Improving Patient Flow Analysis

Improving Patient Flow

There is a wide variety of factors which are associated (that is, can affect and moderate) the patient flow. While the process can be unplanned and uncontrolled, there is the need to define all the factors which may have a significant impact on it, and regulate the activities of all the actors involved in order to better supervise the patient flow, and approach the health care services to the ones which will follow the principles of the patient-oriented care. The optimization of the patient flow can only be achieved when the medical practitioners working in the different departments will follow the team-based strategy of providing care: it enables various possibilities for large and small healthcare facilities to manage their patient flow, and it satisfies the needs of patients (such as receiving qualitative care timely), and of the medical

practitioners (for instance, the avoidance of the burnout from working extra shifts to address the demand for care efficiently).
While the cost-effectiveness, quality, and the avoidance of the errors are what every medical institution aims to achieve, the managing of the efficient patient flow is one of the fundamental principles which can contribute to the embodiment of the principles mentioned above. Swaanenburg reports that the uncertainty, which always interferes with the process of optimization of the patient flow, is also one of the most critical unresolved issues associated with the providing of timely, qualitative, and the patient-oriented care. Swaanenburg states that the process can go wrong from the time of the initial referral of a patient to the healthcare facility. The author emphasizes that, while the care should be provided to the patient with the equally high quality, the issue of the elective and non-elective patients can create a complexity (which may not even depend on the specific actions of the medical staff). He claims: “Elective patients are patients for whom the surgery can be well planned, whereas for non-elective patient’s surgery is unexpected and hence needs to be performed urgently.” (Swaanenburg, 2010, p. 7). The author does not provide a sufficient answer to the question. But presumably, the problem can be resolved with the use of the unified system of the healthcare records, where will be stored massive blocks of systematized data, which can later be necessary for performing evidence-based urgent care.
While it will not be appropriate to suggest that the optimization of the patient flow in the emergency department can be reached with the increase of the awareness concerning the importance of the preventative care (due to the necessity to find a short-term solution), there should be established specific strategies to address the problem, which is that the capacity of the healthcare facility (especially in the case when it is the small hospital) does not match the demand for medical services. Medeiros et al. confirm the point with the following statements which were made basing on the statistical data gathered in 2007: “The number of hospitals and emergency departments is decreasing while demand for care is increasing rapidly. Symptoms of this demand-capacity mismatch include emergency department (ED) crowding, ambulance diversion, and boarding of admitted patients due to lack of hospital beds” (Medeiros et al., 2008, p. 1526). Reduction of the waiting time, according to the author, is the primary goal which the optimisation of the patient flow should target. While the problem can be resolved with the embodiment of the so-called ‘see and treat principle’, which is used in the variety of countries including UK (Medeiros et al., 2008, p. 1526), medical practitioners should ask themselves a question whether it will affect the quality of care, and the comfortability of the staff, which will prevent the later appearance of fatigue and burnout. Medeiros et al. propose to use the alternative approach to the optimisation of the patient flow. It is called PDQ (Provider Directed Queueing). Its main advantage is that it “ places an emergency care physician at triage” (Medeiros et al., 2008, p. 1526), thus, reduces the possibility of the overuse of the medications, and uses the team-based approach to the delivering of care, rather than places all the responsibilities (examination, interventions, treatment, etc.) on the particular doctor. Additionally, this strategy can also be advantageous to the nursing personnel seeking independence from the doctors because of lack of skills and knowledge. They can be educated to expand their responsibilities and provide the more complicated medical services (for instance, they can conduct certain types of analyses). This approach will mainly be suitable for the small local healthcare facilities, where the patient flow can occasionally be unpredictable, and where the number of the hospital members is insufficient to satisfy the needs of all those seeking care.
The term ‘patient flow’ implies going through the several stages of providing and receiving care. Sayah et al. report that its primary constituents are the following ones: waiting in the ED, “ordering, collecting, testing, and verification of lab work”, transferring patients to the inpatient unit, managing of the orders by the inpatient team, and, finally, the performance of the so-called ‘planning activities’ oriented on the decreasing of the duration of patients’ stay in the healthcare facility (Sayah et al., 2013, p. 2). As in the previous case, Sayah et al. propose to use the team-based approach to the providing of emergency care and to the regulation of the patient flow. However, they are extending their strategy to the satisfactory performance of all the services mentioned above. The authors conducted their study in The Cambridge Hospital (TCH), which was always associated with the excessive patient flow, the dissatisfaction of patients, and the exhaustion of the medical personnel (Sayah et al., 2013, p. 1). The so-called ‘front end re-engineering’, which was tested by the team of the researchers, aimed to reduce the above-mentioned problems. Sayah et al. state that the patient flow optimization most likely will be put into jeopardy from the very first minutes of a patient’s referral to the hospital (Sayah et al., 2013, p. 7). They state the following: “We created a process where a customer service expert greeted the patient and placed in an ED bed immediately after a three-question mini-registration to identify the patient’s electronic health record (EHR) or create one for a new patient in the most expeditious way” (Sayah et al., 2013, p. 7). The overall quality of care and the satisfaction of patients increased after the strategy was implemented. The data provided by the Sayah et al. prove that the optimization of the patient flow will only be achieved after the team-based providing of care will be working in the emergency department.
There can be observed the particular case when there are obstacles to the optimization of the patient flow. For instance, when imaging and laboratory department of the hospital is not working under the increased demand for the medical services. It affects the work of the other departments as well, increasing the waiting time, and contributing to the dissatisfaction of a patient with the received care and examination. The implementation of the team-based approach to care can have the short-term, as well as the long-term effect on care under these particular circumstances. The expanding of the responsibilities of nursing personnel, and the constant working of the medical staff occupied with different types of work as the team, not in separation from each-other, can improve the patient flow. For instance, the delay which occurred in the laboratory department can be used to provide a patient with some emergency care, which does not require screening, or, if the case is severe and requires immediate intervention, postpone the registration process, and do the laboratory examination instead, and register a patient later. The effective patient flow management needs constant interactions of the medical personnel.
The reduction of the waiting time, of the overuse of sources etc. are the second-order effects of the implementation of the team-based approach to providing the healthcare services. The third-order long-term effect may be reached only when the strategy will be accompanied by the doctor’s constant emphasis on the importance of self-management whenever possible, and prevention. Hamrock et al. report the following: “ED volumes may be increasing in part because patients are having more difficulty accessing primary care and are turning to EDs to fill these unmet needs” (Hamrock et al., 2014, p. 44). That is, the patient flow can also be regulated preventatively. The overall aim of the team-based approach is to not only provide the care timely and follow the standards of quality of care but also to regulate the patient flow in advance, by emphasizing the importance of the development of the adequate healthcare receiving culture among patients. That is, the long-term third-order effects are harder to achieve, and they can only be tested after the team-based approach to providing care will be existing within the healthcare facility for the extended period. Its consequences, hopefully, can be concluded as follows: “Teamwork contributes to developing a high-reliability system, with the consistency of decision making and standardised operating procedures that help reduce errors and harm” (“Improving…”, 2013, p. 45). The medical personnel may benefit from the team-based strategy, and the patients will gain more possibilities to access the timely receiving of care.
So, the patient flow, which necessarily involves various stages of patients’ receiving care, can be improved only when all those stages taking part within the different healthcare facility departments will function as a whole. The medical practitioners working as a team can together optimise the patient flow, and implement the principles of the patient-oriented care into the functioning of the particular medical institution. The possible effects that it will have on the improvement of the patient flow are listed as follows: the reduction of the waiting time in the emergency department, the elimination of the unnecessary interventions, as well as of the excessive use of the valuable resources, facilitation of the process of placing a patient in the hospital for certain period of time, and, finally, the elimination of the possibilities for experiencing exhaustion and fatigue among the medical personnel.

References
Hamrock, E., Paige, K., Parks, J., Scheulen, J., & Levin, S.

(2014). Relieving emergency department crowding: Simulating the effects of improving patient flow over time. Journal of Hospital Administration, 4(1). doi:10.5430/jha.v4n1p43

Improving patient flow - health.org.uk. (2013, April). Retrieved June 10, 2018, from https://www.health.org.uk/sites/health/files/ImprovingPatientFlow_fullversion.pdf

Medeiros, D. J., Swenson, E., & Deflitch, C. (2008). Improving patient flow in a hospital emergency department. 2008 Winter Simulation Conference. doi:10.1109/wsc.2008.4736233

Sayah, A., Rogers, L., Devarajan, K., Kingsley-Rocker, L., & Lobon, L. F. (2014). Minimizing ED Waiting Times and Improving Patient Flow and Experience of Care. Emergency Medicine International, 2014, 1-8. doi:10.1155/2014/981472

Swaanenburg, E. (2010, April). Optimizing patient flow planning - Tilburg University. Retrieved June 10, 2018, from

https://www.health.org.uk/sites/health/files/ImprovingPatientFlow_fullversion.pdf