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Hardwiring Patient Flow: Making Front-End Flow Work For You

Posted on Tue, Aug 04, 2015
Hardwiring Patient Flow: Making Front-End Flow Work For You

During last month's webinar, Hardwiring Hospital-Wide Flow To Drive Competitive Performance, Drs. Jensen and Mayer shared their secrets for streamlining processes, changing behaviors, and achieving sustainable advances in hardwiring flow throughout your hospital system. Here are a few tips from their presentation.

In healthcare, “flow” is defined as adding value and decreasing waste to processes, services or behaviors as patients move through the service transitions and queues of healthcare. This can be accomplished  by increasing benefits, decreasing burdens or both.

Thom Mayer, MD, FACEP, FAAP and Kirk Jensen, MD, MBA, FACEP, authors of “Hardwiring Flow” and “The Patient Flow Advantage” explored this topic further during a recent webinar.

Finding flow, according to Drs. Mayer and Jensen, requires:

  • Engaging staff from the beginning of the process to ensure they’re with you from takeoff to landing
  • Asking “Why?” and “Why Not?” incessantly about your processes, policies  and  procedures
  • Making your staff feel hopeful by decreasing constraints and finding ways to avoid burnout
  • Taking people out of their comfort zones – just because it’s the way you’ve always done it doesn’t mean it’s the right process for your facility now

Retooling Triage

It’s important to think of triage as a process, not a place. Triage in your ED is the “front door” to your facility for the majority of your patients, and how well your staff accomplishes this will drive flow as your patients  move through the system. Goal No. 1 is to get the patient and the physician (or the advanced practice provider) together as quickly and efficiently as possible.

To optimize the triage process, you must  forecast demand and define your ability to meet it with adequate capacity, whether it be having the appropriate level of staffing to handle patient influxes, or simply having enough clean, empty beds or treatment spaces available. This requires everyone to work together, including the ability to monitor flow in real time, set realistic patient expectations regarding wait times, eliminate bottlenecks and improve patient handoffs. Piece of cake, right?

You need to know:
  • Who’s coming?
  • When are they coming?
  • What will they need when they arrive?
  • Will your service capacity match the projected patient demand?
    • And what’s your plan if it doesn’t?

Knowing this information is essential in the Emergency Department, but also necessary in med/surg units and other inpatient areas. If a patient is horizontal, they think and feel like a patient. If they are vertical, he or she feels like and thinks like a customer. Keep your vertical patients vertical and moving through the healthcare system.  Horizontal patients value real estate (a bed or treatment area) and vertical customers value speed.

Your triage process should:
  • Improve throughput
  • Increase safety
  • Improve satisfaction
  • Improve quality
  • Provide adequate, patient-friendly information
  • Increase revenue

If it doesn’t, it’s time to analyze the triage and front-end processes and retool them, which may mean eliminating triage altogether and moving to direct bedding. The more complex that your healthcare environment is, the more complex unraveling and improving the issues will be. Weigh the benefits of your current system vs. the burdens it creates. Eliminate unnecessary steps and engage your staff from the ground up. Triage should move patients into value-added segmentation streams by putting the right patient in the right area at the right time with the right resources. It should never be simply determining who can wait. There is no value in that.

EmCare has a variety of resources and tools designed to help healthcare executives make informed decisions, including calculators to assess the financial impact of improving flow and to assess ED efficiency. Our partner hospitals have the benefit of the resources of Drs. Jensen and Mayer and innovative strategies to hardwire flow

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