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Determine realistic patient throughput solutions

Patient Access Weekly Advisor, December 5, 2007

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Poor patient throughput is common in hospitals nationwide. EDs are overcrowded, beds are scarce, space is limited, and quality of care and customer service ratings are down significantly.

Susan Werthem, RN, consulting manager for revenue management at IMA Consulting in Chadds Ford, PA, who spoke during the NAHAM Annual Conference in May, offers some new best-practice approaches, such as admissions units, that can help you relieve the gridlock.

The first step is to measure key performance indicators (KPI) to determine the severity of the problem within your organization. Werthem suggested that you take a close look at the following areas:

• The hours that your facility is on diversion. Examine diversion by hour of day and day of week. "See if you can find a trend," Werthem said. Then calculate the ramifications of that trend.
• Admissions. Measure ED and direct admissions by time of day and day of week. "You're looking for trends that might suggest patients are waiting and beds aren't available because the discharges aren't out on time," Werthem said. If that's the case, work to communicate the discharge time expectation to patients and the physicians right from the start.
• Average length of stay (LOS) for general acute care. You'll want to know whether patients of a particular physician have a longer LOS than other physicians' patients. If you know that, you can target particular problems with staff members.
• Noon occupancy. Compare your noon census with your midnight census. "That might help identify a discharge problem," Werthem said.
• Wait times for inpatient beds. This tracks the performance of patient access and illustrates how many patients you are boarding. "Ask yourself if you're utilizing precious inpatient beds for lower reimbursement outpatient services," said Werthem.
• Wait times from registration to ED bed. "Frequently the registration is viewed as the bottleneck," Werthem said. "Obtain the data to identify registration opportunities for improvement or to dispel the myth."
• Average discharge time. It's ideal for your discharge time to average close to 11 a.m. to keep with a healthy discharge flow.

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