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Manage patient throughput

Patient Access Weekly Advisor, January 23, 2008

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Poor patient throughput is common in hospitals nation-wide, large and small, rural and urban. EDs are overcrowded, beds are scarce, space is limited, and quality of care and customer service ratings are down significantly.

This affects many people and, ultimately, its greatest effect is on your patients and the organization's finances. The following are several sources of lost revenue Susan Werthem, RN, consulting manager for revenue management at IMA Consulting in Chadds Ford, PA, associated with throughput problems:

• Cancelled surgeries and other procedures
• Outpatients occupying inpatient beds for less or no reimbursement
• A discharged patient occupying a bed while waiting for tests, a meal, or a ride home
• Diminished DRG profitability due to prolonged LOS
• Loss of market share

Werthem noted two long-term solutions. You can either add more beds and staff members at increased costs, or you can manage patient throughput to increase revenues and open more of your existing beds. Before you consider proposing expansion to your administration, ask yourself:

• What kind of beds do I need?
• Can I find the nursing and technical staff we'll need?
• Will I have consistent use of new beds, or will I be able to use them only during crisis periods?

A more realistic approach is to manage throughput, process to process, said Werthem. For starters, decrease LOS through the following practices:

• Monitoring LOS by physician and DRG
• Enforcing discharge hours
• Discharging patients timely in the computer
• Ensuring timely turnaround from ancillary departments

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