Patient Throughput: A Team Sport

Patient Throughput: A Team Sport

Like a coach can’t count on a winning season based on the ability of an individual player, hospitals can’t expect to improve patient throughput based on the competency of any individual department. The most legendary teams are successful because they harness the power of the team, aligning to achieve the same outcome, communicating about challenges, and strategizing to overcome those challenges by dialing in and leveraging the way individual team members’ strengths work together. To successfully and sustainably improve patient throughput, hospitals and health systems are taking a page from any great coach’s playbook: engender a sturdy team mentality.

Throughput can’t improve within the confines of an emergency department, hospitalist program, PCP office, or any post-acute care setting. The key is to inspire a team mentality to transcend hospital silos so that key players can pass the baton seamlessly across each patient’s care journey.

We recommend examining the following key areas impacted by hospitalists to improve patient throughput:

Develop standard criteria for admissions from outpatient providers.

Often when a patient arrives at an emergency department from an outpatient physician’s office, caring for the patient in the ED is the default plan. However, there are opportunities for both efficiency and betterment of patient care when facilities develop a standard system for evaluating which patients should be sent to the ED and which should be directly admitted to the inpatient service. Work with your ED and inpatient clinical leaders as well as outpatient providers to develop standard criteria that outline which patients are sent to the ED versus directly admitted. A unified system will help your facility place patients who need inpatient beds in an appropriate care setting as soon as possible.

Increase communication between hospitalist and emergency department providers.

When it comes to improving patient throughput, the interface between hospitalist physicians and ED doctors tends to get the most attention. This pain point hinges on ED and hospital medicine physician’s differing approaches. When the ED provider decides to admit a patient, they want the patient out of the ED as quickly as possible to use the bed for another patient. The ED provider doesn’t understand why the hospitalist isn’t appreciating the urgency. On the other hand, hospitalists are navigating based on their own competing priorities (discharging a patient, meeting with a waiting family member, or admitting the next patient from the ED). Because of limited time and resources, hospitalists value a thorough diagnostic work up over a fast transfer and may want to see the patient in the ED before a decision is made to admit. To improve patient throughput, it’s crucial that your inpatient and emergency medicine teams communicate to understand each other’s perspective and set standard patient-centric processes that address both department’s perspectives and meet the patient’s needs.

Bring all players to the table to coordinate care for admitted patients.

Once the patient is admitted, there are multiple ways in which healthcare providers do not function as a team but rather view themselves as solo players. Specialty consultants and the hospitalists cannot function as two ships in the night, each caring for the patient and making medical decisions without communicating or coordinating their care. Likewise, it is critical for the nursing staff and provider groups to communicate effectively when performing their delegated tasks; viewing their roles as a team managing the patient together is essential. The other allied health professionals, such as physical or speech therapy, or the dietician must follow the same team-based patient management approach. Only by working as a team can the patient be assured of receiving the correct care at the correct time with the best outcome.

Formalize discharge planning for post-acute care transitions.

There are three common areas for improvement in the patient discharge process:

1. Interdisciplinary discharge planning

During a patient’s hospital stay, there is often poor coordination on discharge planning. The potential discharge needs of the patient should be determined as soon after admission as possible. The patient condition should be monitored throughout the patient stay and discharge needs must be adjusted as necessary. Any potential change should be documented and communicated to all team members caring for the patient, including case managers, discharge planners, and any therapists or specialists involved.

2. Pre-discharge coordination and patient communication

As a patient approaches their discharge day, hospitalists should consistently communicate with the patient, family, nurses, and case managers to ensure everyone is on the same page regarding when the patient will go home. Too often there is a disconnect between the understanding of these various constituencies on the plan. If the patient’s clinical condition changes and they are not stable for discharge, sharing the clinical indications for the decision with the rest of the team is essential, but often fails to occur.

3. Collaborative inpatient and post-acute care provider care planning

Once the patient is ready to go to a post-acute facility, it is critical that the inpatient provider and post-acute care provider coordinate the plan of care. The post-acute provider and the staff of the facility must be viewed as part of the same team as the inpatient hospital team, with the expectation that the care will be seamless between sites of care, with minimal or no loss of information or change in the care plan.

Efficient care is a multi-step care journey. The efficiency of each step can’t be solved in isolation.  No one clinical department can feel that they are solving the problem if they are not including their teammates. As an example, a great hospitalist program must have as part of its genetic makeup that it works with outpatient offices, with the ED, with case management, with consultants, with the other health care professionals and therapists seeing the patient, and with discharge planning to assure that all patients are managed efficiently. The hospitalists must also coordinate care with the various post-acute settings, whether that be skilled nursing facilities, long-term acute care hospitals, home health care, or physicians’ offices. Case managers and discharge planners similarly can never hope to improve their job performance and the goals that they are measured on without seeing themselves as part of a team with the physicians, the nurses, and the post-acute facilities.

Ultimately, the key to efficient patient throughput is teamwork. Beyond that, it’s recognizing that the care team doesn’t begin and end within any department or facility. Key players across the continuum of care are members of the collective team impacting the efficiency and effectiveness of each patient’s care. Many more difficult tasks have been accomplished in history than improving a specific facility’s patient throughput (think putting a man on the moon or climbing Mount Everest), but with teamwork those tasks were achieved, and with teamwork this seemingly impossible task can be achieved as well.

One Comment

  1. Ken Wright December 30, 2017 at 5:26 pm - Reply

    Ken, Great post. I agree that improved communication (thinking beyond the doors of the ED or the inpatient units) and objective standards have an increased importance in our EDs and inpatient units. Great idea to communicate with primary care regarding the standards for admission.

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