Safely Enhancing Surgical Ward Patient Flow in the Bed Shortage Era by a structured daily Multi-Disciplinary Board Round. A Quality Improvement Research Report.

Acute hospital bed shortage is a serious concern worldwide, constantly involving high-dependency units (HDU), where the non-availability of postoperative beds results in surgery cancellation. In the acute medicine context, the SAFER Red2Green initiative has shown to enhance patient flow.Local problem At the Royal London hospital, in 2016, hospital-initiated cancellations peaked at over 50% weekly due to the inability of high dependency Units (HDU) to discharge step-down patients to the general surgical wards, where bed occupancy was close to 100% and the average length of stay was stable on average close to 7 (+/- 8.6) days.Methods. This was a service improvement research to enhance patient flow which adapted the SAFER Red2Green model to a surgical ward (SAFER Surgery Red2Green). This before-after study involving all 2017 digestive surgery admissions was divided into a three-month feasibility phase followed by a nine-month pilot phase, versus the year 2016 (pre-intervention). Outcome measures: weekly discharges, length of stay (LOS), surgery cancellations, feasibility of a “theatre go” policy, HDU step-downs, 30-day readmissions.Interventions1) Systematic communication of key care plan from the afternoon ward rounds by surgical teams to the nurse in charge; 2) 10 AM Monday-to-Friday multi-disciplinary senior-team daily board round, addressing updated key care plan aimed at early discharges, appropriateness of each inpatient day, causes of delays; 3) hospital and site managers weekly attendance. Results. At three months: +67% discharges/week (p=0.001), -20% LOS (p=0.023), +21% HDU step-downs, (p=0.205). At one year: +10.7% HDU step-downs (p=0.197), increased probability of earlier discharge (p=0.023), -60% hospital-initiated cancellations from 38 to 15 (p>=1), a “Theatre go” policy has been active since month 6. Failed discharges kept at 1.3 %. The MDT board round staff satisfaction rate was over 80%, with key actors’ attendance over 75%. Conclusions. The Barts SAFER Surgery R2G model safely enhanced patient flow and reduced cancellations and unnecessary nurse staff time. It requires senior medical and nursing commitment, however, is designed for any surgical specialty, and has proven sustainable. It warrants further validation.

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Colonization and Infection With MRSA and CRKP and Its Result in an Increased Mortality Rate Within the Intensive Care and High-Dependency Units in Barbados

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.703 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s173-s174

Author(s):

Keisha Gustave

Keyword(s):

Intensive Care ◽

Length Of Stay ◽

High Mortality ◽

Average Length ◽

Cohort Analysis ◽

Health Concern ◽

Queen Elizabeth Hospital ◽

Surveillance Program ◽

Average Length Of Stay ◽

High Dependency

Background: Methicillin-resistant Staphylococcus aureus(MRSA) and carbapenem-resistant Klebsiella pneumoniae (CRKP) are a growing public health concern in Barbados. Intensive care and critically ill patients are at a higher risk for MRSA and CRKP colonization and infection. MRSA and CRKP colonization and infection are associated with a high mortality and morbidly rate in the intensive care units (ICUs) and high-dependency units (HDUs). There is no concrete evidence in the literature regarding MRSA and CRKP colonization and infection in Barbados or the Caribbean. Objectives: We investigated the prevalence of MRSA and CRKP colonization and infection in the patients of the ICU and HDU units at the Queen Elizabeth Hospital from 2013 to 2017. Methods: We conducted a retrospective cohort analysis of patients admitted to the MICU, SICU, and HDU from January 2013 through December 2017. Data were collected as part of the surveillance program instituted by the IPC department. Admissions and weekly swabs for rectal, nasal, groin, and axilla were performed to screen for colonization with MRSA and CRKP. Follow-up was performed for positive cultures from sterile isolates, indicating infection. Positive MRSA and CRKP colonization or infection were identified, and patient notes were collected. Our exclusion criteria included patients with a of stay of <48 hours and patients with MRSA or CRKP before admission. Results: Of 3,641 of persons admitted 2,801 cases fit the study criteria. Overall, 161 (5.3%) were colonized or infected with MRSA alone, 215 (7.67%) were colonized or infected with CRKP alone, and 15 (0.53%) were colonized or infected with both MRSA and CRKP. In addition, 10 (66.6%) of patients colonized or infected with MRSA and CRKP died. Average length of stay of patients who died was 50 days. Conclusions: The results of this study demonstrate that MRSA and CRKP cocolonization and coinfection is associated with high mortality in patients within the ICU and HDU units. Patients admitted to the ICU and HDU with an average length of stay of 50 days are at a higher risk for cocolonization and coinfection with MRSA and CRKP. Stronger IPC measures must be implemented to reduce the spread and occurrence of MRSA and CRKP.Funding: NoneDisclosures: None

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LO007: A pragmatic randomized and controlled evaluation of nurse-initiated protocols

CJEM ◽

10.1017/cem.2016.44 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S32-S32

Author(s):

M.J. Douma ◽

D. O Dochartiagh ◽

C.A. Drake ◽

K.E. Smith

Keyword(s):

Length Of Stay ◽

Average Length ◽

Patient Flow ◽

Intervention Group ◽

Control Group ◽

Emergency Nurses ◽

Specific Patient ◽

Patient Allocation ◽

Ed Overcrowding ◽

Controlled Evaluation

Introduction: Emergency department (ED) overcrowding is a common and complicated challenge for EDs worldwide. Nurse-initiated protocols, diagnostics and/or treatments implemented by nurses prior to patients being seen by a physician or nurse practitioner, have been suggested as a potential strategy to improve patient flow. Methods: This randomized, pragmatic, controlled evaluation of 5 nurse-initiated protocols occured in a crowded inner-city ED. Six physicians and 44 registered nurses, 3 clinical nurse educators and 3 unit managers were involved in revising 5 patient-complaint focused protocols prior to evaluation. Thirty (30/180) emergency nurses were provided 1 hour of training on inclusion and exclusion criteria, procedure and evaluation methods. Data was abstracted in a manner concealing patient allocation. Primary outcomes evaluated included time to diagnostic test, treatment, consultation or ED length of stay. This evaluation was completed following both the CONSORT and SQUIRE guidelines. Results: Time to acetaminophen for the intervention group (n=11) was 1h:04 min on average (95%CI 30min to 1h:37min) whereas the control group (n=9) was 3h:35min (95%CI 2h:21min to 4h:48min). The average length of stay of a suspected fractured-hip in the intervention group (n=5) was 3h:34min (95%CI 1h:49min to 5h:19min) and 7h:34min for the control group (n=4) was (95%CI 5h:26min to 9h:42min). Time to troponin in the intervention group (n=29) was one quarter (average 48min, 95% CI 32min to 64min) of the time it was in the control group (n=14) (average 3h:16min, 95%CI 1h:53min to 4h:39min; p < 0.001). The vaginal bleeding in pregnancy protocol reduced length of stay by roughly fifty-percent; the intervention group (n=11) had a length of stay of 4h:57min (95%CI 3h:46min to 6h:08min) compared to 8h:33min (95% CI 6h:23min to 10h:44min) for the control (n=7) (p < 0.001). There was no statistical difference in the length of stay for patients who received protocolized diagnostics for abdominal pain. Conclusion: Targeting specific patient groups with carefully written protocols can improve the timeliness of care. A cooperative and collaborative interdisciplinary group are essential to success. Having a system in place to ensure ongoing quality in protocol application and interdisciplinary support has proven more difficult than improving the primary outcomes in this evaluation.

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IMPACT OF CLINICAL PATHWAYS COMPLIANCE FOR REDUCING LENGTH OF STAY

Jurnal Administrasi Kesehatan Indonesia ◽

10.20473/jaki.v8i1.2020.79-90 ◽

2020 ◽

Vol 8 (1) ◽

pp. 79

Author(s):

Michael Siswanto ◽

Djazuly Chalidyanto

Keyword(s):

Length Of Stay ◽

Clinical Pathway ◽

Acute Gastroenteritis ◽

Pediatric Patients ◽

Average Length ◽

Clinical Pathways ◽

Multidisciplinary Care ◽

Care Plan ◽

Cross Sectional ◽

Therapy Compliance

Background: Clinical pathway is multidisciplinary care plan based on the best clinical practice for a group of patients with a particular diagnosis, designed to minimize care delay as well as maximize the quality of care and clinical outcomes. In 2017, average length of stay for pediatric patient with acute gastroenteritis was prolonged even clinical pathways had been implemented.Aim: Thid study determined the diagnostic examination and therapy compliance of clinical pathway related to the length of stay.Method: This study was cross sectional research through simple random sampling. Researchers analyzed pediatric patients whose clinical pathway were filled completely by doctors. The inclusion criteria were pediatric patients, admitted to hospitals during January to December 2018 as acute gastroenteritis patients. The data were analyzed using multiple classification analysis.Results: There were 197 patients with clinical pathway filled completely. As much as 60.91% of cases were compiled for diagnostic examination and 88.32% for therapy. There was no statistically significant correlation between diagnostic examination compliance (p > 0.05) and therapy compliance (p > 0.05) of clinical pathway with patients’ length of stay (combined = p > 0.05).Conclusion: Many factors could be related with the length of stay especially patients’ condition itself. In this study, clinical pathway compliance has no impact in reducing length of stay. Keywords: clinical pathway, compliance, length of stay, pediatric.

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1114 Getting it Right First Time: An Audit of Length of Hospital Stay for Mandibular Fractures

British Journal of Surgery ◽

10.1093/bjs/znab259.124 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

F Mitchell ◽

J Parmar

Keyword(s):

Length Of Stay ◽

Average Length ◽

Maxillofacial Surgery ◽

Length Of Hospital Stay ◽

National Standard ◽

Oral And Maxillofacial Surgery ◽

Service Improvement ◽

Mandibular Fractures ◽

Average Length Of Stay ◽

Mandible Fractures

Abstract Introduction GIRFT is a Department of Health programme, created to improve efficiency by providing data that gives departments a national standard to encourage reflection and service-improvement. The 2016 document in Oral and Maxillofacial Surgery, suggests the national average length of stay for isolated mandible fractures was 2 days, 1 day pre-operatively and 1 day post-operatively. This Audit aimed to investigate if all admissions in our trust met this standard, as a short stay reduces costs and improves patient experience. Method Data was collected for all isolated mandibular fracture admissions between January – September 2019, with 89 patients identified. Date of admission, surgery and discharge was recorded which allowed calculation of pre-operative, post-operative, and total stay. Results 78% of patients had surgery within 24 hours of admission. Admissions on a Saturday were most often delayed, with a mean pre-operative stay of 1.60 days and total stay of 2.55 days. Commonly the reason for delay was not recorded, or due to lack of theatre space. 92% of patients were discharged within 24 hours post-operatively. The average length of stay met the 2-day standard, with Monday admissions having the shortest average stay of 1.45 days. Conclusions Whilst the majority of patients are treated and discharged within 2 days, improvements and future audit would assist to get closer to the 100% target. Saturday saw the highest number of admissions, which also had the longest average length of stay. A dedicated weekend trauma list would reduce wait times but may be limited by staffing and theatre space.

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Difficulties in access and estimates of public beds in intensive care units in the state of Rio de Janeiro

Revista de Saúde Pública ◽

10.1590/s1518-8787.2016050005997 ◽

2016 ◽

Vol 50 (0) ◽

Cited By ~ 8

Author(s):

Rosane Sonia Goldwasser ◽

Maria Stella de Castro Lobo ◽

Edilson Fernandes de Arruda ◽

Simone Aldrey Angelo ◽

José Roberto Lapa e Silva ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Rio De Janeiro ◽

Average Length ◽

Patient Flow ◽

The State ◽

System Stability ◽

Ministry Of Health ◽

Average Length Of Stay

ABSTRACT OBJECTIVE To estimate the required number of public beds for adults in intensive care units in the state of Rio de Janeiro to meet the existing demand and compare results with recommendations by the Brazilian Ministry of Health. METHODS The study uses a hybrid model combining time series and queuing theory to predict the demand and estimate the number of required beds. Four patient flow scenarios were considered according to bed requests, percentage of abandonments and average length of stay in intensive care unit beds. The results were plotted against Ministry of Health parameters. Data were obtained from the State Regulation Center from 2010 to 2011. RESULTS There were 33,101 medical requests for 268 regulated intensive care unit beds in Rio de Janeiro. With an average length of stay in regulated ICUs of 11.3 days, there would be a need for 595 active beds to ensure system stability and 628 beds to ensure a maximum waiting time of six hours. Deducting current abandonment rates due to clinical improvement (25.8%), these figures fall to 441 and 417. With an average length of stay of 6.5 days, the number of required beds would be 342 and 366, respectively; deducting abandonment rates, 254 and 275. The Brazilian Ministry of Health establishes a parameter of 118 to 353 beds. Although the number of regulated beds is within the recommended range, an increase in beds of 122.0% is required to guarantee system stability and of 134.0% for a maximum waiting time of six hours. CONCLUSIONS Adequate bed estimation must consider reasons for limited timely access and patient flow management in a scenario that associates prioritization of requests with the lowest average length of stay.

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Impact of Implementation of Additional Endoscopy List on Hospital Inpatient Length of Stay

Recent Advances in Biology and Medicine ◽

10.18639/rabm.2020.1109565 ◽

2020 ◽

Vol 6 ◽

pp. 1

Author(s):

Pamila S Adikari ◽

John Olynyk ◽

◽

Keyword(s):

Length Of Stay ◽

Average Length ◽

Service Improvement ◽

Hospital Inpatient ◽

Improvement Project ◽

Average Length Of Stay ◽

Full Participation ◽

Before And After ◽

Tertiary Hospitals ◽

Satellite Service

Extended average length of stay (ALOS) leads to increased hospital expenditure. Prioritization of emergency endoscopies over routine elective procedures results in delay and adds on to patients’ ALOS at tertiary hospitals. The gastroenterology department of Fiona Stanley Hospital aimed a service improvement project to shorten the ALOS of inpatients by implementing a new quarantined booking and procedural system allowing elective access to endoscopic procedures. An additional endoscopy list (quarantine list) was implemented with full participation of the stakeholders once a month for a 3-month trial period for inpatients by moving resources from a nearby satellite service. A comparison of the ALOS of patients before and after realizing the preceding intervention was carried out using the time and date information obtained from the theater management and the e-referral system of all routine inpatients with a valid e-referral for gastroscopy or colonoscopy. Upper gastrointestinal endoscopies comprised over two-thirds of the inpatient scopes performed. The ALOS and average time spent for referral improved by 1.09 and 1.97 days, respectively. The ALOS reduced by over 1 day, and improvement was noticed in the prereferral segment. Postreferral efficiency did not improve, and undertaking further analysis to determine the root causes for the continual delay is recommended.

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Role of effective care plans in reducing admissions for sickle cell patients.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.156 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 156-156

Author(s):

Bilawal Ahmed ◽

Tami Day ◽

Cara Hirner ◽

Michael Trendle ◽

Jonathan Heidt ◽

...

Keyword(s):

Length Of Stay ◽

Sickle Cell ◽

Patient Population ◽

Hospital Admissions ◽

Average Length ◽

Medical Director ◽

Care Plan ◽

Care Plans ◽

Average Length Of Stay ◽

Individualized Care

156 Background: Adults with sickle cell disease (SCD) vaso-occlusive crisis (VOC) frequently seek care in the emergency department (ED) which often results in hospital admissions. The Hematology-Oncology at Ellis Fischel Cancer Center collaborated with organization’s ED to develop and implement individualized care plans for adults with SCD presenting to the ED with the goal of adequate outpatient management and a reduction in hospital admissions. Methods: Baseline data collected from November 2014 through December 2016 indicated that 108 SCD patients accounted for 195 inpatient hospital admissions, and 40% of all 30-day readmissions for the Hematology-Oncology service line. Further, the average length of stay for patients admitted for SCD crisis was 6.8 days per stay. Medical Director, Oncology Unit Manager, and Performance Improvement Professional collaborated with the ED Medical Director and representatives to develop a disease-specific acute care plan for our adult SCD patient population. The care plan include pathways for lab collection, pain medication regimens, prescription opioid refill policies, a timeline for outpatient follow-up, and criteria for hospital admission. These care pathways were then transitioned to order sets in within the organization’s electronic medical record. Results: Implementation of the SCD care plans resulted in significant improvement in the 30-day readmission rate among the SCD patient population, from 40% to 3%. Further, use the SCD care plans helped reduce the average length of stay for patients admitted with SCD crisis from 6.8 days to 3 days. More importantly, we have been able to sustain this improvement over time. Conclusions: This study clearly demonstrates that collaboration with the ED and development of care plans are key to reducing ED and hospital utilization among patients with SCD, and reducing the average length of stay for SCD patients who require hospitalization for disease management.

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Extrakorporális és intrakorporális anasztomózis rövid távú eredményeinek összehasonlítása malignus daganat miatt végzett laparoszkópos jobb oldali hemikolektómia esetén

Magyar Sebészet (Hungarian Journal of Surgery) ◽

10.1556/1046.73.2020.4.3 ◽

2020 ◽

Vol 73 (4) ◽

pp. 148-152

Author(s):

Kornél Vajda ◽

László Sikorszki

Keyword(s):

Length Of Stay ◽

Gold Standard ◽

Average Length ◽

Colon Surgery ◽

Right Hemicolectomy ◽

Malignant Tumours ◽

Short Term ◽

Significant Difference ◽

Laparoscopic Assisted ◽

Laparoscopic Hemicolectomy

Összefoglaló. Bevezetés: A laparoszkópia térhódítása a jobb oldali colon műtéteknél is nyilvánvaló. Ma legtöbb helyen a laparoszkóposan asszisztált jobb oldali hemikolektómia extrakorporális anasztomózissal a gold standard. A morbiditás randomizált vizsgálatok alapján még 30% körüli. A technikai fejlődés lehetővé tette az intrakorporális anasztomózist. Célkitűzés: Retrospektív módon elemezni rosszindulatú jobb oldali vastagbéldaganat miatt végzett laparoszkópos hemikolektómiák rövid távú eredményeit a két módszer összehasonlításával. Eredmények: 2018. 01. 01. – 2019. 12. 31. között 184 jobb oldali hemikolektómiát végeztünk, ezek közül 122 történt malignus betegség miatt. 51 esetben nyitott és 71 esetben laparoszkópos műtét történt. 37 férfi (átlagéletkor: 70,59 év) és 34 nő (átlagéletkor: 72,14 év) volt. 50 esetben extrakorporális (EA) és 21 esetben pedig intrakorporális anasztomózist (IA) végeztünk. Az EA csoportban 18, míg az IA csoportban 3 szövődmény alakult ki 30 napon belül (p = 0,067). Az EA csoportból 3, az IA csoportból 1 beteget veszítettünk el 30 napon belül (p = 0,66). Az átlagos ápolási idő az EA csoportban 9,48 (5–32) nap, míg az IA csoportban 6,52 (4–19) nap volt (p = 0,001) a szövődményes esetekkel együtt. A szövődményes esetek nélkül az EA csoportban 6,35 (5–10) nap, az IA csoportban pedig 5,55 (4–8) napnak bizonyult (p = 0,09). A műtéti idő pedig az EA csoportban 147 (90–240) perc, az IA csoportban pedig 146,47 (90–265) perc volt (p = 0,11). Konklúzió: Az irodalommal összhangban azt találtuk, hogy IA esetén kevesebb a szövődmény, ezzel is összefüggésben rövidebb az átlagos ápolási idő, és a műtéti időt tekintve nincs szignifikáns különbség. Ezeket figyelembe véve az intrakorporális anasztomózis javasolható jobb oldali laparoszkópos hemikolektómia esetén. Summary. Introduction: Laparoscopy became evident for right-sided colon surgery too. Today the laparoscopic-assisted right-hemicolectomy is the gold standard with extracorporeal anastomosis. Morbidity according to randomized trials is still approximately 30%. The development of the surgical technique resulted in the creation of intracorporeal anastomosis. Our aim was to compare the short-term results of the two methods. Aim: To analyse the short-term results of right-sided hemicolectomy that were performed due to malignant tumours with the comparison of the two methods. Results: A cohort of 184 right-sided hemicolectomy were performed from 01.01.2018 to 31.12.2019 from which 122 were operated on because of a malignant disease. 51 open and 71 laparoscopic operations were performed. The average age of 37 men and 34 women were 70.59 and 72.14 years, respectively. 50 patients underwent extracorporeal (EA) anastomosis and 21 intracorporeal (IA) anastomosis. Within 30 days the number of complications were 18 in the EA group and 3 in the IA group (p = 0.067). 3 from the EA group and 1 from IA group died within 30 days (p = 0.66). The average length of stay were 9.48 days in the EA group and 6.52 days in the IA group together with the complicated cases (p = 0.001) while 6.35 days and 5.55 days without the complicated cases (p = 0.09). The average duration of operation was 147 minutes in the EA and 146.47 minutes in the IA group (p = 0.11). Conclusion: We found concordance with the literature that there are fewer complications in case of IA which might be related to shorter length of stay. There is no significant difference between the surgical times. Bearing these facts in mind, IA might be suggested for right- sided laparoscopic hemicolectomy.

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Temporal Changes in Central-Line–Associated Bloodstream Infection Time Between Events, 2017–2018 Versus 2015–2016

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1051 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s403-s404

Author(s):

Jonathan Edwards ◽

Katherine Allen-Bridson ◽

Daniel Pollock

Keyword(s):

Length Of Stay ◽

Patient Care ◽

Average Length ◽

Bloodstream Infections ◽

Central Line ◽

Significant Shift ◽

Care Hospital ◽

Average Length Of Stay ◽

Period 2 ◽

Hospital Bed

Background: The CDC NHSN surveillance coverage includes central-line–associated bloodstream infections (CLABSIs) in acute-care hospital intensive care units (ICUs) and select patient-care wards across all 50 states. This surveillance enables the use of CLABSI data to measure time between events (TBE) as a potential metric to complement traditional incidence measures such as the standardized infection ratio and prevention progress. Methods: The TBEs were calculated using 37,705 CLABSI events reported to the NHSN during 2015–2018 from medical, medical-surgical, and surgical ICUs as well as patient-care wards. The CLABSI TBE data were combined into 2 separate pairs of consecutive years of data for comparison, namely, 2015–2016 (period 1) and 2017–2018 (period 2). To reduce the length bias, CLABSI TBEs were truncated for period 2 at the maximum for period 1; thereby, 1,292 CLABSI events were excluded. The medians of the CLABSI TBE distributions were compared over the 2 periods for each patient care location. Quantile regression models stratified by location were used to account for factors independently associated with CLABSI TBE, such as hospital bed size and average length of stay, and were used to measure the adjusted shift in median CLABSI TBE. Results: The unadjusted median CLABSI TBE shifted significantly from period 1 to period 2 for the patient care locations studied. The shift ranged from 20 to 75.5 days, all with 95% CIs ranging from 10.2 to 32.8, respectively, and P < .0001 (Fig. 1). Accounting for independent associations of CLABSI TBE with hospital bed size and average length of stay, the adjusted shift in median CLABSI TBE remained significant for each patient care location that was reduced by ∼15% (Table 1). Conclusions: Differences in the unadjusted median CLABSI TBE between period 1 and period 2 for all patient care locations demonstrate the feasibility of using TBE for setting benchmarks and tracking prevention progress. Furthermore, after adjusting for hospital bed size and average length of stay, a significant shift in the median CLABSI TBE persisted among all patient care locations, indicating that differences in patient populations alone likely do not account for differences in TBE. These findings regarding CLABSI TBEs warrant further exploration of potential shifts at additional quantiles, which would provide additional evidence that TBE is a metric that can be used for setting benchmarks and can serve as a signal of CLABSI prevention progress.Funding: NoneDisclosures: None

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Principles of capacity management, applied in the mental health context

Australian Health Review ◽

10.1071/ah17007 ◽

2018 ◽

Vol 42 (4) ◽

pp. 438

Author(s):

Kathryn Zeitz ◽

Darryl Watson

Keyword(s):

Mental Health ◽

Mental Health Problems ◽

Average Length ◽

Patient Flow ◽

Waiting Times ◽

Capacity Management ◽

Mental Health Setting ◽

Mental Health Consumer ◽

Mental Health Consumers ◽

Flow Improvement

Objective The aim of the paper was to describe a suite of capacity management principles that have been applied in the mental health setting that resulted in a significant reduction in time spent in two emergency departments (ED) and improved throughput. Methods The project consisted of a multifocal change approach over three phases that included: (1) the implementation of a suite of fundamental capacity management activities led by the service and clinical director; (2) a targeted Winter Demand Plan supported by McKinsey and Co.; and (3) a sustainability of change phase. Descriptive statistics was used to analyse the performance data that was collected through-out the project. Results This capacity management project has resulted in sustained patient flow improvement. There was a reduction in the average length of stay (LOS) in the ED for consumers with mental health presentations to the ED. At the commencement of the project, in July 2014, the average LOS was 20.5 h compared with 8.5 h in December 2015 post the sustainability phase. In July 2014, the percentage of consumers staying longer than 24 h was 26% (n = 112); in November and December 2015, this had reduced to 6% and 7 5% respectively (less than one consumer per day). Conclusion Improving patient flow is multifactorial. Increased attendances in public EDs by people with mental health problems and the lengthening boarding in the ED affect the overall ED throughput. Key strategies to improve mental health consumer flow need to focus on engagement, leadership, embedding fundamentals, managing and target setting. What is known about the topic? Improving patient flow in the acute sector is an emerging topic in the health literature in response to increasing pressures of access block in EDs. What does this paper add? This paper describes the application of a suite of patient flow improvement principles that were applied in the mental health setting that significantly reduced the waiting time for consumers in two EDs. What are the implications for practitioners? No single improvement will reduce access block in the ED for mental health consumers. Reductions in waiting times require a concerted, multifocal approach across all components of the acute mental health journey.

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