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Patient flow best practices

Photo: Patient flow best practices
Why is optimising patient flow important in a hospital setting?

Patient flow is a term used to describe the movement and processes involved in the progression of patients along a pathway of care. This involves the movement of patients from one location to another, the efficiency of referrals, assessments and decision-making, and how/where certain health services and diagnostic tests are accessed.

This topic is becoming of increasing importance in hospitals, as optimised patient flow results in reduced patient waiting times, decreased costs to the health care system, improved efficiency of assessment and treatment, and consequently decreased harm/adverse events to patients.

What impairs good patient flow in the hospital setting?

● Increased demand in emergency departments (high numbers of patients to see – this may increase during certain times of year, e.g. during Schoolies week, where many people seek treatment for Schoolies-related incidents)
● Low staff numbers
● Delays in registrars coming to emergency departments to see referred patients
● Delays in registrars deciding whether or not to admit patients
● Delays in consultants seeing the patients (generally registrars review patients first (known as being “on-take”), with consultants not being available until several hours later (known as the “post-take” period))
● No available hospital beds for the admission of new patients waiting in the emergency department
● Delays in ordering beds and transferring emergency department patients to inpatient beds
● Delays in performing diagnostic tests (e.g. bloods, imaging)
● Delays in receiving the results of diagnostic tests
● Delays in decision-making by the inpatient team
● Delays in discharging inpatients
● Fewer services available on nights, weekends and public holidays
● A trend towards admitting new patients in the morning, but not discharging patients until the afternoon

How does patient flow affect patient care?

Essentially, poor patient flow can cause delays in assessment, delays in ordering diagnostic tests and delays in receiving/interpreting the results of diagnostic tests. This results in delays in treatment decisions and thereby sometimes increased patient morbidity and mortality. Delays in discharging patients, result in delays in admitting new patients and providing them with adequate treatment.

How does patient flow affect hospital budgets?

Poor patient flow causes delays that may result in prolonged hospital admissions.

This is associated with increased hospital costs, which include the cost of hospital beds, staff wages, patient food, housekeeping issues (such as patient linen/laundry), investigations and treatments.

A study in 2011 of two hospitals in New York demonstrated that crowding and prolonged stays in emergency departments resulted in significantly increased costs to the hospitals. It was found that the two hospitals could potentially save $3.9 million and $9.8 million respectively per year if there was faster movement of patients from emergency departments to the inpatient setting.

A Summary of Patient Flow Best Practices

● Efficient discharge planning, with early involvement of multidisciplinary/allied health staff
● Multidisciplinary teams to see patients in the emergency department if possible, instead of waiting until they are transferred to the inpatient ward
● Whiteboard on inpatient wards to track patient progress – placed in high-traffic areas, where health professionals have access to information such as patient bed number, allied health referrals made, tests ordered, discharge medications and predicted date of discharge
● Increased numbers of senior staff in emergency departments, to supervise junior staff and enhance decision-making
● Consultants to begin seeing more patients “on-take” (when the registrar first sees them), instead of “post-take” (several hours or the day after the registrar has seen them)
● Make small alterations to working hours for staff – e.g. if phlebotomists and laboratory technicians commence work half an hour to an hour earlier, then blood results will be available earlier each day
● Established and reliable pathways for accessing diagnostic test results, with quick provision of imaging and interpretation/reports
● Careful scheduling/separation of acute and elective procedures, so that there is always capacity to provide acute services when needed
● Aiming to discharge patients in the morning, to free up beds for late morning/afternoon admissions
● Setting up temporary external clinics during known busy periods, e.g. during Schoolies week
● Improving staff engagement in making changes to improve patient flow
● Run audits/research on the abovementioned ideas to ensure patient flow is being improved, and identify areas that can still be improved



Sources
http://www.ecinsw.com.au/sites/default/files/field/file/Improving%20acute%20patient%20flow%20paper_0.pdf
http://www.health.org.uk/sites/default/files/ImprovingPatientFlow_fullversion.pdf
https://ama.com.au/ausmed/unlocking-secrets-patient-demand
https://www.mja.com.au/journal/2009/190/11/whiteboards-one-tool-improve-patient-flow

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