Leadership in the next 2 months.