scholarly journals 62 Patient Flow Improvements in a Rural Critical Access Hospital Reduces the Number of Patients Who Leave Without Being Seen

2018 ◽  
Vol 72 (4) ◽  
pp. S27
Author(s):  
J. Thesing ◽  
T. McDonald ◽  
S.L. Hoehn ◽  
P.C. Allegra
Keyword(s):  
Patient Flow ◽  
Critical Access Hospital ◽  
Number Of Patients

scholarly journals Robust capacity planning for accident and emergency services

2020 ◽  
Vol 54 (6) ◽  
pp. 1757-1773
Author(s):  
Elvan Gökalp
Keyword(s):  
Capacity Planning ◽  
Emergency Services ◽  
Simulation Optimization ◽  
Patient Flow ◽  
Waiting Times ◽  
Model Parameters ◽  
Planning Problem ◽  
Accident And Emergency ◽  
Number Of Patients ◽  
The Impact

Accident and emergency departments (A&E) are the first place of contact for urgent and complex patients. These departments are subject to uncertainties due to the unplanned patient arrivals. After arrival to an A&E, patients are categorized by a triage nurse based on the urgency. The performance of an A&E is measured based on the number of patients waiting for more than a certain time to be treated. Due to the uncertainties affecting the patient flow, finding the optimum staff capacities while ensuring the performance targets is a complex problem. This paper proposes a robust-optimization based approximation for the patient waiting times in an A&E. We also develop a simulation optimization heuristic to solve this capacity planning problem. The performance of the approximation approach is then compared with that of the simulation optimization heuristic. Finally, the impact of model parameters on the performances of two approaches is investigated. The experiments show that the proposed approximation results in good enough solutions.

scholarly journals A System-Based Intervention to Improve Access to Hyperacute Stroke Care

2017 ◽  
Vol 44 (5) ◽  
pp. 475-482 ◽  
Author(s):  
Richard H. Swartz ◽  
Elizabeth Linkewich ◽  
Shelley Sharp ◽  
Jacqueline Willems ◽  
Chris Olynyk ◽  
...  
Keyword(s):  
Patient Flow ◽  
Stroke Care ◽  
Hyperacute Stroke ◽  
Greater Toronto Area ◽  
Number Of Patients ◽  
Tissue Plasminogen ◽  
Incident Reports ◽  
The Impact ◽  
Mean Time ◽  
Improve Access

AbstractBackground:Hyperacute stroke is a time-sensitive emergency for which outcomes improve with faster treatment. When stroke systems are accessed via emergency medical services (EMS), patients are routed to hyperacute stroke centres and are treated faster. But over a third of patients with strokes do not come to the hospital by EMS, and may inadvertently arrive at centres that do not provide acute stroke services. We developed and studied the impact of protocols to quickly identify and move “walk-in” patients from non-hyperacute hospitals to regional stroke centres (RSCs).Methods and Results:Protocols were developed by a multi-disciplinary and multi-institutional working group and implemented across 14 acute hospital sites within the Greater Toronto Area in December of 2012. Key metrics were recorded 18 months pre- and post-implementation. The teams regularly reviewed incident reports of protocol non-adherence and patient flow data. Transports increased by 80% from 103 to 185. The number of patients receiving tissue plasminogen activator (tPA) increased by 68% from 34 to 57. Total EMS transport time decreased 17 minutes (mean time of 54.46 to 37.86 minutes,p<0.0001). Calls responded to within 9 minutes increased from 34 to 59%.Conclusions:A systems-based approach that included a multi-organizational collaboration and consensus-based protocols to move patients from non-hyperacute hospitals to RSCs resulted in more patients receiving hyperacute stroke interventions and improvements in EMS response and transport times. As hyperacute stroke care becomes more centralized and endovascular therapy becomes more broadly implemented, the protocols developed here can be employed by other regions organizing patient flow across systems of stroke care.

scholarly journals Description of the effect of patient flow, junior doctor supervision and pandemic preparation on the ability of emergency physicians to provide direct patient care

2020 ◽  
Vol 44 (5) ◽  
pp. 741
Author(s):  
Andy Lim ◽  
Namankit Gupta ◽  
Alvin Lim ◽  
Wei Hong ◽  
Katie Walker
Keyword(s):  
Pilot Study ◽  
Patient Care ◽  
Patient Flow ◽  
High Volume ◽  
Direct Patient Care ◽  
Published Data ◽  
Emergency Physicians ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Process Factors

ObjectiveA pilot study to: (1) describe the ability of emergency physicians to provide primary consults at an Australian, major metropolitan, adult emergency department (ED) during the COVID-19 pandemic when compared with historical performance; and (2) to identify the effect of system and process factors on productivity. MethodsA retrospective cross-sectional description of shifts worked between 1 and 29 February 2020, while physicians were carrying out their usual supervision, flow and problem-solving duties, as well as undertaking additional COVID-19 preparation, was documented. Effect of supervisory load, years of Australian registration and departmental flow factors were evaluated. Descriptive statistical methods were used and regression analyses were performed. ResultsA total of 188 shifts were analysed. Productivity was 4.07 patients per 9.5-h shift (95% CI 3.56–4.58) or 0.43 patients per h, representing a 48.5% reduction from previously published data (P&lt;0.0001). Working in a shift outside of the resuscitation area or working a day shift was associated with a reduction in individual patient load. There was a 2.2% (95% CI: 1.1–3.4, P&lt;0.001) decrease in productivity with each year after obtaining Australian medical registration. There was a 10.6% (95% CI: 5.4–15.6, P&lt;0.001) decrease in productivity for each junior physician supervised. Bed access had no statistically significant effect on productivity. ConclusionsEmergency physicians undertake multiple duties. Their ability to manage their own patients varies depending on multiple ED operational factors, particularly their supervisory load. COVID-19 preparations reduced their ability to see their own patients by half. What is known about the topic?An understanding of emergency physician productivity is essential in planning clinical operations. Medical productivity, however, is challenging to define, and is controversial to measure. Although baseline data exist, few studies examine the effect of patient flow and supervision requirements on the emergency physician’s ability to perform primary consults. No studies describe these metrics during COVID-19. What does this paper add?This pilot study provides a novel cross-sectional description of the effect of COVID-19 preparations on the ability of emergency physicians to provide direct patient care. It also examines the effect of selected system and process factors in a physician’s ability to complete primary consults. What are the implications for practitioners?When managing an emergency medical workforce, the contribution of emergency physicians to the number of patients requiring consults should take into account the high volume of alternative duties required. Increasing alternative duties can decrease primary provider tasks that can be completed. COVID-19 pandemic preparation has significantly reduced the ability of emergency physicians to manage their own patients.

scholarly journals (A181) Process Improvement in Disaster Relief: Implementation of a Fast Track in a Haitian Tent Hospital

2011 ◽  
Vol 26 (S1) ◽  
pp. s51-s51 ◽  
Author(s):  
C. Bloem ◽  
R. Gore ◽  
B. Arquilla ◽  
T. Naik ◽  
J. Schechter
Keyword(s):  
Fast Track ◽  
Disaster Relief ◽  
Medical Center ◽  
Patient Flow ◽  
Waiting Times ◽  
Time Of Arrival ◽  
Study Objective ◽  
Use Of Resources ◽  
Number Of Patients ◽  
Track Area

Study ObjectiveTo determine if instituting an Emergency Department (ED) fast-track area would increase efficiency in patient flow, improve utilization of limited resources, and identify critical versus non-critical patients during disaster relief in Port au Prince, Haiti.MethodsA survey was conducted at L'Hôpital de l'Université d'Etat d'Haïti (HUEH) in Port au Prince, Haiti by Emergency physicians and nurses from SUNY Downstate Medical Center on a disaster relief mission following the 2010 earthquake. The following variables were obtained to assess ED effectiveness: number of patients, acuity level, chief complaints, critical interventions, waiting times, length of stay, specialty service coverage and physical plant space. Additionally, existing practitioners were surveyed regarding existing ED practices. ED operation flow maps were created.ResultsThe assessment revealed a large volume of low-acuity patients mixed with high-acuity patients without identification of acuity level, time of arrival, or designated area for treatment. Although literature reports routine use of START triage, this was not being implemented in this setting. Results of implementing a fast track area included: (1) Improved identification of patients needing immediate treatment. (2) Increased flow of low acuity patients in designated fast track areas. (3) Improved triage protocols maximized appropriate use of resources, and expedited subspecialty consultation.ConclusionBy instituting well-accepted, validated patient flow systems and reinforcing communication regarding resources available and the use of geographic space, better management of incoming emergency patients was achieved.

scholarly journals Improving Healthcare Team Collaboration in Hospital Transfers through Cloud-Based Mobile Systems

2016 ◽  
Vol 2016 ◽  
pp. 1-14 ◽  
Author(s):  
Andres Neyem ◽  
Marie J. Carrillo ◽  
Claudio Jerez ◽  
Guillermo Valenzuela ◽  
Nicolas Risso ◽  
...  
Keyword(s):  
Patient Flow ◽  
Mobile Systems ◽  
Outcome Variable ◽  
Healthcare Team ◽  
Prevention Measures ◽  
Team Collaboration ◽  
Risk Of Death ◽  
Number Of Patients ◽  
Critical Patients ◽  
Technology And Communication

It is a clinical fact that better patient flow management in and between hospitals improves quality of care, resource utilization, and cost efficiency. As the number of patients in hospitals constantly grows, the need for hospital transfers is directly affected. Interhospital transfers can be required for several reasons but they are most commonly made when the diagnostic and therapeutic facilities required for a patient are not available locally. Transferring a critical patient between hospitals is commonly associated with risk of death and complications. This raises the question: How can we improve healthcare team collaboration in hospital transfers through the use of emerging information technology and communication services? This paper presents a cloud-based mobile system for supporting team collaboration and decision-making in the transportation of patients in critical condition. The Rapid Emergency Medicine Score (REMS) scale was used as an outcome variable, being a useful scale to assess the risk profile of critical patients requiring transfers between hospitals. This helps medical staff to adopt proper risk-prevention measures when handling a transfer and to react on time if any complications arise in transit.

scholarly journals The financial impact of hospital closures on surrounding hospitals

2015 ◽  
Vol 4 (3) ◽  
pp. 25 ◽  
Author(s):  
Ashley Hodgson ◽  
Paul Roback ◽  
Andrew Hartman ◽  
Erin Kelly ◽  
Yujie Li
Keyword(s):  
Patient Flow ◽  
Random Effect ◽  
Patient Volume ◽  
Hospital Data ◽  
Hospital Closures ◽  
Number Of Patients ◽  
Operating Margin ◽  
Before And After ◽  
Main Independent Variable ◽  
Independent Variable

Objective: To test whether hospital closures hurt or help surrounding hospitals financially. Do hospital closures improve marketefficiency or do they merely shift the least profitable patients to hospitals that can better cross-subsidize them?Methods: Using California hospital data from 2000 to 2011, the analysis employed random-effect and fixed-effect models to testfor a change in operating margin before and after a series of 2004, 2007 and 2009 hospital closures (the highest volume years forclosures). The main independent variable was each hospital’s predicted percent increase in patient volume due to absorption fromclosing hospitals. We used 5-digit zip code and DRG patient flow data to predict the number of patients each open hospital wouldabsorb from nearby hospital closures.Results: Hospitals experiencing the biggest increase in patient volume due to nearby hospital closings saw a drop in operatingmargin following those closures. This drop could not be explained by changes in payer mix or reimbursement type for thosepatients.Conclusions: Our results suggest that hospital closures are shifting high cost patients to open hospitals, not necessarily improving efficiency in the market.

Abstract WP241: Value Stream Analysis Reduces Door-To-Needle Times in Acute Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Abdeljalil Bentaleb ◽  
Larisa Golding ◽  
Susan Southee ◽  
Lewis B Eberly
Keyword(s):  
Acute Stroke ◽  
Patient Flow ◽  
Wait Time ◽  
Process Time ◽  
Important Goal ◽  
Stroke Patients ◽  
Golden Hour ◽  
Value Stream ◽  
Number Of Patients ◽  
Iv Tpa

Introduction: An important goal in treating acute stroke is minimizing door-to-needle times, consistent with evidence based practice and quality goals. Utilizing methods to streamline the process of patient and information flow in the emergency department (ED) is necessary to reduce treatment times. Hypothesis: Use of value stream analysis to improve efficiency in processing acute stroke patients in the ED should reduce door-to-needle times. Methods: Value stream is the movement of patient and information to deliver the desired outcome. The process from door to treatment was divided into individual steps. We defined process time (the time each step takes) and wait time (the time between each step). The mission was to identify which steps were absolutely necessary before a patient could receive IV-tPA, and to streamline those steps to reduce the process time. All patients who received IV-tPA in 2011 and thus far in 2012 are shown in the graph. Each bar represents an individual patient. Results: Prior to stream analysis, our average door-to-needle time was 122.2 minutes. After the process was rolled-out, the average door-to-needle time was down to 73.8 minutes. Before stream analysis we treated 7.6% of our IV-tPA patients in less than 60 minutes. After analysis we treated 69.2% of patients in less than 60 minutes. The number of patients treated rose from 11 in 2011 (5%) to 17 thus far in 2012 (mid-year, projected 15%). We also found that the number of thrombectomy treated patients was reduced from 39% prior to analysis to 23% following analysis, perhaps partly due to reduced processing time and more patients evaluated within the window for IV-tPA. Conclusion: Streamlining the process of patient flow in the ED by value stream analysis resulted in several outcome improvements in acute stroke patients: 1) Reduced door-to-needle times. 2) Increased number of patients treated within the golden hour. 3) Increased number of patients treated with IV-tPA.

National Emergency Access Targets metrics of the emergency department–inpatient interface: measures of patient flow and mortality for emergency admissions to hospital

2015 ◽  
Vol 39 (5) ◽  
pp. 533 ◽  
Author(s):  
Clair Sullivan ◽  
Andrew Staib ◽  
Rob Eley ◽  
Alan Scanlon ◽  
Judy Flores ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Time Interval ◽  
Inverse Relation ◽  
Bed Occupancy ◽  
Emergency Admissions ◽  
Emergency Patients ◽  
Number Of Patients ◽  
Hospital Bed ◽  
National Emergency

Background Movement of emergency patients across the emergency department (ED)–inpatient ward interface influences compliance with National Emergency Access Targets (NEAT). Uncertainty exists as to how best measure patient flow, NEAT compliance and patient mortality across this interface. Objective To compare the association of NEAT with new and traditional markers of patient flow across the ED–inpatient interface and to investigate new markers of mortality and NEAT compliance across this interface. Methods Retrospective study of consecutive emergency admissions to a tertiary hospital (January 2012 to June 2014) using routinely collected hospital data. The practical access number for emergency (PANE) and inpatient cubicles in emergency (ICE) are new measures reflecting boarding of inpatients in ED; traditional markers were hospital bed occupancy and ED attendance numbers. The Hospital Standardised Mortality Ratio (HSMR) for patients admitted via ED (eHSMR) was correlated with inpatient NEAT compliance rates. Linear regression analyses assessed for statistically significant associations (expressed as Pearson R coefficient) between all measures and inpatient NEAT compliance rates. Results PANE and ICE were inversely related to inpatient NEAT compliance rates (r = 0.698 and 0.734 respectively, P < 0.003 for both); no significant relation was seen with traditional patient flow markers. Inpatient NEAT compliance rates were inversely related to both eHSMR (r = 0.914, P = 0.0006) and all-patient HSMR (r = 0.943, P = 0.0001). Conclusions Traditional markers of patient flow do not correlate with inpatient NEAT compliance in contrast to two new markers of inpatient boarding in ED (PANE and ICE). Standardised mortality rates for both emergency and all patients show a strong inverse relation with inpatient NEAT compliance. What is known about the topic? Impaired flow of emergency admissions across the interface between ED and inpatient wards retards achievement of NEAT-compliance rates and adversely affects patient outcomes. Uncertainty exists as to which measures of patient flow and mortality outcomes correlate closely with NEAT-compliance rates for patients admitted from emergency departments. What does this paper add? This study investigates the utility of two new markers of patient flow from ED to inpatient wards. The Practical Access Number for Emergency (PANE) is the number of patients in ED who have had their episode of ED care completed and are awaiting an inpatient bed at a particular point in time. The Inpatient Cubicles in Emergency (ICE) represents the theoretical number of ED cubicles blocked by boarding patients over a specified time interval (in this study 5 weekdays, Monday–Friday), based on the mean time boarders spent in ED during that interval. Both measures were shown to be significantly inversely related to inpatient NEAT compliance rates (i.e. as PANE and ICE increased, NEAT compliance decreased). In contrast, no relation was seen with traditional markers of patient flow (i.e. hospital bed occupancy and ED attendance numbers). HSMR for both all patients and emergency patients only demonstrated a strong inverse relation with inpatient NEAT compliance. What are the implications for practitioners? When pursuing higher NEAT compliance rates, traditional markers of patient flow across the ED–inpatient interface may be misleading and adversely impact bed-management strategies and patient safety. Identifying when hospitals may be at risk of developing, or already in, a state of reduced access to emergency care may be performed more accurately using new flow markers such as PANE and ICE. The inverse relationship between inpatient NEAT compliance and HSMR, whether calculated for all patients or for emergency patients only, underscores the dependence of inpatient mortality on the swift flow of large volumes of emergency admissions across the ED–inpatient interface. This flow may be compromised by imposing additional demands on a limited number of commissionable beds by way of increasing ED demand and/or use of more beds for elective admissions.

Optimising access and provision of interventional radiology service to patients by utilising a new referral system

2021 ◽  
Author(s):  
Athanasios Diamantopoulos ◽  
Iakovos Theodoulou ◽  
Stephanos Ghobrial ◽  
Vasilis Taliadoros ◽  
Narayanan Thulasidasan ◽  
...  
Keyword(s):  
Interventional Radiology ◽  
Patient Flow ◽  
Ease Of Use ◽  
Referral System ◽  
Referral Process ◽  
Process Data ◽  
Medical Specialties ◽  
Radiology Service ◽  
Number Of Patients ◽  
New Process

Objective: Implementing a streamlined interventional radiology (IR) service in the UK has been a challenge. This study aims to review a set of changes introduced in IR at a tertiary centre, including a new referral process and the designation of IR clinical nurse specialists. Methods: A new process of referring patients to IR using a single generic referral pathway was implemented, replacing an order dropdown-based system. A qualitative survey was designed and distributed as a single-use web link in order to assess the satisfaction and impact of this new process. Responses were based on Likert scale and pertained to perceived qualities of the new referral process. Data analysis was performed to identify specialty and grade-specific trends and possible differences amongst groups. Results: Findings from 98 respondents revealed a strong overall satisfaction with the new referral method and support for its continuation. Subgroup analysis by specialty, concluded medical specialties rated the new referral system more favourably than surgical specialties across all aspects: time efficiency, ease of use, periprocedural support and overall user experience. The new system also increased departmental productivity with an increase in the number of patients treated by 11.2%. Conclusion: Micropolicy changes within individual IR departments such as the replacement of a request-based referral system to one which puts IR in control of vetting and patient flow is one of many changes that reinforce the transformational phase of this specialty. Advances in knowledge: Micropolicy changes within IR departments are key in the progression and widespread recognition of the specialty.

scholarly journals The Effect of Emergency Department Expansion on Emergency Department Patient Flow

2019 ◽  
Vol 34 (s1) ◽  
pp. s123-s124
Author(s):  
Min Joung Kim ◽  
Joon Min Park
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Emergency Department Patient ◽  
Tertiary Hospital ◽  
Hospitalized Patients ◽  
Emergency Ward ◽  
Admission Decision ◽  
Number Of Patients ◽  
Time Required ◽  
Post Period

Introduction:Overcrowding in the emergency department (ED) has been a global problem for a long time, but it is still not resolved.Aim:To determine if an ED expansion would be effective in resolving overcrowding.Methods:This was a retrospective study comparing two 10-month periods before (September 2015 to June 2016) and after (September 2017 to June 2018) the ED expansion in an urban tertiary hospital. The existing ED consisted of 45 beds in the adult area and eight beds in the pediatric area. After the construction, the number of beds was not increased, but a fast track area was newly established in the adult area, and a 25-bed ward for emergency hospitalized patients was opened.Results:The number of patients visiting the ED increased from 77,078 to 87,927. The proportion of patients who returned home without treatment significantly decreased from 11.5% to 0.9% (p<0.001). The number of adult patients increased from 40,814 to 60,720, but the number of patients who could be treated on the bed decreased (22,166 (54.3%) vs. 17,776 (29.3%), p<0.001). The number of pediatric patients was similar in both periods. Median ED length of stay (LOS) of total patients increased from 193.0 min to 205.8 min (p<0.001). Of the 18,900 hospitalized patients during post-period, 1,255 (6.64%) were admitted to the emergency ward, and the boarding (from admission decision to hospitalization) time of the admitted patients decreased from 239.2 min in the pre-period to 190.9 min in the post-period by 38.3 min. However, more time was required for admission decision in the post-period (216.8 vs. 253.3, p<0.001).Discussion:The ED expansion allowed more patients to be treated, and the emergency ward reduced boarding times of admitted patients. However, due to the increase in the number of patients, the time required for medical treatment increased.

Sign in / Sign up

Export Citation Format

Share Document