Health First in Brevard County, Florida, made substantial improvements in patient flow through use of a bed-tracking system and implementing Lean principles, according to a paper from Rand Corp.
The Lean methodology requires strong leadership and looking at each process critically in search of improvement. The health system was suffering from financial problems, low quality scores and low patient-satisfaction ratings. It settled on patient flow as a means to address all three.
Nurses were manually assigning beds when patients were admitted from the emergency department; Environmental Services similarly had a manual process for scheduling rooms to be cleaned between patients; patient transporters were alerted of patients to be moved, but could choose some jobs and not others; ED crowding generally meant long waits; and Health First lost transfers to other hospitals, which meant lost revenue.
Health First implemented a Central Patient Logistics center where monitors display real-time bed tracking across its four hospitals. The system is integrated with its electronic medical record, scheduling system and eICU system.
Discharges are the No.1 priority for transporters now to make way for more effectively scheduled cleaning and future admissions. If one unit is at capacity, a patient can be sent to an alternate site.
Since the system was first implemented in 2012, admissions have increased by 27 percent, ED volume is up 12 percent, yet wait times have decreased. The process in which the ED requests a bed to initiating assignment has been cut in half, from 90 minutes to 45 minutes. The time for assignment of a bed once the patient was ready to move fell from 30.2 minutes to 8.8 minutes.
In addition, overall, the time between ED admission and bed occupancy decreased by 37 percent.
Other organizations, including Stanford Hospitals and Clinics and Kaiser Permanente South Sacramento, also credit Lean principles with helping them reduce ED wait times.
Wisconsin's ThedaCare also points to Lean management for improvements in quality, patient satisfaction, and lower costs and length of stay.
To learn more:
- read the paper (.pdf)