Prolonged wait times are associated with increased morbidity and mortality, as well as decreased patient satisfaction.
Eliminating roadblocks from care can improve access and lead to better patient outcomes.
The American Hospital Association defines patient flow as “delivering the right care, in the right place, at the right time.” This efficient and safe flow of patient care, from admission to discharge, requires a high degree of coordination and for many processes to merge seamlessly.
Unfortunately, an Emergency Department (ED) patient’s journey is often fraught with challenges: availability of resources and bottlenecks caused by delays in testing, the execution of physician orders, waiting to be transferred to the intensive care unit, or waiting to be discharged. Each problem can start a cascade of issues.
For example, if patients aren’t being discharged in a timely manner, then ICU patients waiting in the ED for an ICU bed can’t be transferred to the unit. The result: critical patients must stay in the ED waiting for an inpatient bed. As these wait times become longer, which is contributing to the current nation-wide boarding issue, staffing becomes more difficult, and everyone’s quality of life deteriorates – staff, patients, and their families.
Poor patient flow is directly linked to adverse effects on patient safety and health outcomes. Crowded EDs, ICUs, and other hospital units have been linked to higher mortality and readmission rates. One study found that patients held in the ED until inpatient beds are available have higher rates of morbidity and mortality.
Fixing Flow and Delivering Results
Correcting patient flow problems is typically a systemwide challenge. Even though roadblocks might be visible at only one or two points, they are usually the result of interconnected and multifaceted series of issues. It is not very often that a single solution will be a magic bullet. However, by using a data-driven process improvement approach, organizations have been able to move their patient outcome metrics in the right direction.
Carefully selected technology solutions can be a very effective part of an action plan.
Introducing a Hybrid Model of Care
Baptist Health South Florida needed a different technology approach to alleviate crowding in its ED and improve flow. In 2016, it adopted a hybrid care model that uses a remote provider for teletriage during busy times. Innovative for its day, the move paved the way for hybrid care models we see today, not only in the ED but throughout the care continuum.
Hybrid care models, which use virtual consults alongside in-person care, are changing the way organizations think about patient flow. Hybrid care models enable health care organizations to add resources when and where they’re needed to provide the right care, at the right time, in the right place.
For example, if an ED is unexpectedly full, remote providers can see lower-acuity patients, order needed testing and diagnostics, and in some cases, discharge patients. This frees up on-site providers to handle high-acuity patients and admit others to inpatient beds, reducing patient wait times, boarding, and LWBS.
Hybrid care can also be used to add specialty consults such as behavioral health to the team. Because of the nationwide shortage of mental health resources, behavioral health patients are often boarded in the ED until they can be evaluated, using valuable ED beds and increasing wait times for other patients. Adding Telepsych consults can greatly reduce boarding.
Patient flow data should be carefully monitored, with process improvements introduced as needed. In the past few years, technology has advanced to make both monitoring and finding solutions easier than ever before. By implementing the right solutions in the right situations, organizations — and patients — can reap the benefits of smoother patient flow throughout the continuum of care.
d2i has solutions that can analyze every step of your ED and inpatient workflow to identify bottlenecks, the underlying causes, and real solutions that improve patient flow and outcomes. Contact d2i for more information or to request a demo.