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Streamlining patient placement at a large academic medical center

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Capacity management improvements in bed assignment and workflow

A large non-profit academic medical center and Level 1 trauma center in the northeast asked Philips to help improve daily patient placement. High patient volume was taxing existing bed control management, with bed assignments being handled in an inefficient, decentralized fashion. Philips assigned a seasoned consultant as executive interim leader to lead an engagement which included in-depth analysis of existing procedures and application of industry best practices.

As the engagement concluded, the consultant together with hospital stakeholders agreed to a new set of key performance indicators (KPIs) and the medical center worked to put into place new procedures and processes to realize capacity improvement. The identification of potential discharges aided in the appropriate prioritization of beds, adding significantly to bed availability.

As a result of the engagement, the medical center was able to:

A three-pronged focus on process improvement

The consultant partnered with hospital leadership to explore strategies to improve organizational flow and bring all involved stakeholders to the table – nurses, clinicians, and physicians. Workflow analysis, on-site observations, and stakeholder interviews were conducted with the intent to redesign roles and responsibilities, create new processes, and develop new implementation tools.

Defined as improvements in People, Process, and Technology, the engagement took a three-pronged approach. A summary of initiatives is as follows:

People

Created standard work aligned with roles and responsibilities
Increased placement collaboration with admitting
Introduced clinical milestones to capture potential discharges
Built RN staffing model for integrated campus assignments
Designed RN staffing model that shares bed assignment role

Process

Launched bed huddles
Organized daily prioritization throughput goals
Developed transparent process for bed availability and assignments
Implemented 24-hour follow up on transfers to the medical center

Technology

Deployed ED track board in bed control
Designed PACU and OR electronic schedule view
Increased productivity by doubling workstation monitors
Setup recorded line for expect calls
Upgraded cell phones for utilization with bed control and expect lines
Supported EPIC upgrade

People

The Philips consultant initiated three daily staff huddles to make certain everyone involved was ‘on the same page’ – to reduce variability. Close, ongoing collaboration between staff, with active involvement in admissions, discharges and transfers, now supports productivity goal accountability for each unit.

Process

Lacking a formal hand-off process during shift changes or for report sharing, the consultant developed a comprehensive chronological workflow for bed control – a day in the life – to detail all the substantive touchpoints required over the course of 24 hours. Using this document as a guide, more concise tools were developed to improve certain elements in the process.

Technology

Working closely with the medical center team, the Philips consultant developed a Capacity Management Dashboard – a real-time visualization of bed placement activities across the organization. This data rich environment provides previously unseen insight to the daily ‘churn’ and assists with adherence to the organizations KPIs.

New KPIs critical to success

The medical center’s internal IT team is planning to build a set of reporting tools to track performance against new KPIs as defined by the Philips consultant and hospital stakeholders.

Bed Control and Admitting

Bed request to bed assigned
ICU downgrade and upgrade turnaround time
Diversion for MICU, MedFlight, and transports to a children’s hospital
Discharges by time of day and specialty

Nursing Units and Procedural Areas

ED and PACU boarding hours
Clinical milestones versus actual discharges
Patient transfer order written to transfer completed
Daily ICU transfers completed

Environmental Services (EVS) and Transportation

Total turnaround time in minutes: request to completion
Time of request to time assigned
Time assigned to time initiated
Transports within 30 minutes
EVS cleaning within 60 minutes

Results^*

Successes gained during the consulting engagement triggered organizational capacity management momentum and heighted awareness for efficient throughput. This is a strong foundation to build future capacity management initiatives. The medical center is now pushing forward to fully staff and implement all recommendations including assignment of a nurse leader to oversee capacity management operations.

As a result of the engagement, the medical center was able to:

^*Results are specific to the institution where they were obtained and may not reflect the results achievable at other institutions.

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Meet our team

Peggy Clifton, RN, MSHA, BSN

Senior Consulting Manager

Peggy brings over 30 years of nursing leadership and consulting experience. A solutions-oriented and results-driven professional, she has managed end-to-end engagements with healthcare clients to introduce a variety of process improvements, systems optimization, workflow standardization, and other performance enhancements. She has implemented key initiatives impacting patient throughput, workflow efficiencies, and capacity management for large healthcare systems.

Related practice area

Performance Improvement

A collaborative approach to improving operational efficiency for increased patient satisfaction in a hospital department or across an enterprise.

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