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Abstract
Background Rapid growth in patient volumes led to operating above 85% capacity with increased frequency. This growth strained antiquated patient flow processes that had not matured as patient demand increased. With limited options to increase physical capacity, a centralized effort to optimize patient throughput was prioritized at both the macro – and the microsystem level.
Objectives Getting the patient to the right place, at the right time, meant instituting a measurement system and standardizing bed management practices across the organization. Targeting delays in patient progression led to defining hospital boarding time as the time when a patient meets medical criteria to transfer to another level of care to the time the patient is transferred.
Methods Multiple plan-do-study-act cycles were completed during a pilot. An Xbar-S statistical process control chart assessed the impact of key interventions over time with a primary goal to reduce process variation to improve flow. Key interventions focused on process re-design, standardization of operational definitions, mistake proofing, and education for sustainability.
Results Pilot results showed decreased process variation by 10% and reduced median boarding times by five minutes (statistically significant; p=0.0003), increasing capacity by over 1100 hours. Based on proof of concept, hospital boarding time became an organizational priority. Results showed median boarding time decreased from 140 min to 71 min (49%) and standard deviation decreased from 107 min to 70 min (35%) over a 7 month period.
Conclusions Achieving efficient patient throughput is a complex process that impacts organizational operations. Establishing a measurement system allows for building upon a foundation for continuous improvement.
Xbar-S chart of hospital boarding time by intervention (2016–2018)
