How to Manage Patient Flow

Jeremy Miller, MD, Clinical Advisor, Sg2, for HealthLeaders Media, May 16, 2011

At Sg2, we tout the power of standardization and minimizing variation, but we also recognize that variation, in terms of volume fluctuations, medical care trends and catering to the varied needs of patients is a day-to-day reality. Fluctuating service volumes and case mix create performance complexities, affecting current operations and revenue cycles and influencing future strategic initiatives. The key to successfully navigating care fluctuations is to discern meaningful and actionable information from statistical noise in assessing data, recognizing patterns, managing what you can manage and preparing for what you cannot.

Obstetrics and Other Examples
In my world of obstetrics, where more than 4 million babies are born nationwide every year, accounting for approximately 13% of adult admissions, fluctuations in volume and changes in case mix significantly impact day-to-day management and long-term strategic planning for obstetrics leaders. Here are just a few examples of the variations inherent in obstetrics, according to the US Centers for Disease Control and Prevention:

  • Yearly fluctuations in delivery volume. The total number of babies born in the US declined in 2008 by approximately 2% and again in 2009 by 3%. To put this in perspective though, this is down from an all-time high delivery volume in 2007. The current decline in the fertility rate indicates that some markets soon may see a bounce back as women who delayed childbirth during the recession now choose to begin families.
  • Daily/monthly fluctuations in delivery volume. Deliveries are far more likely to occur on weekdays compared to weekends, and fall/summer months see higher delivery volumes than the winter. Both of these trends point out the need to look beyond the average daily census when assessing facility projections.
  • Clinical trends. I have written many times before about the increasing cesarean section rate (at an all-time high of 33% in 2009), increasing induction rates (23% in 2008) and slow declines in preterm and early-term deliveries. Clinical trends collectively alter the case mix in practice, changing bed needs, neonatal intensive care unit utilization and staffing.


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