Small changes can improve patient flow

Nurse Leader Insider, March 9, 2007

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A recent survey conducted by the American College of Emergency Physicians (ACEP) and software company TeleTracking shows that 65% of respondents surveyed believe that patient flow is an extremely serious problem in their hospitals.

Nearly half (49%) rank patient flow as a "top three" management concern.

These results confirm what hospital officials have suspected for some time-patient flow has become a priority for upper management, which means hospital staff-including nurse managers-should expect to see changes on their units and throughout the hospital that are intended to improve flow.

Patient flow is a hospitalwide concern, and not just endemic to the emergency department (ED), says ACEP President Brian Keaton, MD, FACEP.

"We have to look at potential solutions, and there are only a few," says Keaton. "One is to have more doctors and nurses and beds, but that's not economically feasible. The second is to move people faster, and we are working on that. The third is to build more capacity."

He describes several pain points in moving patients efficiently through the hospital. "There's one line at the ambulance bay. These are patients who generally need immediate care," Keaton says. "There's a second line at the triage desk, and some of them are very sick, too. But they aren't causing a backup. They are spending their time in the waiting room. The problem is sick people who come in through the ED but can't be moved to the rest of the hospital."

Consider methods to improve flow

To ease ED bottlenecks, hospitals should reinvent how they board patients, Keaton says. By spreading the responsibility for boarded patients throughout the hospital, the ED can deliver emergency care faster to patients who need it.

"Twenty floors with one extra patient each is probably a lot safer than an ED with 20 extra people," says Keaton.

Another tactic is for units to designate discharge beds or a discharge room. The space is used for patients who no longer need medical attention, but have not yet been discharged. Using dedicated space for these patients frees up hospital rooms and medical devices for patients who need them.

Discharge rooms offer advantages for those patients awaiting discharge as well. For example, they can wait in a more attractive room that is free of noisy monitoring systems.

Source: Briefings on Patient Safety, HCPro, Inc., March 2007.

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