Patient Flow: a view from across the pond

Q | How is patient flow affecting UK Healthcare?

A | Improving patient flow is the blockbuster process for hospital efficiency; by ensuring that patients move throughout a healthcare environment in the most efficient and effective manner possible, we can reduce delays and make sure patients receive the right care at the right time.

We have come to know well that poor patient flow management is related to a series of problems that typically plague modern hospitals such as: short supplies; long queues and delays, bottlenecks; waste of resources; long length of stays and delayed discharges; low levels of productivity; inappropriateness of clinical settings; and workload variability.

Our success at optimizing patient flow has been limited and it is now critical for the NHS to start looking at this problem through a new lens, and perhaps take guidance from other countries that have successfully tackled it, such as the USA.

Q | What is a good starting place for restructuring patient flow logistics around patient care needs?

A | During their clinical journey, patients pass through various settings of care and structures such as outpatient clinics, emergency departments, operating theatres, wards, intensive care units, post-acute care settings and so on. This quite complicated network of patient flows is often not controlled, with serious negative effects on an organisation’s performance.

With so many areas in distress, it often makes it difficult to know where to start. However, if we examine the progress made by many healthcare organisations in the US, we see that there is a single truth that is adhered to in order to achieve optimal patient flow—right bed, first time, every time. This patient-centric approach may seem simple in its message but at its very core, its purpose is to efficiently and safely enable the clinical encounter between caregivers and patients.

Many hospitals, including the Carilion Clinic, in Virginia, USA, have achieved this by implementing a centralised patient placement model, delivered through a central coordination centre, and underpinned by an IT operations platform. This model represents a more integrated, sophisticated approach to patient flow, moving away from simpler siloed components, such as bed management, case management, transport, and staff assignment. It enables an organisation to efficiently place patients into the right bed from a single operational hub, and provides staff with a single version of the truth about operational status in real-time. The team at the Carilion Clinic, for example, can analyze patient flow, use predictive models to anticipate downstream demand, monitor pathways, track resources and patients, and adjust resources in real-time to accommodate changing circumstances, ultimately delivering a patient-centric service.

Q | What outcomes will the NHS see if they take action to improve patient flow?

A | Patient flow, coordinated through a centralized patient placement center and underpinned by operations management technology, is a well adopted model in the US and has seen benefits in several key areas:

• Optimizes available capacity by allowing real-time visibility of all patients coming into the organisation and those that are already in the system
• Minimizes Length of Stay (LOS) by impacting all operational processes that drive flow, including:

• Placing patients in the correct clinical care location from the time of admittance
• Coordinating porters to enable priority-driven and timely movement of patients
• Streamlining delivery of interventions, both in the Operating Theatres and Radiology
• Efficient and appropriate bed cleaning, thus reducing the bed turn time
• A coordinated discharge process, allowing for:
  • Reduced A&E and PACU hold times through visibility of available and appropriate beds
  • Reduced Left Without Being Seen (LWBS) incidences through coordinated care delivery driven by transparency and accountability
  • Reduced wait times in all areas, including Outpatients, by streamlining the operational processes that drive clinical care
• Improves patient experience by helping the organization deliver efficient, patient-centered care
• Increases staff satisfaction through optimized workflows which give them back the time they need to spend caring for patients
• Reduces harm by reducing patient moves and enabling transparent sharing of data
• Financial savings through “doing more with less”, especially in terms of staffing productivity and improved utilization of assets.

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Dr. Julia Fishman is the Vice President Clinical Operations at TeleTracking.  Dr. Fishman works with hospital clinicians to design the best possible care delivery systems for their needs, using real-time data provided by TeleTracking’s patient flow solutions to make operational improvements.

A former senior specialist in pediatric surgery in a leading London Trust, Dr. Fishman has 10 years of experience with hospital transformation focused on getting people to the right place at the right time so clinicians can deliver the right care. Her strong belief that clinical processes can be better orchestrated has helped many U.K. hospitals manage patient flow, reduce waiting times and provide better, more efficient care. 

Dr. Fishman shares her thoughts on how UK healthcare providers are looking at successful patient flow strategies already in place in the United States, and working to make sure their patients are getting the right care in the right place at the right time.