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Patient Flow Optimization – Managing Process Variability is the Key

According to an IHI (Institute for Healthcare Improvement) white paper…

Patients and providers alike regard waits, delays, and cancellations as a normal part of getting and giving care. Particularly in hospitals, waiting seems intrinsic and, to many, intractable.

Acute care settings are plagued with waits, delays, and diversions. Nowhere is this more observable and its impact more palpable than in hospital emergency departments (EDs). These are busy places, and getting busier.

Diverting ambulances away from hospitals that are at capacity is another problem on the rise. A government study in the US showed that “ambulance diversions have impeded access to emergency services in metropolitan areas in at least 22 states. More than 75 million Americans reside in the areas affected by these ambulance diversions.” *

The so-called “ED problem,” however, is actually a system problem. EDs do not exist in isolation, but are part of a system of care through which patients flow. Increasing capacity in the ED to accommodate more patients, a solution chosen by many hospitals, is like broadening only the large end of a funnel. Increasing input without facilitating a smooth exit (in this case, transfer to other hospital units) worsens the problem.

In a recent report on ED crowding, the US General Accounting Office (GAO) noted the connection between the ED and the rest of the hospital system: “While no single factor stands out as the reason why crowding occurs, GAO found the factor most commonly associated with crowding was the inability to transfer emergency patients to inpatient beds once a decision had been made to admit them as hospital patients rather than to treat and release them. When patients ‘board’ in the emergency department due to the inability to transfer them elsewhere, the space, staff, and other resources available to treat new emergency patients are diminished.”

The units to which ED patients are often transferred must be viewed as integrated parts of the whole system. Most often EDs divert because the hospitals to which they are appended lack the space to move patients forward. A recent study of ED overcrowding showed that the primary reason hospitals go on diversion is the lack of available critical care beds.

While few hospital areas are designed to achieve optimal flow of patients, the emergency department, intensive care unit, and operating rooms and their related pre- and post-care areas tend to be major bottlenecks because they are non-interchangeable resources. Reducing delays and unclogging bottlenecks depends on assessing and improving flow between and among these departments, and throughout the entire system, rather than in isolated departments. IHI believes that the key to improving flow lies in reducing process variation that impacts flow. While some variability is normal, other variation is not and should be eliminated.

ProModel provides hospitals with predictive analytic solutions to determine which variability is normal, which is not and how to reduce or eliminate as much of it as possible. Where variability cannot be eliminated, our VAO (Visualize, Analyze, Optimize) technology and expert services provide you with the ability to accurately account for it, along with unavoidable resource interdependencies, enabling healthcare executives to make better decisions, faster when it comes to improving patient flow.

Download our free Process Simulator Lite to begin experiencing how ProModel’s predictive analytic healthcare solutions can help optimize your patient flow.

*Optimizing Patient Flow: Moving Patients Smoothly Through Acute Care Settings. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2003. (Available on www.IHI.org)