Understanding patient flow in hospitals

"Previous Nuffield Trust work has argued that although the target can be over-emphasised, struggles in meeting it are associated with deeper problems in the capacity to move patients into hospital wards. This briefing draws on theories about congestion to look at why this has become more difficult, and what can be done about it. It aims to be useful to the hospital managers and people involved in Sustainability and Transformation Plans who tackle these problems on the front line, as well as to the policymakers who oversee them."

Understanding patient flow in hospitals
S Karakusevic, N Edwards
Nuffield Trust
October 2016

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Emergency Care Improvement Programme

"The Emergency Care Improvement Programme will focus on helping 28 urgent and emergency care systems across England that are under the most pressure and will deliver real improvements in quality, safety and patient flow."

Access improvement tools, videos and more at the NHS Emergency Care Improvement Programme website.

Improving emergency department flow through Rapid Medical Evaluation unit

"By specifically re-purposing a fraction of existing staff, resources, and infrastructure for patients with lower acuity presentations, we were able to streamline their care and decrease wait times in the ED"

Improving emergency department flow through Rapid Medical Evaluation unit
L Chartier, T Josephson, K Bates, M Kuipers
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u206156.w2663

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Four Simple Ward Based Initiatives to Reduce Unnecessary In-Hospital Patient Stay

"A six cycle prospective audit was carried out to investigate if four simple ward based initiatives could optimise patient flow through a medical ward and reduce LoS [length of stay] of inpatients awaiting social packages and placement."

Four Simple Ward Based Initiatives to Reduce Unnecessary In-Hospital Patient Stay: A Quality Improvement Project
A Shabbir, G Wali, A Steuer
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u208974.w3661

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Waiting time reduction in intravitreal clinics by optimization of appointment scheduling

"This study was designed guided by the Model for Improvement framework to reduce waiting times and visit duration in the intravitreal therapy clinic, while improving patient and staff experience. In our aim to provide good quality, patient-centred care and constantly improve, we optimised the appointment profile and patient flow."

Waiting time reduction in intravitreal clinics by optimization of appointment scheduling: balancing demand and supply
M Ugarte
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u208924.w3618

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5 basic hospital inefficiencies and their quick fixes

"Although many of the issues that lead to inefficiency may be complex, there are still some quick fixes that can add up to huge savings in both staff time and money. Here are some of the most common hospital inefficiencies and some simple strategies that can help to correct them"

5 basic hospital inefficiencies and their quick fixes
J Henry
Healthcare Dive
February 2015

Read more here.  

Traffic lights: putting a stop to unsafe patient transfers

"we feel that our tool could be developed for use for all intra-hospital transfers at Watford General Hospital, and could be more widely used in acute hospital trusts under similar pressures to increase patient flow, reducing the clinical risks associated with patient transfer."

Traffic lights: putting a stop to unsafe patient transfers
A Parbhoo, J Batte
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u204799.w2079

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Improving patient flow in pre-operative assessment

"This improvement project sought to decrease waiting times for patients at a pre-operative assessment service at Raigmore Hospital in Inverness, and to increase the proportion of patients who were seen on the same day as the decision to operate was made."

Improving patient flow in pre-operative assessment
C Stark, A Gent, L Kirkland
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u201341.w1226

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Focus on: A&E attendances

"We explored a range of factors thought to be contributing to increased pressure on A&E in the English NHS and tested whether recent changes in these factors could explain the current pressures observed in the system." 

Focus on: A&E attendances: Why are patients waiting longer?
I Blunt
Nuffield Trust, The Health Foundation
July 2014

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The patient safety culture as perceived by staff before and after introducing a flow-oriented working model

"The aim of the present study was to describe the patient safety culture in an ED at two different hospitals before and after a Quality improvement (QI) project that was aimed to enhance patient safety."

The patient safety culture as perceived by staff at two different emergency departments before and after introducing a flow-oriented working model with team triage and lean principles: a repeated cross-sectional study
L Burström, A Letterstål, M Engström, A Berglund, M Enlund
BMC Health Services Research 2014, 14:296

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Improving patient flow across organisations and pathways

"This scan compiled research about the methods used to improve patient flow across organisations or pathways."

Improving patient flow across organisations and pathways
D de Silva
The Health Foundation
November 2013

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Urgent and emergency services

"Growing demand on A&E departments will make them unsustainable if effective action is not taken quickly to relieve the pressures on them."

Urgent and emergency services
House of Commons Health Committee
July 2013

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Improving patient flow

"The Health Foundation created the Flow Cost Quality improvement programme to focus on the relationship between patient flow, costs and outcomes in two NHS hospital trusts: South Warwickshire NHS Foundation Trust and Sheffield Teaching Hospitals NHS Trust."

Improving patient flow: learning report
The Health Foundation
April 2013

Read more here.

Case studies available here.

Waiting management at the emergency department

"To manage non-acceptable waiting is a driving force behind much of the staff behavior at an Emergency Department."

Waiting management at the emergency department - a grounded theory study
L Burstrom, B Starrin, ML Engstrom, H Thulesius
BMC Health Services Research, 2013, 13:95

Read more here.