If the Patient Protection and Affordable Care Act is upheld, hospitals could face a huge influx of newly insured individuals seeking services. If this happens, hospitals will need to be prepared to keep patients moving through the system to ensure patient safety, patient satisfaction and efficiency. Even if the law is not upheld, hospitals should still optimize patient flow so they see as many patients as possible with as few resources as possible. Sue Kozlowski, senior healthcare consultant at TechSolve, offers four key strategies hospitals can use to improve patient flow.
1. Use real-time knowledge. "Use real-time knowledge of where patients are and how long they have been waiting for the next scheduled step in the process," Ms. Kozlowski says. Software applications can help hospitals gather patient data easily to track when patients need to move to the next step in their care. Data to track include the number of occupied beds, wait time in the emergency room and the number of patients who are in various departments, such as in observation or short-stay units. "Knowing which patients are due for next steps (transfer, end of observation, discharge from intensive care unit, etc.) can be the start of the ability to manage the patient flow. Alerts when times are approaching specified limits can be used to remind staff to complete pending actions," she says.
2. Develop and implement scripted transitions. Hospitals should develop standard protocols for transitioning patients to lower levels of care. These protocols would function similarly to advanced protocols in the ED that allow a triage nurse to order standardized tests for patients with common ailments. Scripts can speed the process for moving patients through the system and avoid costly delays.
For example, Ms. Kozlowski says providers could move patients in the ICU to step-down or regular inpatient units after taking measures, such as response to treatment and vital signs, without needing to get permission from an ICU physician. These scripts can be created by medical staff and used by nurses, nurse practitioners and clinical specialists. Using scripts does not mean providers should not tailor care to patients' needs as appropriate, however. "Individual patients may have special needs and should be approved for these scripts as part of the assessment process," Ms. Kozlowski says.
3. Analyze historical statistics to predict demand. Statistics on patient volume in different areas of the hospital, such as the ED and operating room, can help hospitals anticipate likely volumes in the future and prepare the appropriate amount of resources. "Most hospitals have a higher flow of patients into the ED between 11 a.m. and
11 p.m.," Ms. Kozlowski says. "Are radiology, cath lab and other services also maximized to meet ED needs during those peak times?" For example, she says a stress lab that has a high rate of ED patients should match its capacity to the expected ED demand to so that the services are coordinated and patients can be discharged faster.
4. Begin discharge planning upon admission. Discharge planning can begin as soon as a patient's admission order is approved, according to Ms. Kozlowski. Early planning can help hospitals ensure that patients will be appropriately cared for outside the hospital, which can prevent readmissions and generate cost savings. For instance, providers can start arranging transitions to post-acute care, nursing home care or other services depending on the patient's needs. "Proper planning can prevent hasty, last-minute struggles to coordinate care," she says.
Breaking Down Silos to Improve Patient Flow, Hospital Efficiency
A Three-Pronged Approach to Optimizing Patient Flow
1. Use real-time knowledge. "Use real-time knowledge of where patients are and how long they have been waiting for the next scheduled step in the process," Ms. Kozlowski says. Software applications can help hospitals gather patient data easily to track when patients need to move to the next step in their care. Data to track include the number of occupied beds, wait time in the emergency room and the number of patients who are in various departments, such as in observation or short-stay units. "Knowing which patients are due for next steps (transfer, end of observation, discharge from intensive care unit, etc.) can be the start of the ability to manage the patient flow. Alerts when times are approaching specified limits can be used to remind staff to complete pending actions," she says.
2. Develop and implement scripted transitions. Hospitals should develop standard protocols for transitioning patients to lower levels of care. These protocols would function similarly to advanced protocols in the ED that allow a triage nurse to order standardized tests for patients with common ailments. Scripts can speed the process for moving patients through the system and avoid costly delays.
For example, Ms. Kozlowski says providers could move patients in the ICU to step-down or regular inpatient units after taking measures, such as response to treatment and vital signs, without needing to get permission from an ICU physician. These scripts can be created by medical staff and used by nurses, nurse practitioners and clinical specialists. Using scripts does not mean providers should not tailor care to patients' needs as appropriate, however. "Individual patients may have special needs and should be approved for these scripts as part of the assessment process," Ms. Kozlowski says.
3. Analyze historical statistics to predict demand. Statistics on patient volume in different areas of the hospital, such as the ED and operating room, can help hospitals anticipate likely volumes in the future and prepare the appropriate amount of resources. "Most hospitals have a higher flow of patients into the ED between 11 a.m. and
11 p.m.," Ms. Kozlowski says. "Are radiology, cath lab and other services also maximized to meet ED needs during those peak times?" For example, she says a stress lab that has a high rate of ED patients should match its capacity to the expected ED demand to so that the services are coordinated and patients can be discharged faster.
4. Begin discharge planning upon admission. Discharge planning can begin as soon as a patient's admission order is approved, according to Ms. Kozlowski. Early planning can help hospitals ensure that patients will be appropriately cared for outside the hospital, which can prevent readmissions and generate cost savings. For instance, providers can start arranging transitions to post-acute care, nursing home care or other services depending on the patient's needs. "Proper planning can prevent hasty, last-minute struggles to coordinate care," she says.
More Articles on Patient Flow:
Using HIT to Improve ED Patient Flow, Performance: Q&A with Dr. Michael Westcott, CMIO of Alegent HealthBreaking Down Silos to Improve Patient Flow, Hospital Efficiency
A Three-Pronged Approach to Optimizing Patient Flow