Optimal Patient Flow
Making sure patients move through the hospital in a timely, efficient manner can make the difference between filled beds and empty ones, happy nurses and harried ones, profitable stays and unprofitable ones, satisfied patients and angry ones. We talked with four executives who are joining technology with process improvement to transform patient flow.
Q: What is patient flow?
Rosow: At a granular level, it's efficiently aligning each patient to the right
bed the first time, along with the right resources and care plan. But at a macro
level, it's a hospital wide effort that links every patient care process-from
arrival to discharge-seamlessly with minimal delays or miscommunication.
This is powerful; it enables huge economies and efficiencies. Many hospitals
rely on whiteboards, pen and paper, and a tremendous number of phone calls.
Premise integrates communications and makes work flow proactive through
real-time alerts and dashboards. We actually drive the next action required,
whether it is discharge, transport, or a bed turn. Everyone always has the data
they need without tracking it down, and nurses and clinicians can spend more
time on patient care.
Q: How do patient-flow issues affect your organization?
Stallings: Our job is to make sure there is a clean, safe bed
with appropriate equipment and staff in a safe building. We
might have the physical bed, but without staffing or physicians,
we can't place the patient. Accurately integrating those
components along with core processes that can be orchestrated
is key. Logistics management and analytics are as
important in hospital-based healthcare as in any industry.
Reardon: We're driven by a straightforward desire to provide
care for more patients in the same space. When we have a
backlog in the emergency department, or in perioperative/
postoperative care, we have to turn away transfer requests.
When the demand is greater than the supply, it's not positive
for either our patients or our finances. If we can shave off 10
minutes here and there, we can pick up extra admissions.
Perini: The overall length of stay for inpatients is a significant
challenge. We had an opportunity to shave minutes or even
hours off the front and back end. We want to come close to
matching the demand on any given day. When a physician
wants to admit and we can't tell them yes, we're in a competitive
market and they have options. Plus, if we can move
people from the emergency department to the proper bed
more quickly, we can free up rooms in the ED.
Q: How should process and
technology work together for optimum results,
and how can you ensure that your processes become
"fixed" when you implement patient-flow technology?
Stallings: If your processes are wrong, the software will just magnify a bad
outcome. Installing the software provided us the opportunity to help people see
the benefits if done right. Once our staff saw the software, how it operated and
streamlined their work, there was widespread acceptance of what we were
trying to accomplish, because they could see how much easier the work of
patient flow would be for everyone.
Reardon: It's iterative. Our organization is so large that processes
oftentimes are not fully standardized, and when you implement
a technology tool, it requires greater process consistency. We
made a conscious decision to implement it as quickly as we
could and then circle back on the process work. Patient-flow
processes should be appropriately standardized. Now we're
launching process teams to look at ED and perioperative patient
flows. Technology is just a tool, but it can be a pretty good impetus
to change your process. My new mantra is to standardize the
common processes and manage the uncommon ones.
Perini: You have to force yourself not to overlay good technology
on bad processes. It's so challenging to change processes and
behaviors and traditions. We've made an emphasis on getting
the patient in the right bed at the right time. Once we accept the
patient, Premise lets us more quickly find the bed for that patient.
Q: What are the stumbling blocks to good patient flow,
and how do you overcome them?
Rosow: A key to patient-flow success is breaking down
hospital silos. Patient flow must move within and between
departments seamlessly, which requires buy-in and cooperation
from diverse departments. To that end, a top-down
approach with executive sponsorship is critical.
Reardon: One of the hardest things is getting consistent, current
information. Suppose the ED has a patient waiting for a room. The
floor's working hard on getting another patient discharged and
the room cleaned. How is anyone going to know that? Before we
installed the Premise system, it was all phone calls among busy
people. Sometimes the room would be empty and available for
two hours before effective communication happened.
Perini: The average nurse on the unit is inversely incentivized
to discharge and admit new patients, because those two
functions are the most time-consuming steps of any point in a
patient's care. We still face challenges with how we motivate
and incentivize and change work flow so there's no negative
incentive to telling the system that there's an empty bed.
As soon as he or she does that, the whole cascade starts
automatically, and there's another patient there within 30-40
minutes. We're trying for no lag time between when the room
is clean and when the patient arrives on the floor.
Stallings: We're like an air traffic control tower, a team that
must know who's on the ground, who's taking off, and who
needs to land-sometimes with only 30 minutes of fuel left.
Each patient has different needs that are specific to that person.
We needed a way to better orchestrate patient activity and flow.
Prior to installing the software, we were using a magnetic bed
board with placement specialists sitting in front of it taking calls.
But it was difficult to have an accurate assessment of everyone's
needs and keep track of their activity accurately. Premise helps
us measure our processes and better track what's happening
real time so we can better predict the resources we need and when.
Q: What impact does installing the Premise system have on a hospital?
Rosow: As a hospital becomes more efficient and seamless in its
delivery of care, the change in environment is tangible.
Workloads for housekeeping, transport, and even nursing
are smoother and better planned. The floors are quieter and
calmer- no more scrambling or incessant phone calls. And the
monetary impact is substantial. Our clients have tied their ROI to
increased admissions. If they can get one more patient through
each day, it can contribute a million a year to the bottom line.
Perini: We're projected a payback in just under three years,
through decreasing our length of stay two to four hours and
reducing the amount of time patients are in the ED. When you
shave an hour or two off an emergency visit for an admitted
patient, and you're talking 50,000 visits, that adds up.
It's reducing phone calls on the nursing unit. Also, the
nursing units are measured on patient satisfaction. A patient
who's waited a long time in the ED will be dissatisfied when
he gets to the floor, and that will probably reflect in the unit's
patient sat scores, even though it isn't their fault.
Reardon: We have fewer phone calls and more information.
We have a decentralized housekeeping model. This tool has
been huge for communicating the need to clean the room. We
are using the system to validate how well we are doing and to
identify opportunities for improvement. Housekeeping can be
an easy scapegoat when in fact more substantial opportunities
may be found elsewhere in the throughput process.
Stallings: Nursing and staff can better know what's happening
in their day, and I think that's huge. Also, it gives us the
ability to look at our entire process, the system. Nothing chews
up resources like extreme variation, and having a place where we can collate all
our resources is very valuable. You can make decisions better and faster with
meaningful, real-time information.