Trustee magazine tells the tale of patient flow improvement at Lehigh
Valley Hospital and Health Network
. The main symptom of problems were
backups in the ED and diversions. Here's what they did to improve
patient throughput:

  • A "find-a-bed" team converted offices, waiting rooms and storage areas into space for 70 new patient beds
  • An eight-bed express admission unit was
    opened that allows non-urgent care patients to be directly admitted,
    bypassing the ED completely. Physician admission orders are either sent
    electronically through a CPOE system, or in writing with the patient
  • A short-stay unit was opened to address a
    12.6 percent growth in surgical cases, shifting selected cases to
    another LVHHN campus that had an active ambulatory surgery unit
  • The discharge process was dismantled and
    "stitched together" as a new patient logistics function that took
    control of all discharge and allied functions, including patient
    transport, intrahospital transfer, bed cleaning, discharge reporting
    and centralized ambulance transport (this included implementing a patient flow software application)

Here's a summary of results:

  • Capacity averages an optimal 85 percent, despite an increase of 4,500 admissions over the past two years
  • Bed turnaround time has dropped from 284 minutes to about 62 minutes (and with 100 discharges per day, this was important)
  • 150 percent more patients are admitted each
    month through the Transfer Center, where specially trained critical
    care nurses take urgent patient transport calls from referring
    hospitals and coordinate transport and admission to LVHHN
  • Express admissions have increased by more than 50 percent
  • Short-stay hospital volume has increased steadily
  • Ambulance diversions were reduced 345 hours in 2004
  • Average length of stay in the ED decreased by nearly an hour, from 236 to 181 minutes
  • Patients are seen in the ED 30 minutes faster
  • Patient satisfaction with the ED is now in the 97th percentile of national rankings
  • Employee satisfaction has soared. In 2004,
    LVHHN was ranked the top hospital among the Best Places to Work in
    Pennsylvania, and named the second Best Place to Work among larger
    employers statewide by the Team Pennsylvania Foundation

There's lots more in the article, so read the whole thing.