Inpatient flow management: a systematic review

Abstract

Purpose In hospitals, several patient flows compete for access to shared resources. Failure to manage these flows result in one or more disruptions within a hospital system. To ensure continuous care delivery, solving flow problems must not be limited to one unit, but should be extended to other departments – a prerequisite for solving flow problems in the entire hospital. Since most current studies focus solely on overcrowding in emergency units, additional insights are needed on system-wide patient flow management. The purpose of this paper is to look at the information available in system-wide patient flow management studies, which were also systematically evaluated to demonstrate which interventions improve inpatient flow. Design/methodology/approach The authors searched PubMed and Web of Science (Core Collection) literature databases and collected full-text articles using two selection and classification stages. Stage 1 was used to screen articles relating to patient flow management for inpatient settings with typical characteristics. Stage 2 was used to classify the articles selected in Stage 1 according to the interventions and their impact on patient flow within a hospital system. Findings In Stage 1, 107 studies were selected. Although a growing trend was observed, there were fewer studies on patient flow management in inpatient than studies in emergency settings. In Stage 2, 61 intervention studies were classified. The authors found that most interventions were about creating and adding supply resources. Since many hospital managers these days cannot easily add capacity owing to cost and resource constraints, using existing capacity efficiently is important – unfortunately not addressed in many studies. Furthermore, arrival variability was the factor most frequently mentioned as affecting flow. Of all interventions addressed in this review, the most prominent for advancing patient access to inpatient units was employing a specialized individual or team to maintain patient flow and bed placement across hospital units. Originality/value This study provides the first patient flow management systematic overview within an inpatient setting context.

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Perspectives and practices of health workers around diagnosis of paediatric tuberculosis in hospitals in a resource-poor setting – modern diagnostics meet age-old challenges

“…We observed lengthy procedures and bottlenecks that ended up frustrating both health workers and patients. Poor patient ow has been recognised elsewhere as an impediment to quality of care given to patients [61] and simple care redesign strategies can improve patient ows using existing capacity e ciently, leading to improved physical opportunities to diagnose TB in children. We also noted in the facility with high TB case detection, the existence of positive hospital cultures and norms like teamwork, mentorship and shared responsibility for patient care provided social opportunity, an environment conducive to routine diagnosis of TB in children including improved processes.…”

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