We spend a great deal of time thinking about patient flow and how to improve it. We bet you do too.
After all, poor patient flow hits hospital Emergency Departments and ORs hard. It can lead to bad patient outcomes because of poor quality of care, overcrowding, disorganized handoffs, increased costs, decreased capacity, frustration and more.
According to 4 Signs of a Hospital With Patient Flow Problems, poor patient flow leads to the following:
- Rather than patient-centered care, physician and staff focused silos
- Communication breakdowns and inefficient patient handoffs
- Greater than 3.5 hour ED boarding
- Blocked ED admissions due to discharge-ready patients occupying beds
That's not to mention increased costs due to inefficiencies, poor patient satisfaction scores and more.
So what's a hospital to do?
Consider Smart Data for Your Patient Flow
As a company focused on making use of data to benefit the patient journey, we recommend focusing on data. Not just any data, though. Rather, smart data.
By smart, we mean a combination of real-time data and predictive analytics so you obtain actionable insights from your data and can then make best use of your limited resources.
Interestingly, there's been push back to applying smart data to hospital settings, although it's a complex system with elements that can indeed be predicted. As In Focus: Improving Patient Flow—In and Out of Hospitals and Beyond explains,
"One reason may be that health care is often regarded as an exceptional industry—fundamentally different than complex systems such as airlines or hotels that have benefited from operations management approaches—and therefore subject to different rules. There is undoubtedly some truth to this, but there is also much about a complex system such as a hospital that can be understood and even predicted, experts say.
For example, modeling hospital admissions—even emergency admissions, which are not as unpredictable as one might think—can be done with an 80 percent to 85 percent confidence level, according to Kirk Jensen, M.D., chief medical officer of Best Practices, Inc., and an IHI faculty member. "We know who is coming tomorrow, we know when they are coming, and we know what they will need," says Jensen. "We just don't know their names."
Critical to success is having the right clinical software solution to automate, gather and analyze the data so as to orchestrate patient flow. By looking at the patterns the data uncovers, you can start to implement different approaches.
Elective vs. Emergency Surgeries
Although you can't control all aspects of admissions, you can for non-critical situations and elective procedures which then provides you with additional flexibility to handle the less expected.
In Focus: Improving Patient Flow—In and Out of Hospitals and Beyond offers an interesting example related to Monmouth Medical Center, 525-bed Academic Medical Center in Long Branch, NJ. To deal with overcapacity resulting from scheduling elective surgeries on Mondays and Tuesdays instead of evenly spreading them, Monmouth Medical Center decided to:
"Separate elective and nonelective flows as well as inpatient and outpatient flows; smooth patient census for elective surgery; and estimate and "right-size" resource needs for each type of patient care. All of these steps aim to reduce what IHO terms "artificial variability" in patient census created not by urgent or emergent cases but by electively scheduled procedures and admissions (see Q&A)."
What Data Uncovered About Patient Flow Issues
Monmouth analyzed five months of data and discovered the following:
- A wide daily variance in how many patients were coming in for elective surgery.
- This meant a big swing in demand for staff and other resources.
- The biggest cause was having so many surgeries (orthopedic and three general types: ENT, thoracic and vascular) scheduled early in the week.
- These led to postoperative unit overcrowding.
- Additional resources such as radiology, case management and physical therapy available over the weekend could alleviate the overcrowding.
- How many additional surgeries per week to offset those costs could be calculated.
The Results of Smoother Patient Flow
Here are the results that Monmouth saw after just two months:
- Hitting smoother patient census over five days targets.
- Increased revenue as a result of additional surgeries has covered the cost of additional weekend resources.
- Improved care.
"Under the old admission practices, with wild variation in daily census, nurses had trouble keeping up with the workload on busy days, nurses were floated in from different floors to help, and one nurse was pulled off of direct patient care to do all admissions," says McNamee. "Smoothing has led to less fragmented care: each patient is assigned a nurse who does an admission assessment and develops a care plan. This seems to have improved communication and continuity of care."
"Improving flow has the capacity to improve access for those patients who don't have it," he says. "It can improve safety and reliability—leading to fewer unnecessary process or procedural steps, better professional caregiver-to-patient ratios, and fewer delays."
Breakdown Silos to Improve Patient Flow
Perhaps most valuable to improving patient flow in a hospital is forcing the various departmental silos to breakdown.
If a hospital is to focus on the patient and a successful journey from admission to discharge, then it must ensure that all departments focus equally on the patient across the many touch points. There's no place for a silo when every one is necessary to the patient.
As Better Patient Flow Means Breaking Down the Silos describes, to effectively manage patient flow, it's critical to "match supply and demand on a system-wide, real-time, continuous basis."
Seeing the big-picture is what enables success:
"The hospital’s success at reducing length of stay and increasing bed turns is directly related to the ability to see the big picture. With a better overall understanding of the hospital’s flow patterns, for example, Signorelli says they are increasingly able to expand their planning horizon and look forward as far as a week to identify potential bottlenecks, instead of reacting within 24 hours. “If we can get better at long-range forecasts and continually refine as each day approaches, we can address things ahead of time.... We look at the data proactively; we manage our staffing ratios proactively. We are getting rid of the days when there was a huge patient load and not enough nurses by moving the variability out of the workload, moving the resources to the right places.”
Empower Better Decisions With Smart Data
Here are the kind of better decisions that smart data enables in a hospital. Perhaps most important is what 11 Tips to Improve Patient Flow That Will Impact Efficiency notes:
"Efficient patient flow will increase your healthcare facilities revenue and more importantly keep your patients satisfied and safer."
It also encourages curiosity and a willingness to consider new approaches such as different staffing models. The same article explains,
"Jennifer Mensik, PhD, RN, NEA-BC, FACHE, former administrator for nursing and patient care at St. Luke's Health System in Idaho, states "nurse leaders can, to some degree, control the flow of patients and staff accordingly, if they harness unit-level data to find trends and identify how they change staffing and routines to accommodate those trends." She explains to no longer think of staffing as static. Think in terms of how you can plan better given the knowledge at hand with data."
From a fundamental operational perspective, imagine doing a better job of matching capacity and demand to reduce delays in care. That's only possible if and when you know what demand patterns look like and understand the capacity constraints in your organization. Add to that mobile technology so healthcare professionals can better manage time, care and tasks affecting the patient.
The final tip that this article offers has to do with using advanced data analytics:
"A big data trend in the marketplace is the increased use of analytics to advance patient safety. Valuable insights in real time can impact patient care and safety... Big Data works on the principle that the more you know about something or event, the more you can gain new insights and make predictions about what will happen in the future. This theory can also be applied to the ability to forecast trends in your healthcare facility. "Neural Networks are a predictive technique that can recognize and learn patterns in data".... Advanced analytics will provide better coordination of care, customer service and operations."
Ultimately, Better Patient Flow Drives Revenue Improvements & More
The bottom line, and the reason for relentlessly pursuing patient flow improvements, is how it relates to revenue improvements and greater patient satisfaction.
"In the end, optimizing flow is about improving all quality dimensions of care delivery. When the system is integrated, departments communicate effectively, team members are engaged and goals are aligned, it creates more visibility and collaboration within the hospital. As operations run more efficiently, patients and providers will have a more positive care experience, and the facility will see improvements in revenue."
These are the kind of benefits that TAGNOS clients have seen.
Wondering How to Improve Your Patient Flow with Smarter Data?
If you're struggling with workflow issues in your healthcare facility, we have the solution.
TAGNOS helps hospitals with operational throughput issues in the OR and ED by improving their workflow. It has reduced their overall costs, increased the number of cases that can be performed daily and improved patient satisfaction scores.
TAGNOS can help you make better decisions to improve outcomes and the patient experience in the most efficient way possible. Read the successes that our customers have experienced.
Thanks for reading.
TAGNOS is the future of clinical automation software solutions with Artificial Intelligence. TAGNOS is the only platform offering predictive analytics utilizing machine learning and RTLS. This groundbreaking platform leverages historical patient data continuously and adjusts operational intelligence to provide sustainable improvement to both the patient experience and metrics.
TAGNOS provides clinical systems integration, customizable reporting, dashboards, alerts, critical communication with staff and family to improve turnaround times. TAGNOS supports patient flow, workflow orchestration, and asset management.
In the course of 13 months, hospitals see a 12.7% reduction in its overall cycle time - saving an average of 40 minutes from each case and over $1.6M per year - more than 11x the typical investment.