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Patient logistic system

Patient Access Weekly Advisor, January 23, 2008

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People often point to long wait times in the ED as the source of bottlenecks in the patient access process. The problems do not always originate at the beginning of a hospital visit-however; instead, the discharge is often to blame.

Lehigh Valley Hospital in Allentown, PA, was experiencing what Terry Capuano, RN, MSN, MBA, senior vice president of clinical services, calls "humble" admissions growth of 1%-2% in the early part of the decade.

"We were constrained by our capacity," she says. "We had diversions in the [ED], holds in the [operating room], and we were turning away referral patients from other hospitals. Everything was bulging with demand."

Before Lehigh Valley examined and revised its discharge process, volunteers or staff members from the unit were transporting patients. However, patients were often ready to go for a long time before someone came for them, Capuano says. This process is now a thing of the past. As a result of Lehigh's initial projects, the organization created a patient logistics system.

A transporter is now called, so no one from the unit has to leave the floor to escort a patient. When that person reaches the patient's room, he or she dials a number that goes directly to a bed-board system, which logs in an empty bed and automatically generates a call to a cleaning SWAT team whose sole job is to clean beds for the next patient.

The SWAT team members dial the number when they arrive at a room, and again when they leave. The time it takes to clean various types of beds is monitored and compared to benchmarks.

When the bed is clean, staff members note it in the bed management system. Anyone in the organization can access that system-from the ED to the OR to units. "There was this myth that people were hiding beds. I don't know how true it was, but even if it was, they can't do it anymore," says Capuano.

The time to prepare a bed for a new patient has been reduced from 210 to 60 minutes, and that figure has held steady for two years.

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