By improving patient flow, a hospital can save money on staffing, decrease wait times and boost patient and provider satisfaction. Melinda Noonan, DNP, RN, NEA-BC, director of nursing operations at Rush University Medical Center in Chicago, discusses how her hospital used TeleTracking patient flow software to collect and analyze historical data, improve throughput and plan for the busiest days of the year.
1. Ask every department to participate in promoting efficiency. Patient flow can be disrupted when separate departments and providers do not talk about the hold-ups in each area, Dr. Noonan says. "You really have to be able to have a frank conversation," she says. "Aside from the monthly meetings, environmental services, patient transport and patient placement, get together on a bi-weekly basis and talk about issues." She says the weekly meetings might include discussions on whether nurses are taking reports as quickly as possible. Meeting regularly is essential to breaking down barriers between different departments; otherwise, one department might be blaming another for a throughput problem without understanding the actual cause. "Each person and area only wants to look at their book of business, so you have to have a way of getting everybody to look at their piece in it," she says.
For example, she says Rush is currently working to improve scheduling coordination between different departments. If three separate patients are sent to the same unit from the emergency room, the post-anesthesia recovery department and an outside hospital, the unit may suddenly be bombarded with patients because scheduling times have not been coordinated between departments. While Rush has not yet found a solution to this particular problem, Dr. Noonan says communication between departments is the first step to removing blame and fixing the issue.
2. Use data to predict patterns. Dr. Noonan says Rush uses TeleTracking software to collect and analyze data, which then improves the hospital's ability to predict staffing needs, patient volume and other trends. "People like to say that emergency admissions are random," she says. "They are and they aren't. There is some predictability. Mondays are called 'ER Mondays' all over the country. We actually took historical data and put it through simulation software so we can see that 80 percent of the time, this is what our census is going to be on a given day and shift." She says the ability to simulate patient flow and throughput is essential when mistakes are not an option. "You've got to get matching of staffing and census right now. You can't afford to have mistakes on it anymore," she says. The ability to predict staffing levels on a particular day saves the hospital money by reducing staffing waste and decreases patient wait time by assigning the correct number of providers to the predicted volume.
3. Pay attention to rapidly growing specialties. Because clinical groups do not always grow at the same speed, your hospital may have to adjust beds and staffing over time to keep up with the demands of a certain specialty. "For example, hematology and oncology grew very fast, and we need to designate beds in another area to them," Dr. Noonan says. "Yet you couldn't take the floor away because you still used it for medicine. So we used historical data and fed [timing metrics from TeleTracking] into our simulation modeling software and tested various alternatives." By using simulation software to determine where beds and providers could be expanded, the hospital came up with a plan to use a portion of the medical/surgical unit and train those nurses in caring for non-chemotherapy oncology patients. Certain admission diagnoses were then targeted for the medical unit rather than the oncology unit, where they would have traditionally been placed.
4. Set internal benchmarks based on 'painful' months. In order to create a productivity benchmark, look at the historical productivity in your busiest months and work from there. Dr. Noonan took data from TeleTracking to find out how many patient placements each employee did in a particular month. She looked at June and July 2009, what she calls "the most painful months in the time I've been there." She used those months as a productivity target for busy days and created an internal benchmark for an appropriate staffing level.
5. Examine the biggest portals of entry to your hospital. Like many hospitals, Rush accepts the vast majority of its admissions from the emergency department, surgery, direct admissions from physician offices and outside hospital transfers. "If you're a tertiary center, you're taking in a good number of outside hospital transfers," Dr. Noonan says. To be able to balance patient placement from all four admission sources, Dr. Noonan and her colleagues looked at data on the speed of patient placement from each source. "If outside hospital transfers are placing people really fast, then the ED might be losing some ground," she says. "We look at that on a monthly basis to decide whether we need to slow the outside hospital transfers down."
Learn more about TeleTracking.
Read more about hospital efficiencies:
-4 Ways to Save OR Staff Time
-Triage Sessions, Other Measures Taken to Improve Patient Flow at Montefiore Medical Center
-OR Residents Associated With Higher Patient Morbidity But Lower Patient Mortality
1. Ask every department to participate in promoting efficiency. Patient flow can be disrupted when separate departments and providers do not talk about the hold-ups in each area, Dr. Noonan says. "You really have to be able to have a frank conversation," she says. "Aside from the monthly meetings, environmental services, patient transport and patient placement, get together on a bi-weekly basis and talk about issues." She says the weekly meetings might include discussions on whether nurses are taking reports as quickly as possible. Meeting regularly is essential to breaking down barriers between different departments; otherwise, one department might be blaming another for a throughput problem without understanding the actual cause. "Each person and area only wants to look at their book of business, so you have to have a way of getting everybody to look at their piece in it," she says.
For example, she says Rush is currently working to improve scheduling coordination between different departments. If three separate patients are sent to the same unit from the emergency room, the post-anesthesia recovery department and an outside hospital, the unit may suddenly be bombarded with patients because scheduling times have not been coordinated between departments. While Rush has not yet found a solution to this particular problem, Dr. Noonan says communication between departments is the first step to removing blame and fixing the issue.
2. Use data to predict patterns. Dr. Noonan says Rush uses TeleTracking software to collect and analyze data, which then improves the hospital's ability to predict staffing needs, patient volume and other trends. "People like to say that emergency admissions are random," she says. "They are and they aren't. There is some predictability. Mondays are called 'ER Mondays' all over the country. We actually took historical data and put it through simulation software so we can see that 80 percent of the time, this is what our census is going to be on a given day and shift." She says the ability to simulate patient flow and throughput is essential when mistakes are not an option. "You've got to get matching of staffing and census right now. You can't afford to have mistakes on it anymore," she says. The ability to predict staffing levels on a particular day saves the hospital money by reducing staffing waste and decreases patient wait time by assigning the correct number of providers to the predicted volume.
3. Pay attention to rapidly growing specialties. Because clinical groups do not always grow at the same speed, your hospital may have to adjust beds and staffing over time to keep up with the demands of a certain specialty. "For example, hematology and oncology grew very fast, and we need to designate beds in another area to them," Dr. Noonan says. "Yet you couldn't take the floor away because you still used it for medicine. So we used historical data and fed [timing metrics from TeleTracking] into our simulation modeling software and tested various alternatives." By using simulation software to determine where beds and providers could be expanded, the hospital came up with a plan to use a portion of the medical/surgical unit and train those nurses in caring for non-chemotherapy oncology patients. Certain admission diagnoses were then targeted for the medical unit rather than the oncology unit, where they would have traditionally been placed.
4. Set internal benchmarks based on 'painful' months. In order to create a productivity benchmark, look at the historical productivity in your busiest months and work from there. Dr. Noonan took data from TeleTracking to find out how many patient placements each employee did in a particular month. She looked at June and July 2009, what she calls "the most painful months in the time I've been there." She used those months as a productivity target for busy days and created an internal benchmark for an appropriate staffing level.
5. Examine the biggest portals of entry to your hospital. Like many hospitals, Rush accepts the vast majority of its admissions from the emergency department, surgery, direct admissions from physician offices and outside hospital transfers. "If you're a tertiary center, you're taking in a good number of outside hospital transfers," Dr. Noonan says. To be able to balance patient placement from all four admission sources, Dr. Noonan and her colleagues looked at data on the speed of patient placement from each source. "If outside hospital transfers are placing people really fast, then the ED might be losing some ground," she says. "We look at that on a monthly basis to decide whether we need to slow the outside hospital transfers down."
Learn more about TeleTracking.
Read more about hospital efficiencies:
-4 Ways to Save OR Staff Time
-Triage Sessions, Other Measures Taken to Improve Patient Flow at Montefiore Medical Center
-OR Residents Associated With Higher Patient Morbidity But Lower Patient Mortality