Every hospital organization is unique and has attributes that separates them from others. These can include: number of beds, programs and services, budgets, patient population served, models of care, and staffing models. However, there are many similarities – there never seems to be enough beds and inevitably patients have to wait for services, whether they be internal services or those provided by your community partners. Patient flow and patient throughput is a major focus in all hospitals. The question remains, how do we measure patient flow and what is the gold standard or benchmark for excellent patient flow?
Due to the uniqueness of each organization, there is no one metric or statement that can be set for all hospitals. The targets will continue to evolve and new goals should always be reached for. The key is to start measuring and continue to strive for better.
IDENTIFYING OPPORTUNITIES FOR PROCESS IMPROVEMENT
How do you know where to focus your efforts? That’s where Medworxx can help. Like the old adage says, you can’t manage what you can’t measure. Medworxx data is already doing the measuring—you just need to start looking at the data and creating the internal benchmarks for your unique organization. Monitoring data to identify where process improvement efforts should be focused can include:
Admission day practices – are we admitting the right patients? Medworxx data on Avoidable Admissions will give you the insight into the data to understand who is being admitted and if those patients are appropriate for that level of care.
Discharge practices – are we discharging or transitioning patients as soon as they are clinically stable? Medworxx RFD/T data will provide organizations with the number and percent of potential avoidable days, often referred to as the low-hanging fruit. Even a small reduction in avoidable days can result in aiding significantly in daily bed flow challenges.
Focus on organizational (internal) barriers - Anecdotal information can help guide organizations to areas in need of process redesign. Are there clear referral processes to multidisciplinary team members and are diagnostic tests being ordered early enough in the stay of the patient?
TRENDS FROM PATIENT THROUGHPUT REVIEWS
Through the work Medworxx has completed in the past year conducting Patient Throughput Reviews (PTR), we have documented the following patient flow trends in Admission Day Practices, Discharge Practices, and Internal Barriers.
Admission Day Practices
Potential avoidable admissions ranged from 10-19% with an average of 13%
This number represents all patients that did not meet the clinical criteria for admission. What does this mean for an organization? Those patients occupied a bed but did not require that specific level of care. This prevents other patients that do meet clinical criteria for admission to come into hospital and obtain the required treatments and services. This creates bottlenecks and backlogs in all areas of the hospital. Organizations that measure and create strategies to reduce avoidable admissions will have a positive return on patient flow and throughput.
RFD/T days ranged from 23% to 35% with an average of 31.5%
This represents the patients that were clinically stable but remained in hospital due to barriers, interruptions, or delays in their care. Potential avoidable days is an important metric to measure as these are days that could have been saved and beds turned over for other patients that would clinically require the bed. Reducing these numbers is vital to creating capacity and flow in your organization. It also leads to greater patient and staff satisfaction.
Waiting for allied health assessments/treatments, medication treatments such as IV antibiotics and diagnostic testing orders/delays, are the most commonly documented reasons patients remain in hospital after they have been deemed clinically stable.
Understanding the precipitating factors that contribute to these delays is important. Data can help determine:
When are these delays occurring? Time of day or day of the week, could the issue be related to weekend or off hour coverage issues?
At what point in the patient journey are these delays noted?
Are tests and services being ordered late in the admission or could these services be provided on an outpatient basis?
Objective data enables your hospital to create strategies for improvement. So remember, start small but think big, and before you know it your organization will look back on your journey with a true feeling of accomplishment and the knowledge that slow and steady always ensures successful results.
OPTIMIZING PATIENT FLOW
Benchmarking is key. Begin by getting a baseline to jumpstart your measurements. Start small and ask questions. Develop a culture of continued improvement throughout your organization by:
Engaging and communicating with staff
Developing a plan - start with something attainable and create a plan that strives to keep the finger on the pulse
Revisiting your data on a regular basis
Setting new benchmarks and goals monthly, quarterly, and yearly
These are just a few strategies that will get your started. Medworxx is committed to helping your organization realize its potential. Please reach out to a member of our team as we are excited to help you develop the plan that works best for your organization.