In the United States, ED overcrowding is a major concern in most hospitals. Recent media reports highlight the perils and challenges of busy EDs, including “A Doctor’s Diary: The Overnight Shift in the E.R.” in last month’s New York Times. That article noted, “Americans visit the E.R. more than 140 million times a year – 43 visits for every 100 Americans—which is more than they visit every other type of doctor’s office in the hospital combined.”
While leaders look for long-term solutions, one thing organizations can do is optimize bed placement procedures to reduce the amount of time required to move admitted ED patients to clean inpatient beds. HBI recently spoke with leaders from several U.S. healthcare organizations about their experiences with patient flow solutions. To address follow-up questions from members surrounding typical bed placement performance metrics, HBI spoke with Janet Hanley, vice president of patient technology, innovation, and efficiencies at Sharp HealthCare. Although feasible performance levels can vary significantly from one organization to another—due to factors such as technology used, physical characteristics of the facility, and more—these experiences offer leaders a starting point for gauging how their organizations compare.
HBI: How long does it take for bed placement staff to assign a bed for ED admissions?
Hanley: When there’s an order for admission, the order feeds our patient flow solution and a bed request is created. The ED staff will enter particular attributes that will help the placement of the patient. When the bed request comes across, there’s a second piece that we ask for: We do not assign the bed until ED staff confirm that the patient is ready to move. That means the patient can be packed up and moved to the next bed immediately. On average, we could have a bed request for a couple of hours before the patient is ready to move. However, if we have the capacity, the bed assignment can be instantaneous after that.
In hospitals that function at close to full capacity, especially at specific times during the day, the time from “ready to move” to moving the patient will be affected. My advice for hospitals would be to focus on getting the inpatient beds empty through timely discharge more than on moving the patients upstairs to the unit.
HBI: What is the average time between a patient discharge order being written to actual discharge?
Hanley: Once the patient has a discharge order, our goal is that they should be able to leave the hospital within two hours. We’re tracking this metric across the board.
When multiple doctors are involved and want to see patients right before discharge, but they are in a meeting or surgery, that can delay the process. So, they’re using conditional discharges—the patient can be discharged as long as certain predefined criteria are met. As part of that, we’re focusing on the discharge criteria and working with clinicians to make sure that if these items need to happen before the patient can leave, those aren’t left for the discharge date, but are happening the day before or as soon as possible.
Also, our facilities have several Lean Six Sigma projects on patient discharges and collaborating with clinicians to get patients home or to the next level of care safely. This helps patients in the ED waiting for a bed. We are trying to move the discharges to earlier in the day so that we can effectively manage new patient volume. In terms of measuring performance, we track three metrics across the system: From the time discharge order is created to the time a patient leaves the campus; from the time a patient leaves to the time EVS responds, and from the time EVS responds to the time a bed is clean for the next patient.
HBI: How long does it take for EVS to be notified that a room requires cleaning and to get it ready?
Hanley: On an average, it’s less than 15 minutes because once the patient gets discharged out of the computer, EVS is notified immediately and automatically. The only time we see a longer interval between the patient leaving and EVS being notified is when someone didn’t discharge the patient out of the computer fast enough, and we monitor that. One of our hospital sites does patient tracking—patients have armbands with trackers on them. As soon as the transporter (ambulance service or in-house transportation) arrives to take patients out of the campus, the armband gets cut off and is dropped in an electronic box. This process automatically discharges the patient out of the computer and notifies EVS. In this case, EVS is notified within a minute.
Our EVS vendor is a contracted service; the EVS staff have 30 minutes to respond to the cleaning request and 30 minutes to clean the bed. We have three different bed statuses: “Stat bed” means the bed is needed immediately, “clean next” means clean the bed after completing the current task at hand, and “basic clean” signifies that we may or may not need the bed yet, so the EVS staff can finish cleaning other beds and then clean this one. The response time is shortened if it’s a stat bed, so it could be 15 minutes to get to that room. We never change the cleaning time because you want the room to be cleaned accurately.
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