Software vendor TeleTracking Technologies and the American College of Emergency Physicians commissioned a survey last month on the state of patient flow in North American hospitals (press release - pdf). The survey is based on interviews with managers, directors and executives, representing over 200 hospitals.

Virtually all the hospitals who participated in the survey felt that patient flow management represents an extremely or somewhat serious challenge (99% of respondents). And 53% felt that patient flow challenges have become more serious in the last 12 months. To illustrate how serious the problem is, 60% of the hospitals reported diverting patients to another hospital in the last year, due to overcrowding problems - and a whopping 23% reported going on divert more than 20 times in that same period.

The most amusing question in the survey: "Is there a standing committee to review patient flow problems?" With 80% answering in the affirmative, it goes to show that some problems require more than a standing committee. The survey does report progress, albeit modest. A full 64% of hospitals report admitting patients from the ER in 2 to 4 hours. The most common admission goal is within 1 hour (35%), but 48% fail to meet their goal more than 50% of the time. The good news is that 54% of hospitals report their ability to move patients from the ED to in-patient status has improved in the last year.

The survey asks about two potential strategies to improve patient flow, adding bed capacity and using "patient flow technology." With the current hospital building boom, it's not surprising that capacity is a major consideration for a new physical plant - 57% of respondents are considering increased capacity in response to patient flow constraints. Surprisingly, 22% of hospitals reported expanding bed capacity as an option of "last resort" - they must have already built.

Of course, bed capacity is the most expensive option with the longest lead time for improving patient flow - and the result does nothing to improve productivity, management or the actual flow of patients through the hospital. The other option presented in the survey was patient flow technology, bed management and care delivery logistics applications like those offered by TeleTracking and others. When asked if their hospital had implemented patient flow tech to improve overcrowding, 60% reported they had. Of those that said no, 36% reported that they plan to implement such systems in the next 6 to 12 months.

While the hospitals surveyed remain positive about overcoming their patient flow problems (88%), the majority (76%) recognized that a technical solution will have to be complemented with process and staff changes to be effective.

My read of this survey and the market as a whole is that the "easy" solutions to improved patient flow have been done (remember all those committees?) and the resulting improvements have proven inadequate to eliminate the problem - hence the patient flow problems have become more serious for hospitals. The 60% market penetration for patient flow tech is also interesting. Bed management solutions have been around for a long time, and TeleTracking has hundreds of installations. Perhaps in response to the intractability of patient flow problems, patient flow tech solutions are evolving to look past simple bed management to encompass a broader view of the logistics of care delivery - few hospital have fully implemented these more comprehensive solutions.

Besides the solutions mentioned in the survey, there are other approaches that can improve patient flow. A common strategy for opening ED beds are observation units. (I will be presenting a pre-conference workshop on patient flow and observation units next week here.) Another strategy that is gaining adoption is the use of variable acuity nursing units. (More on variable acuity units here, here and here.) One additional reason why patient flow problems are so hard to solve is the impact of attending physicians - abuse of admissions criteria and discharging patients at 6pm rather than 10am are common occurrences that greatly impact flow. The traditional "whatever you say" response hospital administrators give huffy admitting physicians has to end.

You can read a summary of the results here. Pictured right is an emergency department treatment room in Englehart and District Hospital in Ontario.