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Optimising hospital patient flow - a key step towards high quality and sustainable healthcare?

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Managing patient flow effectively is fundamental to any hospital’s operational efficiency and sustainability. Maximising finite resources, whilst ensuring safe patient outcomes, is a core objective. A winter bed crisis in the NHS and the risks of a potential flu pandemic have placed the issue into sharp focus.

As the UK population ages, debates have concentrated on how the NHS should adapt. In 2014, the NHS Five Year Forward View (FYFV) called for greater integration of services. Consequently, Sustainability and Transformation Partnerships (STPs) and Accountable Care Systems (ACS) are enabling collaboration. Appropriate patient transitions are a key measurement of joined-up health care.

National and local provider initiatives seek to ensure quality integrated care and eliminate unnecessary waits for patients, while minimising costs. Digital technology advances provide a significant opportunity to achieve this. The NHS will be able to improve understanding of patient needs, tailor services, improve outcomes and deliver efficiencies - freeing up resources for frontline services.

The Clinical Utilisation Review (CUR) offers a scientific and internationally recognised evidence-based approach. Using a web-based software CUR solution automates many time consuming manual processes, delivering in-built admission and discharge criteria which effectively remove subjectivity and reduce the negative effect of people working in isolation. Too often, variances lead to patient delays, or worse - readmission. Information should be easily shared using purpose-built technology driving the redesign and delivery of processes.    

CUR identifies patients ready for discharge (RFD), providing insight into systemic bottlenecks. Solutions can be designed to improve patient flow, patient experience and overall service integration with data based on CUR evidence; not a subjective viewpoint. Minimising unnecessary stays is key to managing limited bed capacity and resources. Every day of stay beyond clinical necessity risks the patient’s wellbeing, and costs for the provider.

Hospitals either have a Patient Administration System (PAS) or an Electronic Patient Record (EPR) with an existing flow capability for bed management, or one that at least shows discharge status. Yet, there is no insight into appropriateness of care, avoidable admission or days of stay; nor internationally researched criteria that cover all levels of healthcare.

To overcome this, the NHS SAFER Patient Flow initiative works effectively with CUR. Red to Green Days is a visual management system where a Red Day is a day of no value and a Green Day is when a patient receives acute care only deliverable in hospital, progressing them towards discharge.

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Reducing unnecessary stays is an absolute priority in the NHS. The Last 1,000 Days campaign asks: if you had 1,000 days left to live, how many would you choose to spend in hospital? Patient time is the key metric of performance with quality best measured from a personal perspective.

Achieving good patient flow requires reliable data. An efficient software-based CUR solution will deliver patient assessments that can be conducted daily by nurses in under two minutes. Operational and clinical teams often ask similar questions; however, they aren’t being applied to every patient every day.

CUR also helps introduce standardisation. Using criteria to drive discharge planning empowers staff to make decisions based on proof. A software-based CUR solution enables clinical teams to have a clear picture of discharge blocks - and who needs to take responsibility.

The biggest challenge to adoption is culture change. It’s crucial to gain nurses’ confidence in new technology and show it won’t increase their daily burden. CUR replaces outdated manual practices and this appeals where resources are often stretched.

Introducing ownership and accountability for the patient journey from point of admission requires strong leadership from a trust’s senior team and engagement with partner organisations. All groups in and outside hospitals need to collaborate and act together. Many organisations introduce discharge teams responsible for managing transition, helping to improve integration between services.

To achieve the transformation, trusts need to supplement core capabilities with more advanced solutions, such as, tools identifying patients at high risk of an adverse event and amenable to a particular intervention. They also will need electronic patient records, giving all clinicians the full picture and tools to support the monitoring of wider system programmes. This supplementation of core capabilities should also include enhanced tools that integrate clinical workflow with patient activation data to ensure treatment in the right place at the right time.

Crucially, it will require a fundamental shift in how clinicians, managers and patients use new digital technologies, data and innovations to support delivery of ongoing service improvements to manage flow and deliver positive outcomes for patients each and every time.

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