Optimizing Patient Flow: Moving Patients Smoothly Through Acute Care Settings

Institute for Healthcare Improvement (IHI)

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IHI believes that the key to improving flow lies in reducing process variation that impacts flow. While some variability is normal, other variation is not and should be eliminated. Hospitals working with IHI have tested a range of changes to reduce process variation and improve flow. These changes are described in this white paper. The report is available as a PDF, requiring Adobe Reader.

ED Door-to-Doc Toolkit

Banner Health, with the cooperation of the Department of Industrial Engineering at Arizona State University, reengineered the front end of the Emergency Department patient flow.

Optimizing Patient Flow: Moving Patients Smoothly Through Acute Care Settings

IHI believes that the key to improving flow lies in reducing process variation that impacts flow. While some variability is normal, other variation is not and should be eliminated. Hospitals working with IHI have tested a range of changes to reduce process variation and improve flow. These changes are described in this white paper. The report is available as a PDF, requiring Adobe Reader.

Clinical Decision Unit

William Beaumont Hospital in Royal Oak, Michigan implemented a Clinical Decision Unit in order to better monitor cardiac and other patients without using valuable inpatient space. Guidelines for the Clinical Decision Unit were developed based on best practices from hospitals around the country. In addition, strong support from both physicians and hospital leadership was instrumental in the success of the Clinical Decision Unit. The report is available as a PDF, requiring Adobe Reader.

Clinical Transitional Orders

Standardized forms were created by Englewood Hospital and Medical Center for patients admitted to the hospital from the ED. These forms include transitional orders to be completed by an attending physician or resident and overnight holding orders to be completed by an attending. Using the forms improves patient flow by allowing patients to be moved to the inpatient unit without an attending or resident physician first coming to the ED to write orders. Patients are sent with the form to the inpatient unit where it is completed by the physician.

Code Heart - Reducing Door-to-Balloon Time

Developed by Memorial Regional Hospital in Hollywood, Florida, the goal of the Code Heart Tracking Tool is to reduce the time from when a heart attack patient's arrival at an

Best Practice Initiative: Discharge Resource Room

The Regional Medical Center at Memphis implemented a discharge resource room (DRR) in order to free inpatient space for emergency department (ED) patients. Patients are moved to the ground floor DRR when they are ready to leave the hospital. This provides a comfortable space for them to receive discharge instructions from a registered nurse while wait for transportation to arrive. The report is available as a PDF, requiring Adobe Reader.

EM Express Program

The mission of EM Xpress is to eliminate ambulance gridlock at hospitals by speeding patient offloads. Borrowing from a car racing model, EM Xpress uses “pit crews” to expedite the transfer of patient care between emergency medical services (EMS) and emergency department (ED) staff. The goal of EM Xpress is to offload patients quickly and safely so that ambulance crews can avoid delays at the ED and get back on the road to respond to other calls. This solution was implemented at Valley Hospital Medical Center. The report is available as a PDF, requing Adobe Reader.

Straight Back Triage

Instead of sending patients to the waiting room following triage, patients are sent to one of three treatment areas under the straight-back triage policy. Sending patients to the treatment area sends a visual cue to staff that the patient is waiting to be seen. The strategy was implemented at William Beaumont Hospital. The Straight Back Triage system has had a significant impact on reducing the risks of patients waiting in the waiting room, increasing patient satisfaction, and decreasing throughput time.

Charted Door-to-Bed Process Flow Chart

The goal was to improve door to bed, length of stay and patient satisfaction by reducing delays in ED triage and registration. St. Francis set out to integrate the processes of getting patient registration and clinical information upon ED arrival, and to standardize how long it took a nurse to triage a patient. Since implementation, St. Francis decreased their length of stay from 253 minutes in 2008 to 173 minutes in 2009. Also, the rate of patients who left without being seen decreased from 3.86% to 2.62%, and decreased staff turnover – all during a period of increased ED volume.

Capacity Optimizer Tool

GE Healthcare created The Capacity Optimizer Self-Assessment Toolkit to assist with effective hospital capacity management. There are many variables to consider, which include: the number of staffed beds (medical, surgical, ICU), annual discharges, and average length of stay (ALOS). Managing these variables; such as reducing staffed beds in certain units, or increasing bed turnover, may help you achieve target utilization. The Capacity Optimizer Self-Assessment Toolkit provides data that can help hospitals develop strategies for improving utilization.