Our team of Healthcare Industrial Engineers created this newsletter to share the industry’s best practices with leaders who can apply operational efficiencies in their daily work.
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Hospitals across the country are faced with daily bed management challenges. With ED admissions typically peaking between 3:00pm to 7:00pm, PACU admissions between 12:00pm to 4:00pm, and inpatient discharges between 6:00pm to 8:00pm, it is easy to see why capacity challenges exist.
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Now, more than ever, capacity management requires thoughtful consideration to maximize appropriate utilization of beds, staff, and services. CCC team member, Susie Law shares key tactics for maximizing hospital capacity in this article.
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While bed management is a hospital-wide issue, success requires teamwork. Performance improvement efforts should occur in parallel across departments.
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For example, the ED can work to submit bed requests more timely, inpatient units can streamline discharge planning activities, and Environmental Services can adjust staffing to align with room turn demand by time of day.
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Psst... when prioritizing improvement initiatives, rank their effort and impact. Quick wins from low hanging fruit opportunities motivate teams. Also, publicize success!
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10 BEST PRACTICES FOR IMPROVING PATIENT FLOW
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1) STREAMLINE BED REQUESTS
Submit bed requests immediately upon receiving admission order and incorporate all required information for the patient to be assigned to the appropriate unit. Leverage patient placement technology to automate bed requests, if possible.
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2) IDENTIFY BED COORDINATOR
Identify an RN Bed Coordinator to review incoming bed requests and quickly prioritize bed assignments. The Bed Coordinator should routinely round on inpatient units to resolve discharge barriers and escalate any staffing challenges to the Nursing Supervisor
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3) SUPPORT INPATIENT STAFFING PLANS
Ensure departments schedule the resources required for each patient census level to prepare for incoming ED and PACU admissions. Admissions can be largely predicted from historical data by time of day and day of week. Ensure all staffing grids reflect patient ratios identified by nursing leadership.
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4) EMERGENCY DEPARTMENT TO INPATIENT UNIT HANDOFF
Streamline the patient handoff process from the ED to the inpatient unit. Develop a standard SBAR template to be automatically populated with pertinent information from the medical record. Send the form to the unit electronically, then call to notify them that the patient is on the way. Ensure ED staff are available for questions about the patient.
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5) OPTIMIZE PATIENT TRANSPORT RESOURCES
Evaluate resources available to transport patients from the ED to the inpatient units. Sometimes this is a unique transport department, ED transporters, ED nursing/tech staff, radiology transporters, or inpatient nursing/tech staff. Analyze patient transport demand by day of week and hour of day to ensure resources are available when needed.
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6) REGULARLY DISCUSS DISCHARGE PLANNING
Discuss the target discharge date and key requirements with the patient and family on the day of admission and throughout their stay (ambulatory, tolerating solid food, etc.). Prior to the anticipated discharge date, discuss options with the patient and family regarding transportation home. Over communication reduces unanticipated delays.
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7) ENSURE DISCHARGE DELAYS ARE DOCUMENTED
Standardize the discharge delay reasons for your facility and capture the delay reason for every patient. Analyze delay reason data by unit so improvement efforts may be organized around the most frequent causes for delay.
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8) ENVIRONMENTAL SERVICES (EVS) STAFFING ALIGNMENT
Align EVS staffing resources with patient discharge times by day of week and time of day to support timely turnaround for room cleans. Document patient discharges timely so that EVS is alerted immediately and can begin cleaning rooms as soon as they are unoccupied. Stagger EVS staff breaks to ensure resources are always available to begin room turnaround cleans. Identify and account for isolation room cleans, if possible.
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9) ACTIVE PARTICIPATION IN DAILY BED HUDDLES
Conduct brief bed huddles each morning and afternoon with participation from the Administration, ED, OR, Inpatient Nursing, Case Management, EVS, Lab, CV and Radiology departments. Review anticipated admissions and discharges. In the morning, identify specific actions that will be taken to address discharge delays and request follow up on these actions during the afternoon meeting.
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10) SHARE PATIENT THROUGHPUT METRICS
Measure performance to prioritize processes improvement efforts. Potential metrics include: Bed Request to Bed Assignment, Bed Assignment to Patient Arrival on Unit, Discharge Order to Discharge Time, EVS Bed Dirty to Cleaning in Progress, EVS Cleaning in Progress to Bed Clean, % Discharges by Time of Day.
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