Healthcare News & Insights

A unique approach to improving patient flow in hospitals

Hospitals have tried many tactics to limit patient overcrowding and improve patient flow, including the use of mandated nurse-to-patient ratios. But there’s one strategy hospitals can try that doesn’t require the added cost of hiring extra staff.

200314225-001The typical thinking is that hospital beds are filled to capacity due to high demand for services. An article in the Wall Street Journal by Eugene Litvak from the Harvard School of Public Health has a different take on the situation.

Litvak examines the daily fluctuations in hospital-bed capacity, noting that toward the end of a week, more patients tend to be admitted to the hospital. According to Litvak, this isn’t necessarily because more people injure themselves as the weekend draws near. Rather, it’s due to a factor hospitals can control: planned admissions.

Often, large numbers of patients are admitted for scheduled procedures on the same day, and that typically happens later in the week. These planned admissions, combined with a hospital’s normal patient flow, create a larger demand for beds.

Because this overcrowding can have a negative impact on care delivery, it’s crucial for hospitals to pay closer attention to the number of planned admissions scheduled each day. Here, Litvak says, cooperating with surgeons is necessary.

Surgeons typically schedule patients at their own convenience, rather than thinking of the hospital’s needs. To solve this problem, hospitals must work closely with their surgeons to spread these procedures out equally through the week, which can clear up bottlenecks causing overcrowding.

3 steps to reduce overcrowding

Working to improve patient flow is not only more cost effective than hiring extra staff — it actually saves hospitals money in other ways. One example from the article: By streamlining patient flow through better scheduling, Cincinnati Children’s Hospital saved $100 million it would’ve spent on expanding its facility to accommodate more patients.

For guidance to create a more streamlined patient flow in your hospital, the Institute for Healthcare Improvement (IHI) has put together a white paper with suggestions for hospitals. IHI offers a three-step plan to ensure optimal patient flow:

  1. Find out what your hospital is doing right, and where improvement is needed. The first step is to examine the things your hospital is doing correctly. Take factors such as current staffing levels into consideration. Also look at the frequency that your hospital keeps patients in “holding” locations like hallways or the ED until a bed is available.
  2. Measure your current daily patient flow. After seeing where your hospital’s doing well – and discovering where it’s lacking – the next step is to find out the rate at which patients actually flow through your hospital. Compile data from both individual days and specific times of day, and compare them to other days/times throughout the week. Be sure to consider factors that create variations, including the rates at which surgeons schedule planned procedures.  Figure out which ones can be controlled and which ones can’t.
  3. Start testing changes. Once you’ve figured out the factors that have the most effect on your patient flow, and which days/times cause your hospital the most trouble, consider solutions to help mitigate the damage. It’s best to focus on issues you can control, like surgeon scheduling. One way to “smooth out” the surgical schedule to improve patient flow, per the IHI: Designate separate operating rooms for scheduled and unscheduled surgeries, which leaves more space available for emergency procedures.

Before your hospital spends money on expanding its facilities or hiring extra staff to relieve overcrowding, you may want to try this action plan first.

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