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Enhancing work flow to reduce crowding.

Bruce Siegel¹, Marcia J Wilson, Donna Sickler

¹Department of Health Policy, The George Washington University School of Public Health and Health Services, Washington, DC, USA. siegelmd@gwu.edu

Joint Commission Journal on Quality and Patient Safety

|January 5, 2008

Summary

Hospital crowding, particularly in emergency departments (EDs), is a significant issue. Implementing operations management techniques focused on patient flow and capacity can effectively reduce ED crowding and improve hospital efficiency.

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Area of Science:

Health Systems Management
Operations Research in Healthcare
Patient Flow Optimization

Background:

Significant hospital challenges include ambulance diversion (affecting ~33% of US hospitals) and emergency department (ED) crowding (~50%).
Hospital leaders often perceive ED crowding as a consequence of workforce shortages.
Numerous health systems are actively pursuing strategies to enhance patient flow and alleviate crowding.

Purpose of the Study:

To explore effective strategies for improving patient flow and reducing emergency department crowding.
To identify key components of successful patient flow initiatives within health systems.

Main Methods:

Review of operations management techniques applied to hospital workflow, including performance measurement, demand forecasting, flow redesign, and capacity management.
Analysis of common implementation approaches, such as rapid improvement techniques.
Focus on strategies addressing transitions between ED and inpatient units and overall hospital capacity.

Main Results:

Successful patient flow improvement hinges on organization-wide commitment to measurement, data transparency, and sustained management focus.
Strategies must extend beyond the ED, addressing inter-unit transitions and maximizing total hospital capacity.
Tangible, immediate steps can be taken by health systems to improve flow and reduce crowding.

Conclusions:

Health systems possess actionable strategies to immediately enhance patient flow and decrease crowding.
Further controlled trials are recommended to evaluate existing strategies using standardized performance measures.
Sustained management attention and a focus on inter-unit transitions are critical for reducing ED crowding.