Improving hospital patient flow: a systematic review

Abstract

Purpose Improving hospital patient flow has become a policy priority, to effectively balance the increasing demands of an unknown and variable volume of patients with limited available hospital resources. A systematic literature review was conducted in order to identify actions, actors involved and enablers in improving hospital patient flow. The paper aims to discuss this issue. Design/methodology/approach Searches were conducted in Scopus, Web of Science, MEDLINE and The Cochrane Library for quantitative and qualitative empirical primary studies with patients (adults) receiving inpatient acute hospital care. The study protocol was based on PRISMA-P guidance. A critical appraisal of included studies was performed by using the Quality Improvement Minimum Quality Criteria Set. Findings In total, 38 key papers were identified. A wide range of actions are reported, but most studies focus on one or a few departments instead of a whole hospital. Process efficiency is most often used as a performance indicator, clinical outcomes are poorly analyzed, and patients’ expectations and experience are rarely considered. Top-management commitment and front-line staff involvement are considered key factors for the success of implementations. Patient involvement in the process improvement is rarely mentioned. Originality/value Achieving improvements in hospital patient flow requires the design and implementation of complex, multifaceted and coordinated interventions. This study may be of value to healthcare managers, helping them to act effectively in their context, and to researchers of future studies including the different variables and the patient’s perspective.

Patient Throughput Initiatives in Ambulatory Care Organizations during the COVID-19 Pandemic: A Systematic Review

“…Therefore, these strategies and related characteristics were not found in prior systematic reviews focused specifically on patient throughput. Pre-COVID-19 strategies to improve throughput that were found in systematic reviews consisted of the use of medical scribes [4,5], the use of lean management and process improvement [2,3,6], the use of triage liaison [10], and the role of nurses [11]. Additional studies focused on the establishment of access centers, call centers, patient placement centers, ED clinical laboratory, ED self-registration kiosks, ED result waiting area, physician-assisted triage, patient flow automation, and rapid admissions units [2,7], the use of hospital staff to undertake responsibility for ED admissions [2], and admissions screening for MRSA [2].…”

“…Several systematic reviews on patient throughput/patient flow have been conducted. Some of these reviews looked at the relationships between lean health care and patient flow [3], the impact of scribes on patient throughput [4,5], strategies used to improve patient flow [6,7], the role of computer simulation modeling on patient flow [8], and the impact of triage-related intervention to enhance patient flow [9][10][11].…”

Solutions for improved hospital-wide patient flows – a qualitative interview study of leading healthcare providers

“…The last two decades have seen a growing interest in how to improve healthcare productivity by focusing more on the patient flow, i.e. how to enable a higher throughput of patients through hospitals [ 12 , 16 – 22 ]. Focusing on the flow of patients has been proven to decrease patients’ length of stay (LoS) and increase the speed with which patients are processed toward discharge [ 13 , 20 , 23 – 25 ].…”

“…Focusing on the flow of patients has been proven to decrease patients’ length of stay (LoS) and increase the speed with which patients are processed toward discharge [ 13 , 20 , 23 – 25 ]. It may also help balance a varying number of patients along a continuum of care constrained by insufficient healthcare resources [ 22 ]. Additionally, a long LoS exposes patients to unnecessary risks of iatrogenic complications such as infections [ 21 ].…”

Why Machine Learning Integrated Patient Flow Simulation?

“…Patient flow analysis to and in a hospital has been one of the hot research areas in health services research and health economics (Kreindler, 2017;Gualandi et al, 2019). It can be conducted from clinical and/or operational perspective (Côté, 2000) in a single unit/department (e.g., ambulatory care unit (Santibáñez, 2009), intensive care unit (Benjamin and Christensen, 2012), emergency department (Konrad et al, 2013;Cocke et al, 2016;Hurwitz et al, 2014), surgery department (Antonelli et al, 2014;Azari-Rad, 2014)) or in multiple units/departments (e.g., Abuhay et al (2016 and, Kovalchuk et al (2018), Suhaimi et al (2018)) of a hospital using simulation.…”