The safe patient flow initiative: a collaborative quality improvement journey at Yale-New Haven Hospital

Yale-New Haven Hospital (YNHH) began a successful journey to achieve safe patient flow in fiscal year (FY) 2008 (October 1, 2007-September 30, 2008). The 966-bed (now 1,541-bed) academic medical center faced several challenges, including overcrowding in the Adult Emergency Department (ED); delays in the postanesthesia care unit, which affected the flow of patients through the operating rooms; pinched capacity during the central part of the day; and a lack of interdependent institutionwide coordination of patients.

The Safe Patient Flow Steering Committee oversaw improvement efforts, most of which were implemented in FY 2009 (October 2008-September 2009), through a cascade of operational meetings. Process changes were made in various departments, such as the Adult ED, Physicians/Providers, and the Bed Management Department. Organizationwide method changes involved standardizing the discharge process, using status boards for visual control, and improving accuracy and timeliness of data entry.

Between FY 2008 and FY 2011, YNHH experienced an 84% improvement in discharges by 11:00 A.M. The average length of stay decreased from 5.23 to 5.05 days, thereby accommodating an additional 45 inpatients on a daily basis, contributing to YNHH's positive operating margin amid increasing volume and overall decreasing inpatient length of stay.

YNHH improved clinical, operational, and financial outcomes by embracing five key components of demand capacity management: real-time communication, inter/intradepartmental and interdisciplinary collaboration, staff empowerment, standardization of best practices, and institutional memory.