Pat Ramming, manager of the Throughput department at Seton (see this post)  was gracious enough to take the time to provide us with some additional background on their efforts at Seton: 

I was curious how they selected the target areas for their patient flow improvement initiative.  They spent more than a year on this project, starting with a hospital wide patient flow study. Based on analysis of the data, sixteen bottlenecks were identified; they selected bottlenecks with the biggest impact on flow for implementation.  Once specific bottlenecks were chosen, teams were assembled to develop process changes and plan implementation.  Each target bottleneck had its own team and plan.

The biggest challenge?  "Changing nurses habits.  And of course, finance."

The article about Seton's experience mentioned using patient flow software, but not the name (Tele-Tracking).  The software is used in Bed Control (in their Throughput Dept.), Nursing, Environmental Services, Dietary, and Finance (for reporting).  When asked how much of a contributing factor capacity management software was to their success, Pat said, "We designed our processes around the [capabilities provided by] the application. I can't imagine doing the job without it."  She said the biggest impact of the software was bringing Environmental Services into the patient care arena.

One of the most effective patient flow optimization tools is the Universal Unit (AKA, variable acuity unit, flex beds, flexible monitoring, house-wide monitoring - description here). Even with their improvements, ICU capacity continues to be an issue at Seton -- in fact, they were full this morning when we chatted.  Because they look at inappropriate admissions across the hospital, they have identified Universal Beds as a future project for improving patient flow.  (Most ICUs have around 20 percent inappropriate admissions, so they pay 3 to 4 times the cost of care delivered in a Med-Surg unit.)

The Seton Healthcare Network is a constant learning organization, and their patient flow team continues to meet monthly to drive continued improvement and respond to changes.  One change to accommodate will be the new county policy of "no diversions" (starting July 1, 2005) where hospital emergency departments will no longer be able to go on divert. Pat and her team are also in the process of rolling out these process improvements across the Seton Healthcare Network (they have a total of 5 urban and 2 rural hospitals); this will provide common processes across the system and an enterprise level view of bed management.  Their patient flow initiative is even extending to the design of a new facility that will incorporate their new patient flow processes into the design.