South Nassau Communities Hospital in Oceanside, N.Y., has seen an increase in admissions from approximately 15,000 in 2002 to more than 22,000 today, according to Joseph Lamantia, executive vice president and COO of the hospital. In addition, the hospital's emergency department volume has risen from approximately 41,000 annual visits to roughly 57,000 annual visits in the same period. To accommodate this burgeoning volume while avoiding a similar increase in costs, South Nassau Communities Hospital has had to invest in capacity management strategies that optimize efficiency.
Capacity management links to strategy
Capacity management can have a significant impact on the hospital's financial strength, as it involves the purchase and distribution of high-cost resources, including staff and supplies. "Managing utilization in a hospital has a profound effect on our ability to manage expenses," Mr. Lamantia says. Utilization affects more than just finances, however; it contributes to quality and patient satisfaction. "We have a robust strategic plan focused on quality, patient service and growth. We would not be able to achieve any of those goals if our hospital had a line in the ED. Patents would not only not be able to get in, they would stop coming," he says.
Mr. Lamantia shares five strategies hospitals can use to improve capacity management.
1. Right size the organization. When a hospital has sustained efficient operations for a period of time, its leaders should assess the amount of space available and patient demand and right size the organization. For example, Mr. Lamantia says if a hospital has three 30-bed units each consistently running 20 patients daily, the hospital may consider closing one unit and consolidate the patients into the two remaining units. The hospital can reassign the staff from the closed unit to any open positions in the organization, which can reduce the expense of overtime for employees in shorthanded areas.
Hospitals also have the option of closing and opening units temporarily as needed depending on patient volume. Hospitals may opt for this choice if they experience significant swings or seasonal changes in patient volume. By flexing units down, South Nassau Communities Hospital has been able to reduce the amount of employee overtime, resulting in a savings of $1.5 million since 2009, according to Mr. Lamantia.
2. Develop organization-wide awareness. South Nassau Communities Hospital's awareness among leaders and employees of the need to improve utilization and streamline care has led to greater efficiency and savings. The hospital developed this awareness by creating a multidisciplinary patient throughput committee in 2009 that evaluates throughput and creates initiatives to improve it.
One of the committee's projects was reducing the hospital's diversion, which is when the hospital is challenged to accept EMS transported patients due to unavailable beds, equipment or other resources. To reduce the amount of time on diversion, the hospital's physicians and staff had to learn that patient throughput is not restricted to one area, but affects each part of the hospital. "It's common to think when the ED is busy, the ED needs to get together and figure out how to improve efficiencies. But [the ED] is really at end of the chain," Mr. Lamantia says. Although the ED plays a significant role in throughput because it is the "front door" of the hospital for the majority of patients, patient throughput is not its sole responsibility; this measure is the responsibility of everyone in the organization. With this new attitude, the hospital implemented measures that reduced the hours of diversion from 230 in 2009 to 28 in 2011. "There was no one silver bullet," Mr. Lamantia says. "It had to do with utilization management, length of stay, centralized patient logistics, lean [tools] and, to really sum it all up, organization-wide awareness of capacity management."
3. Establish a patient logistics department. Another change that made a great impact on capacity management at South Nassau Communities Hospital was the establishment of a centralized patient logistics department. The department is run by a director of patient logistics who has the tools to monitor the status of beds — whether dirty, in the process of being cleaned, available or occupied. The director also had a transport notification system that showed where people were moving in the hospital, allowing the organization to efficiently assign patients and staff to different areas of the hospital based on availability. "From a capacity management standpoint, having a centralized logistics department has been a huge driver for us in improving efficiencies," Mr. Lamantia says.
4. Communicate clearly and often. Communication is essential in ensuring safe and timely transfers of patients between levels of care. In the ED, improved communication between the ED staff and receiving units helped lower ED length of stay. In 2009, the average ED length of stay for patients who were admitted was approximately 11 hours. Today, the average is less than six hours.
5. Engage hospitalists. South Nassau Communities Hospital's hospitalists have been a valuable resource in improving capacity management. Their expertise in inpatient care and the hospital's case robust management program has helped to reduce the average length of stay from 6.9 days in 2009 to five days today, according to Mr. Lamantia. The hospital plans to expand the hospitalist model to continue to improve patient throughput and the quality of care.
9 ED Expansions to Meet Growing Patient Volume
New Building, New Challenges: Adapting Workflows to Updated Facilities
Capacity management links to strategy
Capacity management can have a significant impact on the hospital's financial strength, as it involves the purchase and distribution of high-cost resources, including staff and supplies. "Managing utilization in a hospital has a profound effect on our ability to manage expenses," Mr. Lamantia says. Utilization affects more than just finances, however; it contributes to quality and patient satisfaction. "We have a robust strategic plan focused on quality, patient service and growth. We would not be able to achieve any of those goals if our hospital had a line in the ED. Patents would not only not be able to get in, they would stop coming," he says.
Mr. Lamantia shares five strategies hospitals can use to improve capacity management.
1. Right size the organization. When a hospital has sustained efficient operations for a period of time, its leaders should assess the amount of space available and patient demand and right size the organization. For example, Mr. Lamantia says if a hospital has three 30-bed units each consistently running 20 patients daily, the hospital may consider closing one unit and consolidate the patients into the two remaining units. The hospital can reassign the staff from the closed unit to any open positions in the organization, which can reduce the expense of overtime for employees in shorthanded areas.
Hospitals also have the option of closing and opening units temporarily as needed depending on patient volume. Hospitals may opt for this choice if they experience significant swings or seasonal changes in patient volume. By flexing units down, South Nassau Communities Hospital has been able to reduce the amount of employee overtime, resulting in a savings of $1.5 million since 2009, according to Mr. Lamantia.
2. Develop organization-wide awareness. South Nassau Communities Hospital's awareness among leaders and employees of the need to improve utilization and streamline care has led to greater efficiency and savings. The hospital developed this awareness by creating a multidisciplinary patient throughput committee in 2009 that evaluates throughput and creates initiatives to improve it.
One of the committee's projects was reducing the hospital's diversion, which is when the hospital is challenged to accept EMS transported patients due to unavailable beds, equipment or other resources. To reduce the amount of time on diversion, the hospital's physicians and staff had to learn that patient throughput is not restricted to one area, but affects each part of the hospital. "It's common to think when the ED is busy, the ED needs to get together and figure out how to improve efficiencies. But [the ED] is really at end of the chain," Mr. Lamantia says. Although the ED plays a significant role in throughput because it is the "front door" of the hospital for the majority of patients, patient throughput is not its sole responsibility; this measure is the responsibility of everyone in the organization. With this new attitude, the hospital implemented measures that reduced the hours of diversion from 230 in 2009 to 28 in 2011. "There was no one silver bullet," Mr. Lamantia says. "It had to do with utilization management, length of stay, centralized patient logistics, lean [tools] and, to really sum it all up, organization-wide awareness of capacity management."
3. Establish a patient logistics department. Another change that made a great impact on capacity management at South Nassau Communities Hospital was the establishment of a centralized patient logistics department. The department is run by a director of patient logistics who has the tools to monitor the status of beds — whether dirty, in the process of being cleaned, available or occupied. The director also had a transport notification system that showed where people were moving in the hospital, allowing the organization to efficiently assign patients and staff to different areas of the hospital based on availability. "From a capacity management standpoint, having a centralized logistics department has been a huge driver for us in improving efficiencies," Mr. Lamantia says.
4. Communicate clearly and often. Communication is essential in ensuring safe and timely transfers of patients between levels of care. In the ED, improved communication between the ED staff and receiving units helped lower ED length of stay. In 2009, the average ED length of stay for patients who were admitted was approximately 11 hours. Today, the average is less than six hours.
5. Engage hospitalists. South Nassau Communities Hospital's hospitalists have been a valuable resource in improving capacity management. Their expertise in inpatient care and the hospital's case robust management program has helped to reduce the average length of stay from 6.9 days in 2009 to five days today, according to Mr. Lamantia. The hospital plans to expand the hospitalist model to continue to improve patient throughput and the quality of care.
More Articles on Capacity Management:
20% of ED Patients Not Admitted to Hospital Were Referred by Physician9 ED Expansions to Meet Growing Patient Volume
New Building, New Challenges: Adapting Workflows to Updated Facilities