Patient flow is the key to increasing revenue
Maximizing technology important
A tremendous opportunity for increasing revenue lies in improving your hospital’s patient flow, says Marjorie Bogaert, a senior manager who works in the areas of patient flow, capacity management, and care management for the international consulting firm, Cap Gemini.
"I’ve seen a huge number of hospitals who have been able to increase their emergency department (ED) business and their regular admissions, as well as patient and physician satisfaction, in this way," adds Bogaert, who leads consulting teams working with hospital clients throughout the United States. "No matter where we go in the country, we find that the No. 1 or No. 2 problem on the CEO’s list is patient flow," she points out. "It varies a little by market."
Underbedded or understaffed?
Some fast-growing areas, such as Portland, OR, and Las Vegas, are known particularly for being "underbedded communities," according to Bogaert. In some cases, a hospital may have enough beds, but not enough staffed beds, she notes. In assessing client operations, Bogaert says, it is not uncommon to find as many as 10 patients being held in the ED, waiting for a bed, for 24 hours or more. In other cases, patients needing beds wait long hours in the recovery area, she adds.
There isn’t one easy answer to the patient flow dilemma, Bogaert says, and certainly the front end is not the total problem. But she notes that her teams find a large number of admitting and access departments that still have manual processes. "We have clients in situations where they still have little blue or pink cards — indicating male and female patients — and staff walk over to the bed board [to try to find a place for them]," says Bogaert. "As for how many beds are clean, how many are dirty, they really don’t know. They may have an admitting/discharge system, but they don’t have an electronic bedboard," she notes.
Such operations are "very labor-intensive and very dependent on people," Bogaert explains. "A high percent of those we see have not moved to technology."
Even those facilities that actually have a bed management system that provides such information as whether beds are clean or dirty may not be fully automated, she points out. "We’ll see an admitting rep who is still using a manual log, and then entering the information into the system.
"Or we’ll ask if they’ve seen the reports, and the answer is no,’" Bogaert says, "or how long it will take to clean a bed. They have no idea."
Unless the bed management system is part of a well-planned process, she emphasizes, "you’re not going to maximize the technology."
Another key to the access piece of the patient flow process, Bogaert says, is having a nurse who serves as "bed czar" or works closely with admitting in some role. "That’s critical in determining the appropriate level of care."
"One of the other positions we see that is very important — with any midsize to large hospital — is an ED access care manager, who will help determine if a patient needs to be admitted and, if so, at what level of care," she notes.
Without that manager in place, coordination tends to be lax, with patients being admitted to a level of care that is not appropriate, or just put in the next available bed, Bogaert adds. "Then there is a huge amount of work involved in moving the patient."
It’s also important, she says, for those mid- to large-size hospitals to use a bed placement algorithm, whereby cardiac patients, for example, always go to Unit A, and if that unit is filled, to Unit B, so that staffing is aligned properly. "Chemotherapy patients are normally on a floor where nurses are trained in chemotherapy," Bogaert says, "so if those patients are put anywhere else, the hospital will have to get the nurses down there."
A tremendous opportunity for increasing revenue lies in improving your hospitals patient flow, says a senior manager who works in the areas of patient flow, capacity management, and care management for the international consulting firm, Cap Gemini.
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