Enhancing Hospital-Wide Patient Flow to Reduce Emergency Department Crowding and Boarding.

Area of Science:

• Healthcare Management
• Hospital Operations
• Patient Flow Optimization

Background:

• Emergency Department (ED) overcrowding and patient boarding are significant global issues impacting patient outcomes and hospital operations.
• Poor patient flow is a primary driver of ED overcrowding and boarding.
• Addressing these issues is critical for improving healthcare delivery.

Purpose of the Study:

• To implement a multidisciplinary rounding team to address patient flow barriers in real time.
• To reduce inpatient length of stay and improve bed capacity.
• To alleviate ED boarding and overcrowding through enhanced hospital throughput.

Main Methods:

• A before-and-after process improvement project was conducted on a 30-bed inpatient medicine floor.
• Multidisciplinary rounding was utilized to enhance care team communication and collaboration.
• Real-Time Demand Capacity model concepts informed the strategy for bed supply and demand management.

Main Results:

• Implementation of multidisciplinary rounding led to a statistically significant reduction of 0.83 days in patient length of stay.
• ED boarding hours for the targeted medicine floor decreased by an average of 8.83 hours per month (>50% reduction from baseline).
• Increased inpatient bed capacity was achieved, directly impacting ED flow.

Conclusions:

• Increasing inpatient bed capacity effectively reduces ED access block and overcrowding.
• Daily multidisciplinary rounding on inpatient floors expedites discharges, creating necessary bed capacity.
• This approach enhances overall hospital throughput and efficiency.