Patient flow is one of those current buzzwords that may or may not mean anything to you. It’s a top concern of hospital executives because of its impact on revenue – ideally, administrators want to keep beds filled. On the other hand, they also want to prevent the kind of overcrowding that means referring physicians will choose other hospitals. The Institute for Healthcare Improvement (IHI) suggests that hospitals strive to keep 85-90 percent of their beds full, to allow room for emergencies.
Bottlenecks are a common problem in patient flow. When demand (number of patients) exceeds capacity (number of empty beds and available nursing staff), backlogs can occur. The emergency department (ED) is notorious for being backlogged – when nursing units cannot accept more patients, they are held in ED hallways (this is sometimes referred to as “boarding” patients). Similar backlogs can occur in the OR or PACU. But even the housekeeping department can contribute to bottlenecks, if patient rooms aren’t being cleaned and prepared in a timely and safe fashion. Bottlenecks between the ED and inpatient units can also result from inefficient handoff processes; nurses don’t always understand each other’s workflows.
On patient floors, bedside nurses are critical to patient flow – but they need to be in the loop. Once they can see the big picture, they can better understand how the way they use their time affects the entire system.
The IHI has studied the factors that affect patient flow. While hospitals cannot control the number of patients walking through the door or complications that arise once they’re admitted, the IHI suggests scheduling surgeries to allow extra time for emergencies and making other workflow improvements. Likewise, the AHRQ has published guidelines for hospitals wanting to form a multi-disciplinary team to plan a patient flow improvement initiative. (However, it didn’t explicitly suggest including nursing representatives. It’s important for administrators to get nursing’s buy-in, and let them know the reasoning behind any new protocols.)
Some hospitals are investing in new patient tracking technologies, in an effort to optimize the use of existing beds, rather than adding more space. The most sophisticated of these systems use real-time location systems (RTLS). They consist of tags that are attached to the patient being tracked, and network of sensors throughout the facility that detect where the tags are in real time. Such systems can help nurses work more efficiently by providing real-time updates about anything that can affect their workflow – like a lab result or physician order that has just become available. They can also generate alerts when a benchmark isn’t met, for instance when a patient has been waiting in the ED too long for an inpatient bed.
Are you interested in working to improve patient flow in your facility? The TeleTracking Blog has created a patient-flow checklist for nurses and you can read it online. The basic message, however, is this: You should do everything in your power to be sure each patient is moving steadily toward a safe and timely discharge. For example, collaborate with hospitalists and surgeons to ensure patients are not held in the ICU any longer than necessary. Use standardized hand-off reporting procedures. Do your part to ensure urinary catheters are removed promptly. Adhere to all infection prevention protocols and practice hand hygiene. And collaborate with case managers early on if you find out the patient has any type of socioeconomic problem that could delay discharge or lead to an unnecessary readmission.
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