You certainly aren’t being ignorant – you make a good point on why beds availability as a KPI shouldn’t be used. One problem with your scenario (bear with me – I’m a bit long winded):
The point of all this is there should be a standard time for each procedure – including a recovery time; but there ought to be a little flexibility for complicated case, where patient’s have unexpected pathology or take longer to recover.
In manufacturing – TPS style – any ‘patient’ who needs more than a ‘standard time’ sets off an Andom alarm and is pulled off the line and examined elsewhere.
We can calculate average standard times for procedures in areas like surgery. We can also calculate average standard times for different DRGs. However the difference in standard deviationis tremendous between the 2. For example, I can know with relative certainty that a specific cath procedure will take 45 minutes, have 1.5 hour of cath recovery, and 5 hours of CVICU recovery time. If someone comes in complaining of shortness of breath, possibly a COPD issue, but not sure, the LOS std deviation is amazing. So, finding a standard time for that process is a little unreasonable – that is where one part of the problem lies. It’s actually the less acute patients that have the greater variability in treatment time – on average. There is much more variation in a person’s care than in making a widget. I’ve worked in both environments and can attest to it. That is why Lean 6 sigma is so needed in healthcare.
Now – as for beds being available as a KPI. I wouldn’t use that either. There are some other variables that go with that. Nurse:Patient ratio is one. Your bed capacity may change daily based on your staffing. I think bed turns, bed utilization (in place of a full bed measure), bed turnover times, intent to discharge vs discharge (i.e., the difference in time), discharge time of day, ED to Floor time after disposition, diversion hours, transport response time, are all better measures of throughput than beds full. Last problem – other than clinical data, most hospitals are data poor in terms of throughput. Only since 1999 or so has there been a huge effort for throughput as an improvement issue. Baby boomers, financial issues, etc. have caused this, in my opinion. I wished they had looked at it sooner.
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