iSixSigma

Throughput

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  • #25479

    BritW
    Participant

    Do any of you have a designated person/people for patient flow from the ED or Direct admits to an inpatient bed – someone like a Patient Flow Coordinator?  If so, who do they report to at your facility?

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    #61464

    sharon fiola
    Member

    we have a bed management clerk, but no one in nursing other than unit managers responsible for actual bed flow…..the evening and night supervisors manage on their particular shifts but otherwise it is a team effort.  

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    #61468

    Rameshp
    Participant

    Hi Brit,
    Yes we do have a Patient flow co-ordinator in our facility who is an RN and reports to our Administrative driector of the facility.

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    #61469

    Lesley
    Participant

    Hi
    we have someone we call a navigator to move patients through from our ER to the assessment ward and into the main hospital. They report to the ER managers but work across the boundaries of medicine and surgery. The issue for us was hitting the 4 hour target for transit through the ER department here in the UK and this post removes the bottleneck found in onward moves
     

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    #61472

    Jonathon Andell
    Participant

    Having a dedicated staff expediter is a band-aid on a broken process. It would make more sense to analyze and modify the process, than burn resources on find-and-fix missions.
    Just one person’s two-cents’ worth.

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    #61473

    BritW
    Participant

    This function is a part of the process, not a bandaid. It’s not an expediter, like in manufacturing/supply chain.  How would you propose having a link between what comes into the hospital and bed availability on the floor – especially the need to move patients from room to room to make way for incoming admits?  There is no other way I have found other than having someone make an diagnostic assessment, due the demographic due diligence (males can’t be roomed with females, isolation requirements such as TB, etc.), tell the floor they are receiving a patient, then making patient moves to accommodate the new arrival.  It may not be called a patient flow coordinator, but the function still has to exist.
    It isn’t a broken process having this position – most hospitals do.  It is actually a part of the process – people just call the position different things.  The info I’m looking for is who this position reports to in other facilities, what autonomy do they/don’t they have over the floor nurses, and what reporting functions are out there to benchmark against.  I know my answer to the last two- just looking for some responses to the first question.

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    #61475

    Carr
    Participant

    Hi Brit,
         Our hospital has a shift nursing supervisors that report to nursing administration.  They use a bed tracking system to manage the flow.

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    #61486

    SandyD
    Member

    Brit,
    I agree with this position being a part of the process, not a bandaid.  It’s similar to the water spider concept in a production process.  The difference being the movement of patients rather than incoming products for processing.  I hadn’t thought of applying the concept to a hospital setting.  But now that I’m thinking about it, we could also utilize this position to improve communications on transfer from one department to another.  I work in a 50 bed rural hospital.
    If you have any suggestions for how I could present the concept to the director of ER and our inpatient floor, I’d appreciate hearing them.  Any details on the responsibilities of this position would be helpful. In our environment it would have to be part of an existing staff person’s responsibilities rather than a stand alone position.  As I’ve only been in the hospital environment for 4 months, I’m still getting the hang of things.  But do know that patient handoffs are an issue.

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    #61487

    BritW
    Participant

    A few ideas:

    For your size hospital, you may not need an extra position, however, it is critical whoever does the position not report to a floor/unit Director (fox guarding the hen house).  I would consider having a sole position however.
    Position needs to be clinical – part of their job is to assess direct admits to make sure they are in the condition represented by the admit orders – if they have advanced, then they may need to go to a different floor or even the ED.  Someone needs to move patients from unit to unit as capacity is maximized.
    If you do not have electonic bed tracking (and maybe even if you do) it is wise to have someone designated (accountable and responsible) for bed turns on each unit (especially med/surg).
    Start tracking bed turns, patient out to room ready, ed hold times between admit order and patient in room, housekeeping TAT, et al.  If you don’t measure it, it won’t be fixed.
    Create a formal handoff procedure (this is a Joint Commission requirement as well as a necessity).  Part that is often missed is transport – we use a “hall pass” concept with a 3×5 index-type card that goes from nurse to transporter – even on discharge.  You will also have handoffs from unit to unit, unit to ancilary, and admitting to unit.  Good idea to connect med reconciliation to these steps as well.
    There are a few more, I will forward later.
    One thing I have found useful – get the basic steps on a whiteboard. Patient Arrives – Triage/Assessment – Admit Orders – Assign Bed – LOS – Discharge Order – Transport Out/Room Clean.  Have the stakeholders design how they want it to be instead of retrofitting what already is. 

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    #62021

    kumar
    Participant

    we are having patient co-ordinater in EMD. he reports to administrater.

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