Here's a nice story that describes how Seton Medical Center in Austin improved their patient flow. They were experiencing the usual problems, ED diverts, boarding patients overnight because rooms were unavailable, and admitting physician compaints about delays and unavailable beds.
To improve patient flow, the hospital staff divided into several teams, focusingon four key areas: ED diversion, post-anestesia care unit (PACU) holding, patient access to the facility, and in-house and out-of-house transfers. Ultimately, these teams merged to form the patient throughput department.
The results are impressive:
Before the initiative was begun, the average holding time in the PACU was 120 minutes per patient. In the last three months of 2004, the average total hold time per month was just 180 minutes for all patients.
In 2003, the hospital had to divert patients brought by emergency medical services a total of 458.24 hours because there were no beds. In 2004, the time dropped to 49.57 hours. In December 2003, the average patient stayed in the ED for 296.26 minutes before admission. In November 2004, the time had dropped to 190.22 minutes.
They created a Throughput department, managed by Pat Ramming, RN. The team includes house supervisors (RNs who coordinate house-wide patient flow 24/7), bed board staff (non-clinical staff that coordinates and tracks bed assignments), and express admissions nurses (nurses who off-load patient admitting from unit staff). The use of admissions nurses contrasts nicely with this approach at a Dublin hospital, where patients go to a special admitting unit (where they are of course admitted) before being transferred to the floor.
This article (requires registration) from January 2002 describes the ED divert situation in Austin that partially prompted Seton's patient flow improvement efforts.