Inefficient discharge planning and patient flow is a widespread issue for many hospitals.
"I consistently see patient throughput issues at hospitals of all types and sizes across the country, from large academic medical centers to small community hospitals," said Barbara Bryan, BSN, managing director at Prism Healthcare Partners, a Chicago-based consulting firm.
Ms. Bryan joined fellow managing director Bonnie Barndt-Maglio, RN, PhD, to share with Becker's Hospital Review.
Common misconceptions of patient throughput
"The No. 1 misconception about patient throughput is that it can be easily solved with just a few changes led by the nurses or case managers," said Dr. Barndt-Maglio.
In reality, patient throughput initiatives usually take six months to a year to institute a hospital-wide change. The initiatives require dedicated interdisciplinary participation and consistent communication among all stakeholders — not just nursing and case manager staff.
Another common misconception is that throughput begins in the emergency department. "We argue the ED is the victim of poor patient throughput, rather than the source, since they are dependent on beds available in inpatient areas," said Dr. Barndt-Maglio.
She emphasized that efficient patient throughput starts with effective discharge processes, which allow the hospital to turn over beds as quickly as possible.
Critical factors for a successful throughput improvement project
The first step to launching an effective patient throughput initiative is establishing a sound project infrastructure, according to Ms. Bryan.
Hospital leaders should identify an executive sponsor who has the authority to drive an organization-wide effort. The initiative should also contain committees and work groups with interdisciplinary membership and front-line representation. "Physicians can make or break a successful throughput project, so it's very important to involve them in each of the work groups from the very beginning," said Ms. Bryan.
The executive sponsor and work groups should establish goals, expectations and project ground rules, along with a project timeline containing key milestones for achieving those goals. Ms. Bryan said six months to 12 months is an ideal timeline, depending on the size of the hospital and the complexity of the throughput problem.
The initiative should also contain a solid communication plan allowing for regular and open communication via many methods, including newsletters, town hall meetings and team huddles on inpatient units, according to Dr. Barndt-Maglio. "You really cannot over-communicate during these initiatives," she said.
After developing a sound project structure, leaders should thoroughly examine key patient throughput processes. "You need to understand your current state, so you can determine your future state," said Ms. Bryan.
Leaders should also take advantage of existing tools and technology to enhance patient flow processes during the initiative and establish meaningful performance metrics and methods of measurement to gauge progress.
The benefits of improved patient throughput
A successful patient throughput initiative offers numerous clinical benefits for a hospital, including improved capacity, patient satisfaction, length of stay and ED wait times.
A hospital can also achieve significant cost savings through improved throughput. Ms. Bryan demonstrated the potential savings opportunities by highlighting data from a two-hospital system in the Northeast. The health system frequently diverted patients from its EDs and had a length of stay well above the national average. After working with Prism to institute a comprehensive patient throughput strategy, the hospital reduced excess days by nearly 50 percent and achieved $1.5 million in cost savings.
"Of course we know reducing every single excess day is unrealistic," said Ms. Bryan. "With most hospitals, we see improvement range from 20 percent up to 50 percent."
Decreasing the amount of days the patient stays in the hospital not only lowers costs through decreased resource use, but also allows for additional capacity, which can generate more revenue.
"There is a great revenue opportunity for hospitals that have the volume to fill available beds," said Dr. Barndt-Maglio. "Those additional beds may relieve constricted services or even develop new service offerings."
For example, one hospital she worked with used extra beds to expand the capacity of a cardiac service line, which was part of the hospital's strategic plan for growth.
Taking on a patient throughput project can be challenging and time-consuming. But by involving key stakeholders and implementing the critical success factors, a focused patient throughput initiative can significantly benefit organizations with improvements in quality, capacity, and cost.
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