The American Agency for Healthcare Resource and Quality has several statistics on patient flow, overcrowding, and missed revenue. All of them are rather upsetting. One example:
“Nearly half of EDs report operating at or above capacity, and 9 out of 10 hospitals report holding or "boarding" admitted patients in the ED while they await inpatient beds.”
The lost revenue, the poor patient satisfaction, and the many faces of inefficiency makes hospitals difficult both for patients and staff or administrators. Despite the fact proper patient flow could solve many of these problems, it can be difficult for hospitals to adapt new, more practical processes. In a recent interview with John Nosta, the keynote speaker aptly explained:
“Hospitals are battle ships. While they battle disease, they also have tremendous mass and inertia. Of course, this is driven by both the necessity for critical mass to manage both care and costs… But it's hard to turn a battle ship.”
Hospital administrators (and everyone else) may want better patient flow and practices, but that doesn’t make it any easier to enact. This leaves executives knowing what they want but a lot of mixed messages on how to get there.
Patient Flow describes not just the way patients move from one station to another in a hospital. It includes the many physical and mental factors that create a positive experience and lead to the best results for hospitals and their patients.
The goal, then, is not just to move faster and faster—patient in, patient out. It’s about creating value, which often means reducing wasted time (and resources). One important first step to optimizing this patient flow is simply understanding Queueing Theory.
Queueing Theory seeks to understand what causes waiting to occur. From there, we can extrapolate how to remove and preempt blockers. We can create that system of higher accessibility and increased quality of service.
Queuing Theory is a highly mathematical process and generally part of operations research. To see the theory in action, there’s a very good webinar over here on the topic presented by the University of Tennessee Knoxville.
When patients are hit with long wait times, the first response seems obvious: add another staff member to the mix. That should erase those wait times. However, the idea of an “average” wait time is a bit misleading. In fact, with or without a second staff member, there will still be both downtime and patients who experience little to no wait time. Then, there are times when the wait is much longer than “average”—even with added employees.
The number of patient visits can be difficult to predict and prepare for and patients can be left waiting while excess staff wastes time. While adding employees certainly can move patients along faster, it’s not a particularly scalable or efficient method.
In some scenarios, it can be easy to assign better patient flow a quantitative ROI. Fewer patients are diverted. More patients are seen without losing quality of care. Happy patients leave positive reviews, return, and refer. However, better patient flow also has a less visible ROI: happier staff.
Hospitals can be hectic. Nurses are often at the mercy of scheduling and outside forces, meaning they may end up stationed in places they aren’t comfortable with or aren’t prepared for. Even with automation and technology, it isn’t necessarily getting better. One way to give power and confidence back to staff members is through predictable patient flow. That means regularity as well as an empowered employees. Better flow means staff members are able to have a better sense of control, creating a better overall workplace. It’s clear the importance of patient flow does not stop at the number of patients admitted and dollars saved.
The goals here are several fold. One is to make each queue smaller, another is simply to decrease capital and resource requirements, and there are several smaller goals to help execs achieve this. In terms of the patient flow itself, you’ll need to cut out extra steps that waste time—and this should happen everywhere related to queues. You can also reduce arrival rates by dispersing patients to different queues.
How to achieve this and create better patient flows:
Better signage: patients get lost. Even nurses in unusual hospital wings can get turned around. Many patients still seek out smaller facilities simply to avoid adding “getting lost” to their list of things to worry about. For almost every patient, the hospital is already a stressful place. Being unable to quickly and easily maneuver the many corridors leads to a poor experience and a lot of wasted time.
Giving patients and staff the tools they need to find where they’re going ASAP is one easy step towards efficient patient flow.
Enlist real-time oversight: Rooms that may have been empty a few minutes ago are now full. The doctor that was meant to be here ten minutes ago is still on their way. Though healthcare is famous for its many moving and complicated parts, hospital services must still be delivered quickly and reliably. One way to solve this problem and remove kinks from occurring is real-time data on equipment and staff (or even patients).
This is most commonly related to Real Time Location Systems (RTLS), where standards like Bluetooth or RFID can be used to track assets. When a nurse needs quick access to a wheelchair, an RTLS can direct them quickly and reliably. On top of making patient flow smoother, it also leads to less wasted capital on expensive equipment as existing tools are now much easier to locate.
Locate bottlenecks: Are patients getting stuck at check-in? There are going to places patients end up waiting. The first step is to find them. Luckily, there are several technologies out there to help make this easier. Automated check-in through Bluetooth and apps is just one way to completely erase steps in the process. Patient and staff tracking can also help illuminate where problems are occurring.
Remove crossed paths: For both practical and visitor experience reasons, patient flows should be set up to keep everyone moving forward—not back-pedalling or constantly retracing their steps. In this case, Just-in-Time (JIT) methods are being used not only in the healthcare supply chain but also the waiting room. In inventory control, JIT means responding directly to the demand and keeping on top of the current need and issues. It’s about working to fulfil the specific present needs in the process and remove waste at every step.
In the hospital, it means knowing which doctor is where at all times, and keeping the patient flow running in a real-time optimized manner rather than the age-old methods of sitting patients in the waiting room, moving them to an empty private room, letting them stew, go back and forth, and eventually meander back to the counter.
As outlined above, there are several options available to hospital executives to manage their patient flow. No matter what route you take, there is one thing to keep in mind: Focus on one paint point.
Even before searching out a solution provider to create your Bluetooth indoor navigation system or your automated check-in, know that your solution should solve a specific problem for you and your visitors. Without this focus, even the best patient flow optimization scheme is destined to fall short.
When the time comes to start building, keep in mind that any user-facing app is meant to be just that. It’s user-facing. You drive returns by maintaining focus on the visitor experience and quality of care. This is also true for nurses and staff members. Any app or program created for them must not only support better processes, it must be practical. An overwhelming amount of bells and whistles will actually detract from a solution’s effectivity. (Just recall how a deluge of alarms led to an accidental overdose).
There are many worries holding hospitals back from investing in technology to battle inefficiencies like poor patient flow. It will be up to hospitals to find the use case that solves their problems without annoying staff or upsetting IT. However, there are many options available that are neither overly intrusive or complex. One common example is the affordable Bluetooth indoor navigation system (found in, for example, the Monthey Hospital shown above). These kinds of systems are comparatively simple, requiring only the addition of Bluetooth beacons and an app. It’s use cases like these that will drive better patient flow and also bring value to staff and the hospital as a whole.
Want to learn more on how to drive a patient-first attitude with IoT-based solutions? Contact us today!