Note: This post was originally published in May 2021 and has been updated for accuracy and comprehensiveness.

What is Patient Flow?

Patient flow is the moving of patients within your healthcare facility. It involves medical care, resources, decision-making, and having the proper internal systems in place. Optimizing patient flow is critical for healthcare facilities for two main reasons, patient safety and quality of care.

It's fair to say that 2020 and the pandemic will go down in the history books. 

And if the pandemic taught us anything, it taught us:

"It is within our power to create a health system that invites everyone to be part of an affordable, sustainable, accessible, high-quality system that keeps people healthy and improves our communities and society at large.", cites Laura S. Kaiser, FACHE, President and Chief Executive Officer for SSM Health [source] "Transforming an Industry that Treats Illness to Instead Create Health."

As a medical gas systems provider, CHT agrees that we collectively have the power to address patient health, safety, and flow in hospitals. Improving your patient flow is a way to increase revenue and patient satisfaction.

Several hospitals and health systems are pursuing strategies to improve patient flow. An efficient patient flow will increase your healthcare facilities' revenue and, more importantly, keep your patients satisfied and safer.

Failing to achieve the proper care at the right time puts your facility at an operational efficiency deficit, which in turn places your patients at risk for less than optimum care and potential harm.

"Achieving hospital-wide patient flow, and ultimately improving outcomes and the experience of care for patients, requires an appreciation of the hospital as an interconnected, interdependent system of care. It also requires strong leadership; in fact, the role of executive leaders is critical for success." [Source: Rutherford PA, Provost LP, Kotagal UR, Luther K, Anderson A. Achieving Hospital-wide Patient Flow. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2017. (Available at www.ihi.org)

If you're convinced that improved hospital-wide patient flow is suitable for operational efficiency, make sure to include these 17 guidelines for ensuring better patient flow. 

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Due to the pandemic, we witnessed first-hand the overcrowding of the hospital emergency rooms. To alleviate some of this pressure, some hospitals collaborated with surrounding hospitals. 

On to our first tip...

Tip #1: Share Capacity Data With Surrounding Hospitals

By building partnerships with hospitals in your area, you can become more efficient at getting patients the care they need in a timely manner. In addition, sharing capacity data will ensure that patients arrive at or are transferred to healthcare facilities with sufficient room. 

In the thick of the pandemic, Boston hospitals shared data and agreed to mutual aid across their systems.

"At this point, I think of us all as one big hospital system," Tabb (president of Beth Israel Lahey Health) said. "The virus doesn't respect hospital lines; it doesn't respect health care system lines; it doesn't even respect state lines. We're all in this together. That's the only way that we're going to get through it." [source] Boston Hospitals, Even Longtime Rivals, Work Together To Manage Flow Of COVID-19 Patients

Tip #2. Coordinate the Arrival and Discharge of Patients Undergoing Elective Procedures

The pandemic's immediate impact on the medical industry was the slowdown of elective procedures/care and even procedures conventionally considered non-elective. 

With elective procedures on a slight uptick, orchestrating the arrival and discharge of patients undergoing elective procedures (the timing of which is often under institutional control) could be a more effective and lasting solution.

Spacing elective surgeries throughout the week will help alleviate strain on post-operative units instead of block scheduling, leading to capacity crunches. [source]

Tip #3. Establish Timely Discharge in the Morning Hours

Another way hospitals can relieve congestion is by discharging patients earlier in the day when appropriate.

Leaving the hospital early in the day gives "patients time to get home, get their prescriptions filled, and have a visiting nurse come in," says Brenda Ohta, Ph.D., senior director of care management.

Tip #4. Improve Hospital Layout for Easy Navigation

One way an emergency department can increase patient throughput is to consider the layout. The layout should make it as easy as possible for staff and patients to navigate the facility and complete tasks.

Tip #5. Form a Patient Flow Team for Quality Improvement

Numerous research studies have shown the importance of creating multidisciplinary teams to plan quality improvement interventions. 

One of the benefits of a multidisciplinary team is that members will bring different perspectives and knowledge about problems, underlying causes, and potential solutions. [source] "Improving Patient Flow and Reducing Emergency Department Crowding: A Guide for Hospitals."

Tip #6: Align Reporting With Your Department Heads for Optimization

When you create a consistent reporting framework between your department heads, the patient flow will become optimized with your patients in mind.

As in many healthcare facilities, care is given from one department to the next. This could be from admissions, radiology, surgery, and more. As a patient moves from one area to the next, it's imperative all activities are documented from each department.

Clinicians can become frustrated when they have no insight or control over the actions taken outside of their immediate department.

Tip #7: Create a Culture of Accountability

Hospital culture can impact patient care. A hospital’s values, mission, and practices must be understood and consistent with all employees. Data reflects there is an interrelationship between safety culture and patient safety improvement.

Based on a study conducted by Lesley Curry and colleagues, it was concluded that hospital culture might be positively influenced by creating a strong hospital culture. Curry also found investing in strategies that foster company cultures will support high performance and may help hospitals in their efforts to improve clinical outcomes. 

Further findings showed a direct correlation between hospital culture and the impact on clinical teams and departments' work. [source: Curry LA, Brault MA, Linnander EL, et al. Influencing organizational culture to improve hospital performance in the care of patients with acute myocardial infarction: a mixed-methods intervention study]

Tip #8: Gain Executive Support and Direction for Improving Patient Flow

Keeping in line with the findings above, the approach taken by senior managers and leaders matters. 

It can increase the risk of harm when department heads do not support staff and hospital culture.

FierceHealthcare wrote an article on 5 Ways CEOs Can Change Hospital Culture.

In summary:

• CEOs will set a clear direction.
• They will treat people as their best resource.
• Make their employees feel safe - which will build trust.
• Challenge their employees and problem-solve. Talk about issues that will be critical to the success of their organization.
• Always question the status quo to help their facility grow.

Tip #9: Explore Different Staffing Models

Jennifer Mensik, Ph.D., RN, NEA-BC, FACHE, former administrator for nursing and patient care at St. Luke's Health System in Idaho, states,

"Nurse leaders can, to some degree, control the flow of patients and staff accordingly, if they harness unit-level data to find trends and identify how they change staffing and routines to accommodate those trends."

She explains it's important to no longer think of staffing as static. Think in terms of how you can plan better, given the knowledge at hand with data.

Match capacity and demand.

When your organization knows its capacity constraints and demand patterns, it can make changes to align with demand. When both are matched, delays in care can be reduced. For example, examine average and peak daily emergency department admissions. 

"Examining historical data on average and peak daily emergency department (ED) admissions helps predict the demand and allows for planning for the capacity needed to meet the demand. Predictions can be used to make system adjustments to meet the conditions." [source: Institute for Healthcare Improvement]

Tip #10: Use Technology to Improve Patient Care and Safety

Patient flow is attainable when healthcare facilities have the right tools for collaboration and measurement.

Care Command Center gives healthcare institutions a much-needed operational tool. It quickly "integrates with your existing systems to facilitate a collaborative environment focused on efficiency, experience, and quality. Care Command Center gives everyone in the care continuum the information they need to orient and act."

The high visibility of clinician-facing boards allows staff and patients real-time awareness with a HIPAA-compliant waiting room whiteboard.

"Patient surgery-tracker screen in the waiting room" by Amy Guth is licensed under CC BY 2.0 

Tip #11: Set Goals With Attention to Patient Acuity

The "patient flow standard" (Standard LD.04.03.11) was published by the Joint Commission to help healthcare facilities manage their patients' flow throughout the hospital.

The 4-hour time frame referenced in the Standard is a guideline for hospitals to use as a reasonable goal in their boarding time - when a patient is held in the emergency department to the time they are admitted or transferred.  

Hospitals measure and set goals for patient flow based on:

• Availability of patient beds.
• Throughput of areas where patients receive care, treatment, and services (such as inpatient units, laboratory, and radiology).
• Safety of areas where patients receive care, treatment, and services.
• The efficiency of the non-clinical services that support patient care and treatment (such as housekeeping and transportation). 
• Access to support services (such as case management and social work).

Source: The Joint Commission. 2021 Hospital Accreditation Standards. Joint Commission Resources, Inc. Jan. 2021

Using data will help hospitals manage any issues affecting their emergency department, i.e., patient boarding, leading to patient harm, and quality of care.

Tip #12: Provide an Automated Bed Board Tool 

University of Utah Hospitals & Clinics was "experiencing long patient wait times before admission and patients being held in the ED or PACU for extended periods before admission." They wanted to improve the patient experience and remove inefficiencies.

Teletracking helps improve access to quality care. Teletracking assisted the University of Utah Hospital (UUHC) by providing an automated tool to revise its patient flow system. This helped increase customer and employee satisfaction and discharge rate. The system created transparency in bed availability, the status of discharges or transfers, and incoming patients.

Modern Healthcare, a healthcare business news leader, research & data moderated a webinar on the benefits and steps to improve UUHC's patient flow. The entire discussion on automating patient flow consists of the challenges they were facing and the results.

Tip #13: Highly-Trained Staff on Time Management

One of the most effective skills to have for healthcare professionals is time management. Understanding how to plan and control your time spent on daily tasks is crucial to patient safety.

Here are a few tips on time management you can implement today.

6 Time Management Tips for Healthcare Professionals

• Establish goals
• Prioritize
• Take advantage of technology
• Use electronic health records
• Delegate
• Know when to say no

Time Management Tips for Busy Hospital Executives

• Sharpen your communication skills
• Target your time for essential responsibilities
• Empower your colleagues

Important Time Management Tips for Nurses

• Plan a schedule 
• Try and minimize distractions as much as possible
• Stay organized

Tip #14: Invest in Mobile Technology

"90% of hospitals surveyed have made or are planning significant investments in smartphones and secure unified communications platforms." Megan Knowles, Becker's Hospital Review - Survey: 90% of hospitals investing in smartphones for clinical communication 

"The survey found nearly half (48 percent) of hospitals have identified or were identifying return on investment models to justify mobile investments demonstrate cost reductions, outcome improvements, and staff/patient satisfaction."

Tablets can also be used for a better patient experience. Paperwork could be eliminated, which will expedite the process.

According to a release from Spyglass Consulting Group, platforms are providing:

• Cross-platform support
• Unified communications
• Event-driven communications
• Analytics and reporting tools

Tip #15: Connect Maintenance and Operations to the Patient Experience

Patient satisfaction is a top priority for healthcare facilities.

According to Dude Solutions, "The maintenance department influences your patient experience, and how you can create a better experience for everyone with an awareness and the right tools."

Communicate more effectively between your departments - from maintenance to housekeeping and more. A patient's experience and satisfaction can depend mainly on a task from the maintenance department. Think lighting, doors, or broken equipment.

Balancing your workflow will ultimately help your patient flow.

Tip #16: Utilize Advanced Data Analytics 

A big data trend in the marketplace is the increased use of analytics to advance patient safety. Valuable insights in real-time can impact patient care and safety.

In this article, we included an infographic on 7 Big Data Healthcare Trends.

Big Data works on the principle that the more you know about something or an event, the more you can gain new insights and make predictions about what will happen in the future. 

This theory can also be applied to the ability to forecast trends in your healthcare facility. "Neural Networks are a predictive technique that can recognize and learn patterns in data."

Advanced analytics will provide better coordination of care, customer service, and operations.

Tip #17: Boost Patient Flow With Offsite Notifications 

To keep patients, caregivers, and providers healthy and safe, healthcare organizations must improve patient flow management.

Q-Notify is an SMS patient notification system that sends important updates to patients and caregivers during outpatient medical visits and procedures.

Instead of sitting in a crowded lobby, Q-Notify allows patients to wait for their appointment safely offsite.

The Joint Commission Standards for Accredited Hospitals

The Joint Commission addresses patient flow in a standard all Joint Commission-accredited hospitals must comply with. The new patient flow standard requires hospitals to:

• Create a process that supports the flow of patients through the hospital.
• Address the hospital's need to plan and care for the admitted patients whose bed is not ready or unavailable.
• Address the need for the hospital to plan the care for patients who are placed in an overflow location.
• Formalize how ambulance diversion decisions are made and implemented.
• Requires the hospital to measure and set goals. 
• Manage patient “boarding” and work to reduce the length of time that ED patients are boarded.
• Review the measurement results against the stated goals.
• Take action to improve patient flow when goals are not achieved.
• Communicate with behavioral health providers to strengthen the coordination of care.

Conclusion

Today the healthcare environment notices that enhanced and efficient patient flow is critical in achieving value-based health. Optimizing patient flow is essential for healthcare facilities for two main reasons - patient safety and quality of care. Improving your patient flow is also a way to increase revenue and patient satisfaction.

With technology, hospital leaders can generate the statistics administrators desire in real-time. CHT can improve your healthcare facility's cost, productivity, and inspection success with their many medical gas services.

Medical gas testing, software, and inspection will provide you with a safe, cost-efficient hospital. 

CHT offers medical gas services to help you reach your compliance goals. To help you navigate through these challenges, we offer a free 30-minute discovery call.