Using a Diagnostic to Focus Hospital flow Improvement Strategies

Abstract

Current methods to evaluate hospital flow primarily measure micros-system issues, such as numbers of diversions from the ED, or how many patients are boarded in some way somewhere in the hospital, or specific delays in hospital units and annual admissions. The narrow focus on delays, although appropriate, generally leads to attempts at fixing a large system problem from the viewpoint of a micro-system. A newly developed hospital diagnostic that utilizes a broader view of flow can be used to evaluate how a hospital might best respond to delays, but also how to maximize the number of turns each bed generates in a year. The diagnostic utilizes easily obtainable and commonly collected hospital metrics. The diagnostic allows a hospital to categorize itself depending on the number of bed turns and the efficiency of using those beds. Based on a self-evaluation a hospital can determine which improvement strategies would be most useful, or if ongoing improvement strategies are properly focused to achieve an ultimate goal of reduced delays and increased bed turns (the goal of 90 or more adjusted turns and a bed use efficiency of around 90%). A business case for improvements can be based on increasing turns either by accommodation of more demand or by decreasing unneeded capacity. Improvements in throughput per bed allow leadership to justifiably focus resources on the appropriate change concepts. Serial measurements of the bed turns and bed utilization metric allow the organization to measure the effects of flow improvement strategies over time.

(The work presented here is from the efforts of the IHI Innovation Team.)