Given that the Supreme Court upheld the constitutionality of the Affordable Care Act (ACA) and the aging of the population, health care providers will be forced to handle increasing patient demands, further taxing a system that is already at capacity in many cases. The top three priorities for health care executives over the next three years as identified by the HealthLeaders Media Industry Survey 2012 are patient satisfaction and experience, clinical quality and safety and process improvement. It is possible for all three priorities to be addressed simultaneously by optimizing patient throughput and capacity without increasing existing resources.

Today it is not uncommon to hear comments such as “There are too many patients boarding in the emergency department”; “there are no inpatient beds available for surgical patients”; or “I had to wait for eight hours before there was a bed for me.” Statements such as these seem to indicate that there is a patient throughput problem; however, poor patient throughput is a result of a problem and not a problem in and of itself.

The question that needs to be asked is, “What drivers of efficient patient throughput are problematic?” To identify opportunities aimed at optimizing patient throughput, six key drivers should be studied: workflow/processes, physician practices, staff effectiveness, patient/family engagement, service utilization and IT systems capability. By focusing on and improving key throughput drivers, hospitals can achieve significant enhancements in patient flow, capacity, service excellence/quality and the overall patient experience.

Each of the six patient throughput drivers has the ability to significantly impact how efficiently or inefficiently patients move through the continuum to access the services they need.

1. Workflow/Processes—Process optimization requires not only an in-depth understanding of the inputs, actions and outputs specific to any given process, but also the inputs’ ability to impact the desired results elsewhere in the process. The goal is to ensure the patient is receiving the right care, staffing and supplies at the right time and place across the continuum. Each activity within the process must be value-added from the patient’s perspective. By utilizing the Lean methodology or other process improvement approaches, wasted time, steps, supplies and space
can be eliminated, improving patient throughput and overall experience. Another mechanism to improve patient throughput is implementation of “pull” systems, which proactively move the patient through the patient care experience.

2. Physician Practices—As one of the principal providers of health care services, physicians and how they practice medicine are important drivers of patient throughput. A simple behavior such as rounding late in the day can result in evening discharges and can have a tremendous impact on bed availability. Modifying physician behaviors and practices can be very challenging; however, physicians understand and appreciate data, so the more data and information you have to support the desired change, the greater your likelihood of success. Many of the physician practice changes will not only improve patient throughput but also the physician’s productivity, which will further facilitate their buy-in and support.

3. Staff Effectiveness—In order for patients to flow through the continuum of care without delays or bottlenecks, staff across the organization must be positioned—and easily repositioned—to effectively meet fluctuating patient demand. Having more efficient care providers leads to better
patient throughput because they complete their tasks in a shorter period of time. When staff must leave the patient to find supplies, duplicate a test, repeat questions already asked or carry out other non-value added activities, patient throughput and often patient outcomes are negatively
impacted. An organization’s ability to flex staff to match patient demand is the cornerstone of staffing effectiveness.

4. Patient/Family Engagement—Facilitating patient and family engagement to improve care delivery, clinical outcomes and the health care experience is recognized as an essential component of any hospital’s quality improvement program. Patient and family involvement is also important in optimizing the patient’s throughput. By talking with patients and family members in advance of an admission or procedure and setting expectations regarding the course of clinical care and duration of the inpatient stay, the overall length of stay can be reduced and throughput increased. Early engagement of the patient and family also helps to reduce the anxiety of the unknown and to focus the family instead on what needs to be done to bring the patient back home as quickly as possible.

5. Service Utilization—Patient throughput in nursing, diagnostic, treatment and procedural services is dependent on the number of patients that can be cared for given a certain set of resources, i.e., MRI, OR, GI Lab, etc., for a given period of time. The goal is to maximize the number of patients who can be cared for utilizing that set of resources. To increase patient throughput, consider reducing the patient care time by eliminating non-value-added activities, decreasing room turnover time, extending operating hours, adjusting staffing and modifying the scheduling parameters. Patient delays in a department often have throughput ramifications for other services. For example, is overcrowding in the ED a result of unpredictable variances in ED demand or because of inpatient bed unavailability? Service utilization is ultimately a careful balance in the management of capacity and demand and having the ability to anticipate and accommodate what is to come.

6. IT Systems Capability—Efficient patient throughput cannot be accomplished without IT systems. For example, IT systems enable real-time alerts when a bed is ready to be cleaned, generate reports to identify opportunities for improvement, display tracker boards so clinicians and family members know where the patient is, and provide the electronic medical record to facilitate the sharing of patient information and collaboration between clinicians. Each one of these systems, and so many others, contributes to the efficient and effective delivery of patient care services. Innovations in IT solutions will continue and it will be important to understand how these systems impact patient throughput.

A comprehensive review of patient throughput will necessitate assessing various patient types, as the clinical throughput experience will vary by patient type. For example, the throughput experience of a scheduled surgical patient will vary greatly from that of an emergency room patient, as will the problematic drivers. By implementing improvements to the six key drivers one at a time, patient throughput can be optimized, improving patient satisfaction and quality of care.

27 June 2012