Understanding the ins and outs of patient flow
Improving patient flow in a hospital is a broad and complex challenge. Executive Director Improvement Rebecca Power shares what we’ve learned through our work together so far.
Patient flow is the movement of patients through a hospital – from admission to discharge. Addressing the cause of bottlenecks in patient flow and matching resources to each patient helps make sure they get the right care, at the right time and in the right place. No part of a hospital operates in isolation and delays are often due to blockages elsewhere along the patient journey.
With so many patients moving through our health system every day, you can start to see how complex and difficult this challenge is.
But through our previous (pre-pandemic) work, we know there are ways to test small ideas in contained areas of the health system.
In 2017–18, we worked with 15 Victorian health services (including nine regional services) through our Patient flow collaborative – with each project team identifying one area of patient flow to test a solution and measure its impact. With some great results.
- Northern Health implemented an ambulance offload strategy to help maximise the time ambulances spend on the road. This resulted in offload times decreasing by an average of 5.6 minutes, giving back 2,570 ambulance hours.
- St Vincent’s Melbourne created a rapid assessment team, with a senior ED consultation and nurse staffing ‘virtual cubicles’ for early assessment and treatment. This resulted in 40 per cent improvement in the average time to treat – from 35 minutes to 21 minutes.
- Northeast Health Wangaratta introduced ‘Countdown to discharge’ to encourage planning for patient discharge from the day they are admitted. They used an innovative process that allowed all multidisciplinary care team members to track a patient’s journey through the hospital. This resulted in 30 per cent of patients being discharged before 10 am, and average length of stay in a sub-acute ward was reduced by two days.
- Peninsula Health developed ‘Green Light’, a simple checklist which enabled acute teams to identify patients suitable for transfer to the sub-acute ward without geriatrician review. This reduced acute length of stay by more than 2.5 days for transfers using the checklist.
Overall, the collaborative led to 26,900 more people having a shorter stay in the emergency department (under 4 hours). And 17,578 more ambulance transfers were made within the target timeframe.
At the other end of the patient journey, our Specialist clinics access improvement partnership targeted system constraints and gaps impacting on timely access to specialist (outpatient) clinics.
In 2017, we partnered with 11 health services and all improved their performance:
- five services improved the percentage of urgent patients seen within 30 days
- three services improved the percentage of routine patients seen within 365 days
- three services reduced ‘did not attend’ appointments
- four services improved their new to review ratio.
With the significant disruption of the pandemic, we know our hospitals have been placed under even greater pressure which impacted patient flow – especially with new COVID-19 screening processes on admission and the creation of COVID wards.
So it was definitely time to take up our work in this area again and apply what we’ve learned – how we can help identify where the problem is, and what works and what doesn’t.
Starting our Timely Care initiative last year, we have six health services who will be testing local solutions to patient flow through a fast-tracked initiative.
I look forward to sharing their results in a few months’ time.
Rebecca Power is our Executive Director Improvement.