Optimal Patient Flow

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.