Background:
In an attempt to improve the efficiency of patient care, the Institute for Healthcare Improvement (IHI) has studied “hospital flow.” This work suggests that a multidisciplinary approach using formulas that examine flow in a “real‐time” manner leads to greater success in decreasing bottlenecks and improving length of stay (LOS).
Purpose:
Using IHI's methods, we implemented a program to decrease hospital bed wait times for admitted ED patients and decrease overall LOS.
Description:
We formed a multidisciplinary “flow committee” consisting of physicians, nurses, and administration. A process was implemented whereby nurse‐managers from all inpatient units, including the ED, and the nursing house supervisor met every 6 hours to review the inpatient bed demand and capacity based on admission and discharge prediction formulas proposed by the IHI (Fig. 1). We also implemented biweekly “wasted bed walk‐throughs” to assess the number of admitted patients whose condition did not warrant continued hospitalization or who had experienced a delay in care delivery. Review of this material at weekly flow committee meetings revealed poor organization of transport personnel, as manifested in wait times for transfer between units and to diagnostic tests, and variation in anticoagulation practices, both within and outside the hospital, resulting in prolonged LOS for inpatients and unnecessary admissions. Based on these data, we implemented a hospitalwide bed transportation and tracking system and created an anticoagulation protocol that spanned the inpatient and outpatient settings. We also created a “transitional care unit” to accept patients of all acuity from the ED while decisions could be made by the nurse‐managers regarding the most appropriate unit for admission based on 6 hour prediction meetings. Implementation of these initiatives led to decreased wait times for admitted patients despite an increase in the number of beds requested and a decrease in LOS (Fig. 1).
Figure 1. Monthly length of stay 2007.
Conclusions:
We successfully implemented the IHI protocol for assessing “hospital flow” and consequently addressed issues that led to a decrease in bed wait time and overall length of stay.
Author Disclosure:
M. Johnson, UTHSCSA, Employer; L. Leykum, UTHSCSA, Employer; N. Ray, University Health System, Employer; L. Dodge, University Health System, Employer; G. Rufe, University Health System, Employer; V. Huerta, University Health System, Employer; M. Mote, University Health System, Employer; L. Du, University Health System, Employer.