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Overview
The challenge
Efforts to reduce bed turnaround time have historically focused on onerous—and often unsustainable—campaigns to convince physicians of the importance of discharging patients earlier in the day, ignoring non-clinical contributors.
The organization
Cedars Sinai Medical Center is a 952-bed teaching hospital located in Los Angeles, California, US. They experienced bed turnaround delays partially associated with understaffing of housekeeping at peak admission, discharge, and transfer times.
The approach
Cedars Sinai created a discharge team of support services staffed at peak times—admissions, discharges, and transfers—to concentrate onbed turnaround.
The result
The dedicated discharge team decreased average time to clean a roomby 40 percent—from 75 minutes to 45 minutes.
The three steps
Three steps Cedars Sinai took to adopt demand-driven housekeeping schedules:The challenge
Efforts to reduce bed turnaround time have historically focused on onerous—and often unsustainable—campaigns to convince physicians of the importance of discharging patients earlier in the day, ignoring non-clinical contributors.
The organization
Cedars Sinai Medical Center is a 952-bed teaching hospital located in Los Angeles, California, US. They experienced bed turnaround delays partially associated with understaffing of housekeeping at peak admission, discharge, and transfer times.
The approach
Cedars Sinai created a discharge team of support services staffed at peak times—admissions, discharges, and transfers—to concentrate onbed turnaround.
The result
The dedicated discharge team decreased average time to clean a roomby 40 percent—from 75 minutes to 45 minutes.
The unit experienced drastic reductions in bed turnaround times—beforeimplementing the discharge team, the average time to clean a room was75 minutes, and the team brought the time down to 45 minutes, a decrease of40 percent.
Based on the success of the initial 9-month pilot, the program was rolled outhouse-wide at the end of 2007. Each team member is assigned to a zone of thehospital to mimic the pilot unit’s staffing arrangement, which had the addedbenefit of reducing housekeeper travel time.
How Cedars Sinai adopted demand-driven housekeeping schedules to expedite bed turnover
Recognizing that they had little control over physician rounding behavior,administrators at Cedars Sinai examined the opportunity to improve bedturnaround times and decrease ED boarding. They ultimately decided tocreate a discharge team of housekeepers at peak times to concentrate onbed turnaround.
Cedars Sinai administrators met for a “rapid improvement event” to brainstormthe causes of bed turnaround delays and potential solutions. Administratorsfound that while peak ADT (admission, discharge, transfer) activity requiringrapid bed turnaround occurred between 1:00 p.m. and 6:00 p.m., the day shiftwith the highest level of housekeeping support ended at 3:00 p.m. Fewerhousekeeping staff members were present at the very time they were needed todeal with ADT peaks, and housekeeping staff on evening shifts struggled to turnaround the backlog of beds that had built up just prior to the start of their shift.
As a result, administrators created a discharge team within housekeeping—scheduled from 10 a.m. to 6:30 p.m. seven days per week—to manage peakADT activity. The team is tasked only with discharge bed cleaning andturnaround, and does not perform any upkeep of patient and family waitingrooms. FTEs for the team were reallocated from both day and evening shifts,making the transition revenue-neutral. Increasing staffing at peak ADT times hasreduced the lag between when the bed is vacated and when the housekeeperarrives to clean it.
The discharge team was piloted on one 32-bed telemetry nursing unit for severalmonths to determine overall efficacy. Initially, both staff and administrators inhousekeeping were concerned about finding staff for the new discharge team.The housekeeping department first asked for volunteers to switch to the newshift, then worked with staff who had not volunteered to develop a flexiblescheduling pattern that ensured adequate coverage for the discharge team.While the housekeeping department experienced slightly higher turnover in thefirst months of the discharge team, turnover returned to its previous level as staffsettled into their new shifts.
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