Inpatient pathways and the patient flow challenge: Developing a targeted end-to-end inpatient flow model to address the patient flow challenge and create a step-change in ED performance.
In the 2015/16 financial year, total attendances in ED across the UK increased by 5% year on year. However, the number of patients waiting more than 4 hours from arrival to admission, transfer or discharge increased by 97%.
In the first 2 quarters of 2016/17, ED attendances were 7% higher than the same period in 2013/14, but breaches were a staggering 253% higher.
This is the equivalent of an additional 3,739 patients breaching per day in 2016/17 compared to 3 years earlier.
It is clear from these figures that NHS Trusts have reached a critical tipping point. With an ageing population that continues to grow, demand is only going to increase. Couple this with a £1.85 billion deficit for NHS providers and commissioners in 2015/2016 and it becomes clear that a huge step change in performance is needed.
The only solution is to improve the flow of patients through the hospital.
A targeted and proven solution
The end-to-end inpatient flow model addresses this challenge through the following key interventions:
- Proactive Discharge Planning – Implementing a discharge planning tool to:
- Visualise and track the current discharge status of ward patients
- Align and coordinate supporting discharge services to expedite safe discharge, ensuring patients leave the hospital on their PDD (planned discharge date)
- Coordinated Bed Management – Implementing a systematic and comprehensive bed management approach to:
- Improve communication and understanding of bed availability and status
- Forecast likely demand to identify any potential capacity constraints
- Coordinate admissions with discharges to maximise effective handover and utilisation of beds
- Ensure the patient goes to the right bed, first time
These interventions are underpinned by the implementation of a problem solving methodology and an end to end management framework that visualises the process, promotes communication and collaboration across the end to end pathway and highlights bottlenecks in the process that are inhibiting performance. Through clear process and ownership, the operational teams are equipped with the tools and capability to effectively manage and overcome the current and future problems; improving the flexibility, responsiveness and safety of the service.
Our patient flow solution delivers benefits far and wide. We have delivered:
- Improved ED performance and fine reduction – Improved 4 hour ED performance by up to 21 percentage points (75 – 96% adherence), reducing fines by over £200,000 per month
- Eliminated 12 hr ED breaches and fines – We have reduced 12 hr ED breaches by up to 100% over a 6 month period
- Reduced ED Treatment times – Reduced ED treatment times by 57%
- Improved patient handover – Reduced ambulance turnaround time by 16%
- Proactive discharges – Increased morning discharges by 13%
- Reduced patient length of stay – Reduced average patient length of stay by up to 30% in key medical specialties
- Increased bed availability – by reducing length of stay, we have created additional capacity equivalent to 42,000 bed days per year, or 3 full wards
- Improved patient safety – Reduced the number of unnecessary bed moves including medical outliers by up to 31%
- Improved patient experience - Increased patient satisfaction from 84% to 94%
- Reduced impact on elective activity – 23% reduction in operations cancelled due to bed availability