ShariWelch

Great sessions today's at the Urgent Matters Perfecting Patient Flow
conference
. Patient flow arose in our consciousness
through the ED. Of course the
cause for most ED patient flow problems lies beyond the ER. Most of
today's presentations dealt with the ED, with some focus on hospital wide
patient flow. I wonder if there should be two
separate tracks, one for patient flow optimization across the hospital
(include the ED) and one to dive deep into ED operations. Some of the
sessions today were two tracked, which worked well.

Another attendee asked me what I thought of the conference; her
assessment, "it's all just common sense." Hmmm. This is not rocket
science, but when you're inside the box we call health care, solutions
can seem impossible if not non existent. After all the top patient flow
problems are
identified, all the best tools utilized, the biggest factor for success
is
organizational will and execution. Our health care system needs to make
some pretty major changes. Yet when you consider the inherent
resistance to change the challenge isn't technique or science so much
as art, craft and maybe luck.

Bound by tradition and the "rules," hospital organizations must break away and adopt meaningful
change to improve patient flow and patient safety. An example of that
was Carolyn Santora's presentation on boarding patients. Carolyn laid
out the rationale for boarding patients in their inpatient units rather
than in the ED. Radical stuff, but after a review of the facts the
resulting changes were simply
common sense. You might be surprised at the well known hospitals that
are boarding patients up on inpatient units rather than the ER. There is no rocket science here, just gut wrenching change.

In another session, we came up with the top 5 patient flow bottlenecks (in order of impact):

  • Lack of beds or monitored beds
  • Medical staff culture
  • Access to data or information - e.g., organizational silos or "data poor" organizations
  • Competition for beds - ED, surgery, direct admits and transfers
    all competing for beds (this is really an artificial variability issue)

Here's an interesting technique used at one hospital where patients are given an anticipated
discharge date at admission (they even put a sign above the patient's
bed with their target discharge date). When it's discharge time, patients are moved to a discharge
lounge to free up their bed. Anectdotally, patients sent to the
discharge lounge seem more proactive in finding a ride home than
patients who wait in their rooms.

The photo right Shari Welch, MD, discusses her poster on the impact dashboards have on patient flow at this evening's reception.