March 8, 2006
Capacity management is no easy task. Multiple bed management functions -- occurring from before admission through discharge -- and their interrelations affect patient and bed status and how this information is relayed. Although challenging, taking action to improve your hospital's ability to manage demand is critical for optimal financial performance.
The emergency department (ED) is a logical starting point for improvement to patient throughput, particularly as it is often the first to reach full capacity and 50 percent or more of admissions typically originate in the ED. A new HFMA educational report, sponsored by McKesson Corporation, examines how some hospitals are meeting the challenge.
Overcoming a Capacity Crisis
In June of 2001, Ingalls Health System, a 500-bed community hospital in Harvey, Ill., spent the equivalent of 10 full days on hospital bypass. The ED was overwhelmed, and doctors were frustrated because they couldn't admit patients.
"We had to take some very drastic action," says Jim Smith, former director of physician integration at Ingalls and currently consulting manager for IMA Consulting in Chadds Ford, Penn. He served as the capacity management guru at Ingalls and was director of the two-year patient throughput initiative.
Quick Relief
First, the hospital needed a "quick-relief valve" to manage patient flow and show a dramatic improvement to the medical staff. Within 30 days, Ingalls administrators created a patient throughput center -- known as the admission and discharge center -- to serve as a staging area for patients who have an order for direct admission but cannot be admitted because a bed is not available. The admission and discharge center was placed in a converted office area of the first floor, next to the hospital's admitting department and preadmission testing center.
Then installation began for five patient areas, which could be expanded to seven after 4 p.m. by using the preadmission testing center. The admission and discharge center is still in place today. There, staff assess each patient and initiate care, and patients complete the necessary paperwork.
"The inpatient nurses love it because patients come 'packaged' with the front-end, labor-intensive work already done," Smith says. Ingalls was the first to add such a center in the Chicago area, and other hospitals have followed.
All Hail the Bed Czar
Ingalls also added a "bed czar," whose official title is director of patient access, although she is not responsible for admitting. At hospitals around the country, bed czars have a range of titles, but their responsibilities are basically the same. They manage patient flow by ensuring the timely transfer of patients from the ED to the inpatient units.
Several other key changes also followed, such as establishing an 11 a.m. discharge time and adding a patient tracking system to monitor delays in admission. In June 2002, Ingalls had reduced diversion hours to 51, down about 79 percent from the year before. By trimming diversion hours, Ingalls not only helped boost its inpatient revenue to 26 percent over budget, but it also eased the stress on admitting and discharge.
Shorter LOS for Cardiac Cath Patients
One other noteworthy success was that length-of-stay (LOS) for intrahospital transfers of cardiac catheterization patients at Ingalls dropped from 5.15 days to 4.9 days. The change came after Ingalls no longer admitted patients the evening before the scheduled procedure, as had been customary practice. Instead, staff managed the patient's preparation through the hospital's admission and discharge center the morning of the procedure.
Sharing Capacity Management Know-How
Some organizations, such as San Antonio's University Hospital, are sharing what they've learned along the way through collaborations like Urgent Matters, a $6.4 million initiative of the Robert Wood Johnson Foundation, housed at The George Washington University in Washington, D.C. Khoa Nguyen, MPH, an improvement expert with Urgent Matters, has studied hundreds of hospitals combating capacity issues. A key piece of advice he offers is to tackle the issues as an enterprise.
"Whether the tools and processes you choose are low-tech or high-tech, leaders must embrace this as hospitalwide change," Nguyen says. "Then they must embed capacity management metrics into hospital dashboards and performance evaluation."
SOURCE: Tackling the Capacity Crisis: Successful Bed Management Strategies, an HFMA educational report sponsored by McKesson Corporation.
Additional Resources
- Tools and tips to improve patient throughput from Urgent Matters
- Tools and tips from the Institute for Healthcare Improvement
- Process Improvement in Hospitals: a Four-Part Series of HFMA reports
- HFMA Executive Roundtable: Improving OR Throughput: Real World Successes and Challenges
- Healthcare Financial Management articles
- "Containing Costs in the ED," April 2005
- "Effective Demand Forecasting in 9 Steps," November 2004
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HFMA'S ANI 2006 PROVIDES IDEAS AND TOOLS SO YOU CAN ACHIEVE RESULTS
At HFMA's 2006 Annual National Institute (ANI) in Orlando, FL, June 17-21, you can network with your peers, meet leading vendors in the Idea Exchange Exhibit, and attend breakout sessions that provide you with ideas and insight you can use to do your job better.
Sessions include:
Strategies to Improve Critical Access Hospital Margins, which includes tips on developing a bed management strategy.
Implementing an Effective Case Management Improvement Program, which teaches you how to determine the financial and operational impact of inefficient and non-standardized case management processes.
The Impact of Effective SSI Enrollment on DSH Payments, which offers tips and practices to improve the admission process.
Get complete details and register for HFMA's ANI 2006 now!
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HFMA Wants You to Know ISSN: 1540-0697. Volume V, Issue 5. Copyright 2006, Healthcare Financial Management Association. All rights reserved.