What is Patient Flow and how can it be optimized?

Patient flow is the movement of patients through a healthcare facility. It involves the medical care, physical resources, and internal systems needed to get patients from the point of admission to the point of discharge while maintaining quality and patient/provider satisfaction. Improving patient flow is a critical component of process management in hospitals and other healthcare facilities.

Optimizing patient flow encompasses quickly, efficiently, and effectively meeting the demand for care by moving patients through care pathways while improving coordination of care, patient safety, and health outcomes. To optimize patient flow, providers seek to successfully match the appropriate amount of resources to each of their admissions.

Patient Flow Problems in Hospitals

Patient flow is primarily associated with hospitals, especially with back-ups and overcrowding in emergency departments and inefficient scheduling in surgical departments. Poorly managed patient flow in hospitals can lead to adverse health outcomes, including increased re-admissions and mortality rates. Even hospitals that are expanding their facilities and hiring additional staff are not immune to issues of overcrowding and poor orchestration of patient admissions, transfers, and discharges.

Inefficient scheduling leads to some patient flow problems. For example, surgical services may schedule the bulk of their elective surgeries earlier in the week, so patients can recover when resources are more readily available. This strategy causes post-operative units to become overcrowded, and staff and support services to become stretched.

Disorganized handoffs — between referring physicians and hospitals, as well as between departments within a hospital — also lead to patient flow problems. Hospitals, therefore, are taking a critical look at their admissions and referral processes in an effort to make improvements.

What Is the Emergency Department’s Role in Patient Flow?

Patient flow issues often originate in the emergency department (ED). An influx of patients can cause EDs to become backed up, especially when non-critical patients use the emergency department as a source of primary care. This over-crowding can lead to long wait times, ambulance diversions to other hospitals, delayed discharges, patients leaving without being seen and patient boarding (admitting patients without beds and leaving them in hallways until beds become available).

Strategies to Improve Patient Flow

Dr. Eugene Litvak, a noted expert in the field of patient flow, suggests that greater attention to the issue of patient flow would “accelerate progress toward reliable, safe, efficient care.” Among the strategies espoused by Dr. Litvak and other experts to optimize patient flow in hospitals are:

Establish an emergency department “fast-track” process, along with protocols for triage, tests, and treatment to streamline patient handoffs.
Smooth the elective surgical schedule, by spacing elective surgeries throughout the week to help alleviate strain on post-operative units instead of using block scheduling, which can lead to capacity crunches.
Increase the rate of morning discharges. Leaving the hospital early in the day gives patients more time to fill prescriptions and settle in at home, and it opens up beds for incoming patients.
Use patient flow software and telehealth to automate processes and gather data for analysis. One health system has found that using an online portal through which primary care providers can ask questions of specialists helps to reduce the need for face-to-face consultations, which can be hard to schedule for busy specialist practices. Patients who don’t need to be seen are managed with a phone call or chart review, freeing appointment slots for patients who do need to be seen.

Patient Flow Standards and Guidance for Hospitals

The Joint Commission addresses the issue of patient flow in a standard all Joint Commission-accredited hospitals must comply with. The standard requires hospitals to:

Create processes that facilitate good patient flow throughout the hospital.
Address what happens when beds aren’t ready for admitted patients.
Make sure patients in overflow locations receive proper care.
Formalize how ambulance diversion decisions are made and implemented.
Set patient flow goals and measure progress toward those goals.
Manage patient “boarding” and work to reduce the length of time that ED patients are boarded. A cap of four hours is recommended by the Joint Commission.
Review results of flow management initiatives against stated goals and objectives.
Take improvement actions when goals are not achieved.
Work closely with behavioral health providers to better coordinate care.

Additional guidance is available from the Agency for Healthcare Research and Quality, which offers step-by-step instructions that can be used by hospitals in planning and implementing patient flow improvement strategies to ease emergency department crowding. The guide covers everything from how to form a patient flow team, to facilitating changes, anticipating and addressing challenges, and sharing results.

The Institute for Healthcare Improvement offers a White Paper that shares strategies, promising change ideas, and resources to help hospital leaders and improvement teams take on the challenges of achieving hospital-wide patient flow. The report stresses the importance of taking a system-level approach to improving patient flow and building the will to do so throughout the entire organization, from the highest levels of leadership to point-of-care managers and staff. Delivering the right care, in the right place, at the right time, they say, will help hospitals reduce their costs and retain revenue, in addition to improving patient health outcomes.

Patient Flow and Health Outcomes

As hospitals increasingly focus on value-based care instead of fee-for-service care, incentives will likely continue to grow for the operational changes hospitals need to make to improve the flow of patients through their facilities. Hospitals that support those operational changes with relevant cultural changes will be in the best position to improve patient flow.