Managing Hospital Capacity and Improving Patient Flow

1
Managing Hospital Capacity and Improving Patient
Flow
Findings from a HAP Member Survey May 2008
(updated)
2
Distribution of Respondents by Primary Role
Within the Hospital
Source HAP survey of Pennsylvania Acute Care
Hospitals, April 2008
3
Reporting Relationship for Patient Flow/Capacity
Management Coordinators
reporting to
Source HAP survey of Pennsylvania Acute Care
Hospitals, April 2008
4
What is the main root cause of hospital patient
flow problems in your facility?
Source HAP surveys of Pennsylvania Acute Care
Hospitals, May 2006 and April 2008
5
From your perspective, what is the main root
cause of hospital patient flow problems in your
facility?
Source HAP survey of Pennsylvania Acute Care
Hospitals, April 2008
6
From your perspective, what is the main root
cause of hospital patient flow problems in your
facility?
C-Suite (CEO in 2006)
Emergency Services
Source HAP surveys of Pennsylvania Acute Care
Hospitals, May 2006 and April 2008
7
Other Causes of Patient Flow Problems

• Inadequate space in the ED
• Increased length of stay
• Telemetry Availability
• Physical Layout
• Capacity Management (9 respondents)
• Census Driven
• Physician Admission/Discharge Practices/Processes
• Multifactorial

Source HAP survey of Pennsylvania Acute Care
Hospitals, April 2008
8
Indicate the degree to which the following are
impediments to timely and appropriate discharge
of patients to post-acute settings
rating factor as Problematic or Very
Problematic
NOTE No comparison available from 2006. Source
HAP survey of Pennsylvania Acute Care Hospitals,
April 2008
9
Are insurance precertification requirements an
impediment to timely and appropriate discharge of
patients to post-acute settings?
rating factor as Problematic or Very
Problematic
NOTE No comparison available from 2006. Source
HAP survey of Pennsylvania Acute Care Hospitals,
April 2008
10
Is patient clinical complexity an impediment to
timely and appropriate discharge of patients to
post-acute settings?
rating factor as Problematic or Very
Problematic
NOTE No comparison available from 2006. Source
HAP survey of Pennsylvania Acute Care Hospitals,
April 2008
11
Is post-acute capacity for long-term care
(skilled nursing) an impediment to timely and
appropriate discharge of patients to post-acute
settings?
rating factor as Problematic or Very
Problematic
NOTE No comparison available from 2006. Source
HAP survey of Pennsylvania Acute Care Hospitals,
April 2008
12
Is post-acute capacity for home health an
impediment to timely and appropriate discharge of
patients to post-acute settings?
rating factor as Problematic or Very
Problematic
NOTE No comparison available from 2006. Source
HAP survey of Pennsylvania Acute Care Hospitals,
April 2008
13
Is post-acute capacity for long-term acute care
(LTAC) an impediment to timely and appropriate
discharge of patients to post-acute settings?
rating factor as Problematic or Very
Problematic
NOTE No comparison available from 2006. Source
HAP survey of Pennsylvania Acute Care Hospitals,
April 2008
14
Is post-acute capacity for inpatient rehab an
impediment to timely and appropriate discharge of
patients to post-acute settings?
rating factor as Problematic or Very
Problematic
NOTE No comparison available from 2006. Source
HAP survey of Pennsylvania Acute Care Hospitals,
April 2008
15
Other Problematice/Very Problematic Obstacles
to Timely and Appropriate Discharge

• Family availability Patient/Family support
  Waiting for family to pick up absent family
  Family Compliance Family/patient decision
  making Delays in discharge related to family
  availability to pick up patients Patient/ Family
  acceptance of discharge plan
• Ambulance service to LTC Transportation to
  facility Transportation Ride
• Late discharges Discharge Times Physician
  Rounding Practices length of time for physician
  to discharge patients Lack of physician timely
  discharge Physician writing discharge orders
  Physician reimbursement and misaligned incentives
  between hospital and physician.
• Inpatient psych Psych facility homeless
  alcohol/drug abuse Psych State Hospital
  Behavioral Health
• Transfer due to tertiary care needs Tertiary
  Care beds for transfer
• Community Inpatient-based hospice care

Source HAP survey of Pennsylvania Acute Care
Hospitals, April 2008
16
Is the issue of improving patient flow important
to others in your hospital?
Source HAP surveys of Pennsylvania Acute Care
Hospitals, May 2006 and April 2008
17
Is the issue of improving patient flow important
to others in your hospital?
C-Suite Perspective
Source HAP surveys of Pennsylvania Acute Care
Hospitals, May 2006 and April 2008
18
Is the issue of improving patient flow important
to others in your hospital?
Emergency Services Perspective
Source HAP surveys of Pennsylvania Acute Care
Hospitals, May 2006 and April 2008
19
Is the issue of improving patient flow important
to others in your hospital?
Surgical Services Perspective
NOTE No comparison available from 2006. Source
HAP survey of Pennsylvania Acute Care Hospitals,
April 2008
20
Is the issue of improving patient flow important
to others in your hospital?
Patient Flow Coordinator Perspective
NOTE No comparison available from 2006. Source
HAP survey of Pennsylvania Acute Care Hospitals,
April 2008
21
Does your hospital routinely collect and analyze
ED data on . . .?
responding "Yes"
Source HAP surveys of Pennsylvania Acute Care
Hospitals, May 2006 and April 2008
22
Other ED Data Collection

• Transfers to other facilities (4 respondents)
• Nurse acuity weighted mean
• Time in capacity zonesred, yellow, green per
  month
• Time to obtain a bed from admissions
• HPPV
• Returns and admission
• Lab/x-ray, tat's for ED patients
• Cause of diversion, fast track, MD satisfaction
• Returns within 72 hours
• Time to bed assignment, report, admission
• Patients in hallway beds
• Admissions/observations
• Hours of inpatient boarding
• Orders written

Source HAP survey of Pennsylvania Acute Care
Hospitals, April 2008
23
Does your hospital routinely collect and analyze
inpatient data on . . .?
responding "Yes"
Source HAP surveys of Pennsylvania Acute Care
Hospitals, May 2006 and April 2008
24
Other Inpatient Data Collection

• MD satisfaction
• Code Flow Hours
• From MD discharge order to time patient vacates
  bed discharged by noon (3 respondents)

Source HAP survey of Pennsylvania Acute Care
Hospitals, February 2008
25
Have you established a patient flow or bed
management coordinator or department in your
facility within the last 2 years?
By PA Region
Statewide 68.3
NOTE No comparison available from 2006. Source
HAP survey of Pennsylvania Acute Care Hospitals,
April 2008
26
Have you established a patient flow or bed
management coordinator or department in your
facility within the last 2 years?
By Bed Size
Statewide 68.3
NOTE No comparison available from 2006. Source
HAP survey of Pennsylvania Acute Care Hospitals,
April 2008
27
Has your hospital adopted a "no divert policy?
Source HAP surveys of Pennsylvania Acute Care
Hospitals, May 2006 and April 2008
28
Strategies Most Often Employed by Hospitals to
Manage Capacity and Improve Patient Flow
Successful Overall percentage () represents
combined scores for Successful and Very
Successful ratings.
Source HAP survey of Pennsylvania Acute Care
Hospitals, April 2008
29
Strategies Least Often Employed by Hospitals to
Manage Capacity and Improve Patient Flow
Successful Overall percentage () represents
combined scores for Successful and Very
Successful ratings.
Source HAP survey of Pennsylvania Acute Care
Hospitals, April 2008
30
Other Strategies Employed

• Dedicated ED patient transporter
• Geisinger Quality Institute (GQI)
• Physician Assistant employed in the ED

Source HAP survey of Pennsylvania Acute Care
Hospitals, April 2008
31
Most Successful Strategies Employed by Hospitals
to Manage Capacity and Improve Patient Flow
Successful Overall percentage () represents
combined scores for Successful and Very
Successful ratings.
Source HAP survey of Pennsylvania Acute Care
Hospitals, April 2008
32
Least Successful Strategies Employed by Hospitals
to Manage Capacity and Improve Patient Flow
Successful Overall percentage () represents
combined scores for Successful and Very
Successful ratings.
Source HAP survey of Pennsylvania Acute Care
Hospitals, April 2008
33
My hospital has used or is using this resource to
manage capacity and improve patient flow.
responding "Yes"
Source HAP surveys of Pennsylvania Acute Care
Hospitals, May 2006 and April 2008
34
Other Resources Used

• Corporate ED Consultant
• Navicare Technology
• Eugene Litvak
• FMEA on patient flow
• ENA overcrowding work project
• Premier, DOH
• VHA
• HAP
• HMI
• University Health Consortium

Source HAP survey of Pennsylvania Acute Care
Hospitals, April 2008
35
Rate the following resources in terms of value,
that you have used or are using to manage
capacity and improve patient flow.
rating resource as Valuable and Most
Valuable combined
Source HAP surveys of Pennsylvania Acute Care
Hospitals, May 2006 and April 2008
36
Would you be willing to share your successes on
managing capacity and improving patient flow with
others?
44 hospitals
100 hospitals
22 hospitals
Source HAP survey of Pennsylvania Acute Care
Hospitals, April 2008
37
Distribution of Survey Responses
Source HAP survey of Pennsylvania Acute Care
Hospitals, April 2008