The Institute for Healthcare Improvement suggests using morning team meetings, "AM bedside huddles," to plan strategies for improving daily patient flow.
According to IHI, the team meeting should address admissions, discharges, transfers, specific problem areas and solutions to those problem areas. The meeting should consist of unit directors or representatives from all medical and surgical units, the emergency department, operating rooms, surgical centers, post-anesthesia care units, cardiac catheter and specials labs and intensive care units, in addition to the vice president of nursing, medical chief of staff and medical director of the ICU.
At the daily meeting:
- Each representative should get one minute to discuss his or her units' census, discharges, anticipated admissions and anticipated in-hospital transfers.
- Meeting time should be between 10 and 15 minutes.
- Time should be used to create a highly structure agenda to promote efficiency.
- Executives should be aware of a potential need for moderation between bed teams and physicians.
- Evaluate elective surgery cancellations based on ED and other service demand.
For overall capacity management strategy:
- Institute a centralized bed authority responsible for processing admissions and transfers. This individual will convene the AM bedside huddles and moderate all capacity communication. For hospitals with 200 beds, this can be accomplished by one person per shift. For larger hospitals, the position may be shared by a group.
- Institute multidisciplinary rounding with a team of nurse managers, staff nurses, pharmacists, social workers, nutritionists, case managers, pastoral services and discharge planners.
- Develop admission and discharge criteria to coordinate standardized patient flow. Rounding may be used to ascertain the readiness of a patient for discharge.
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