Putting each and every patient in the right hospital unit improves efficiency and quality outcomes, which in turn reduces costs and raises earnings.
That sounds obvious. Still, all too many patients end up in the wrong place. Patients wait in corridors and emergency departments for an inpatient bed. Outpatients held for observation wait in units designated for inpatients. Other outpatients take up beds in hospital surgical suites while inpatients wait and wait.
Why? Because hospitals have allowed inefficiency and low productivity to create crowding, which in turn affects where and when patients go.
It becomes a vicious circle: Patients in the wrong places cause confusion among staff members, which slows the flow of work and raises the risk of errors, while more and more patients flow into the wrong beds.
Careful, though. Don't jump to the conclusion that more beds will solve the problem. More beds may in fact make the problem worse, especially if hospital policies and processes do not specifically discourage misplacing patients.
Here are eight guidelines for providing more patient beds in the right places without hammering a single nail.
1. Direct Low-Acuity Patients Away from the ED
Emergency Departments (EDs) treat too many low-acuity patients. While the ED must evaluate all patients for life-threatening emergencies, it is possible to redirect low-acuity patients through education and high fees. A policy requiring admitting nurses and physicians to educate low-acuity patients about the system would re-direct a number of these patients. Counseling could explain that ED physicians must help critically injured or ill patients as soon as possible and that visiting the ED when it isn't necessary can take up life-saving time. Patients with no primary care physicians can be referred to nearby urgent care centers. The ED should be sure to set fees for low-acuity complaints well above urgent care fees. While it may not seem that education works, it does. Some patients do take the message to heart. More will do so with repeated counseling.
2. Send Outpatients to Ambulatory Care Facilities
Some outpatient procedures can be performed more efficiently and at lower costs in ambulatory care centers. A policy requiring physicians to recommend ambulatory care centers to patients when appropriate would help to free up hospital space for patients who need it.
3. Move Admitted Patients out of the ED Right Away
Admitting patients from the ED can go faster by setting a policy that moves patients from the ED to the appropriate inpatient unit as soon as the work-up is done. But what if the inpatient unit has no beds? Implementing policies often involves cleaning up inefficient processes. In some instances, there are plenty of vacant rooms with beds that have not been prepared for incoming patients. To implement the new policy, the process for preparing beds will have to speed up.
4. Corridors are Never the Right Place for Patients
Many EDs and other hospital units often place patients in hallway beds. This is never acceptable. It is too easy to confuse the patients and their needs and too difficult to take care of them should an emergency arise. Educational policies that reduce the numbers of low-acuity patients in the ED can help reduce reliance on corridor space. Sending more outpatients to ambulatory care can help. Speeding up triage can improve the patient flow process and the movement of patients from the ED to inpatient beds.
5. Don't Mix Inpatients and Outpatients Being Held for Observation
Mixing inpatients with outpatients held for observation can create confusion. The treatment and the recordkeeping differ for each kind of patient, but a nurse with one outpatient and four regularly admitted patients may fall into treating them all the same.
Research shows that larger hospitals may hold as many as 20 outpatients for observation every day. In such cases, these patients will receive better, more consistent treatment if they are in a separate unit. In hospitals where the ED physicians manage patients under observation, the separate unit must be located near the ED.
By contrast, small hospitals may only hold two or three patients per day for observation, making a separate unit impractical. For these hospitals, a separate section within an inpatient unit or ED will suffice.
6. Move Inpatients to Less Intensive Care Beds As Soon As Possible
Everyone knows that keeping patients in Intensive Care Units (ICUs) and Progressive Care Units longer than necessary runs up costs. It is often difficult to move patients into a less acute status within these units due to how they are staffed.
An example of placing a patient in an Intensive Care Unit for less than a critical need would be placing the patient there for the heart monitors when a central monitoring system would alleviate the problem.
7. Plan to Maintain Service Line Integrity During Surges
Hospitals typically maintain service lines in specific areas so that all the orthopedic patients are together, all the cardiac patients are together, and so on. When an accident causes a surge in the orthopedic unit or a hot day produces a sudden influx of cardiac patients, it can overwhelm the integrity of the service lines. Orthopedic or cardiac patients may end up strewn throughout the inpatient floors.
Thinking ahead and planning for surges can prevent this. Such planning must be done regularly because conditions change constantly. At times, one unit will have enough beds in the unit and in an adjacent unit to handle a surge. At other times both units will be full and require an alternate plan to handle possible surge patients. Bed placement meetings need to be held regularly during a surge.
8. Set Discharge for Elective Surgery Patients Before Admission
Suppose an elderly woman has no family support nearby. If she goes into the hospital for a cardiac procedure, she will need support upon discharge. The schedule for admissions and the procedure for discharge will have to account for that by allowing enough time for, say, the woman's son to fly in and get settled without requiring the woman to spend expensive extra days in the hospital. A patient with no family support will have to go to a rehab or nursing facility, one that has a bed available the day the patient is discharged.
Implementing policies and processes ensuring that hospital patients are in the right place at the right time can solve many problems that appear to require architectural solutions. It is important to implement efficient policies and processes before considering architectural solutions. That's because bigger facilities, acquired at significant expense, cannot solve problems related to policies and processes.
On the other hand, policies and processes can change and solve problems free of charge.
Kristyna Culp, MBA, managing principal, FreemanWhite Catalyst, serves as the leader for Operations and Director of Process Improvement. Catalyst is the firm's consulting division specializing in strategic, operational, and master planning. can be reached at http://laboratory-manager.advanceweb.com/Users/Richard%20Heap/AppData/Users/Richard%20Heap/AppData/Local/Microsoft/Windows/Temporary%20Internet%20Files/Content.Outlook/J0URSI8Ufirstname.lastname@example.org or (704) 517-1949. Jane Stuckey, RN, BSN, MS, FACHE, can be reached at email@example.com.