This paper, published in Nurse Leader, provides an overview of what
North Carolina Children's Hospital
is doing to tackle patient flow
bottlenecks. While specific bottlenecks are not mentioned, there is
good information about approaches Carolyn Viall and her team took to
improve throughput.

By consultation
with an outside organization, the health care system is aggressively
tackling the issues of patient throughput. The system has been able to
identify the issues that impact patient throughput, but in the past, a
piecemeal approach has been ineffective at putting a comprehensive
program in place that has the needed impact on patient throughput. A
coordinated case management program with restructured care coordinators
and social work staff functions is a focus of the program. Improved
data flow with an information technology solution for bed management
and utilization review will also be put into place shortly.

In my experience, most hospitals have already tried the easy
piecemeal solutions. Real success lies in changes that cross existing
organizational structures, including the medical staff. Adopting
patient flow software applications have direct benefits from some
hospitals and provide a framework for implementing organizational
change that extends way beyond the actual application.