With C-suite leaders placing an acute focus on patient access, throughput and capacity, hospital executives are considering how to deliver services more effectively and reduce bottlenecks.
Several CEOs and health system executives recently told Becker's that addressing these challenges requires various care delivery strategies, predictive analytics, artificial intelligence, and streamlined care coordination.
What is the most impactful, yet underutilized, strategy hospitals can implement to improve patient throughput and capacity in the next five years?
Editor's note: Responses were lightly edited for length and clarity.
Rob Allen. President and CEO of Intermountain Health (Salt Lake City): We're embedding proactive care throughout our operations so we can move upstream to keep people well and stay ahead of preventable disease and injury, help them avoid unnecessary medical treatment and expense, improve overall health outcomes and create much-needed capacity for those in our communities who need it most.
One example of this is how we redesigned our kidney services approach to focus proactively on patients who had a likelihood of needing a kidney transplant, leading to early referrals for needed transplants and surgeries, and creating the capacity needed to deliver this important care at the most appropriate time in their healthcare journey. The results show significant improvements in outcomes, with about 68% of patients with end-stage kidney disease receiving a kidney transplant and preventing the need for ever starting dialysis, whereas nationally, over 70% of patients with end-stage kidney disease start dialysis after an unplanned visit to the emergency room and a hospital stay. Intermountain's results also lead to significant patient savings of about $800,000 each year, or $1,679 per member per month for health plan members.
Second, we're focused on simplifying all aspects of our healthcare delivery model, from the moment a patient makes an appointment until the necessary care is provided. Unfortunately, the U.S. healthcare system as it's currently constructed isn't built with consumers in mind. According to a recent national survey, nearly two-thirds of Americans think the healthcare system is intentionally designed to be confusing.
Another survey indicates that it can take a new patient more than 26 days to schedule a doctor's appointment and even months for some specialties. We can and must do better. Simplifying the total experience for patients and members — and eliminating obstacles and unnecessarily complex processes and requirements — is critical to creating the capacity needed to offset the significant workforce shortages we're facing today and for the foreseeable future.
We're supporting these combined efforts to increase overall capacity with targeted, strategic use of artificial intelligence and other emerging technology solutions to help reimagine how we work and improve the care we provide. For example, an innovative ambient listening pilot at Intermountain's St. Joseph's Hospital in Denver is freeing our nurses from burdensome paperwork so they can spend more time where it makes the most meaningful impact — with patients.
Additionally, physicians and advanced practice providers across Intermountain are using similar AI technology, saving up to two hours a day in patient charting time to create additional capacity to see more patients.
Patrick Cawley, MD. CEO of MUSC Health and Executive Vice President for Health Affairs of the Medical University of South Carolina (Charleston): The population is aging. The population is stepping into their 60s and 70s — the baby boomers — and that's the age at which they need a lot of healthcare. They start to use a lot of inpatient healthcare and a lot of emergency rooms.
On top of that, here in South Carolina, we have a growing population. Then the people that are moving are baby boomers, and they're older — they're Medicare age. So that's what's occurring, and this problem is going to really hit us over the next 10 to 15 years. So we've got to start thinking about how to take care of those patients.
The most underused thing at the moment is that we need to think harder about different ways of caring for patients. So, for example, even things like hospital at home. Hospital at home has its issues, but are there patient populations that we currently put in the hospital to monitor? Can we leave them in their home and monitor them rather than admit them or bring them to the ER?
Additionally, in a lot of places, we're capacity constrained by the number of doctors we have now. So, for example, a typical hospitalist takes care of about 15 patients in the hospital. But we don't add to that — we might have the beds available — but we don't add to that because the hospitalists can't take care of more than 15. So I think we've got to think about: Is there a way for hospitalists to take care of 30 patients? That's going to require a new way of thinking, a different level of teamwork.
We have to embrace a greater rate of change in how we care for patients and shift our current paradigms to future paradigms.
Michael Charlton. President and CEO of AtlantiCare (Atlantic City, N.J.): We have a strategy that will significantly improve AtlantiCare's patient throughput and capacity over the next five years. The strategy is our Real-Time Capacity Management, powered by predictive analytics and AI and our partnership with Oracle Health.
First, proactive resource allocation. With AI-driven systems, we can forecast patient surges based on historical data and real-time inputs. This allows us to adjust our staffing and bed allocation well in advance, ensuring we're always prepared.
Next, dynamic bed management. Imagine having real-time dashboards showing bed occupancy, discharge readiness and patient flow bottlenecks. This would help us coordinate faster bed turnover and reduce our bottlenecks significantly.
Automated discharge planning is another game-changer. AI tools can identify discharge-ready patients earlier by integrating clinical progress with standardized protocols. This improves the speed of patient transitions and frees up beds for new admissions.
Integrated care coordination is crucial. RTCM platforms can connect departments like the ER, ICU, OR and inpatient wards for seamless handoffs, minimizing delays due to miscommunication.
Lastly, data-driven capacity expansion. Predictive modeling helps us determine when and where additional capacity, like flex units, is necessary without the need for permanent infrastructure expansion.
Despite its potential, RTCM remains underutilized. Complex implementation is one reason; many hospitals lack the infrastructure or expertise to implement RTCM effectively. Change resistance is another; staff may resist AI-driven decision-making or feel uncomfortable with data-driven management styles. Additionally, hospitals often focus on short-term fixes, like adding beds, rather than systemic long-term strategies.
However, the long-term impact of RTCM is undeniable. It can lead to reduced ER boarding and diversion, shorter lengths of stay due to proactive discharge planning, higher staff efficiency through optimized staffing, and enhanced patient satisfaction with shorter wait times and smoother transitions.
Michael Stern. Current President and COO and Incoming CEO of Tower Health (West Reading, Pa.): The biggest issue that we always need to address is making sure that the patients are discharged when they need to be discharged, making sure they're in the right location and making sure that when they can be downgraded — if they're in a cardiac care unit and they can be downgraded to a step-down or a regular medical bed — doing it quickly and proactively, rather than waiting a few hours.
One of the big issues in healthcare has always been consistently our discharge times. Where patients should be going home at 11 a.m., like at a hotel, they end up being at the hospital until the late afternoon, when our EDs are already starting to bubble over.
And you have borders in the ED, so it's something that we've gotten much better at. But getting the patients discharged out of the hospital in the morning, rather than the afternoon — as soon as they're ready to go home, rather than making it this long, drawn-out process — is really key so you can get the patients up to the right floor and avoid building up that surge.
And then, obviously, if you can put them in an outpatient setting, that's the best of both worlds. If there are more venues and more access points, depending on the situation, that is obviously key.
There are a lot of patients on the behavioral health side that are in the emergency room, so we need to help figure out the right placement for them so that we can have the true medical-surgical patients down in the ED.
But that's been something that we've all been trying to solve — getting the patients out and having them in the right bed at the right time. So that is something that we're very focused on. And our leadership team has done a good job, but we continue to push on that with our hospitalists, our nocturnists and our residents. When they round, it can't be as regimented. Where the residents round at 11 a.m. Well, OK, but the patient needs to go home. So we need to do patient-centered care. We focus on the patient and revolve around that.