The Safe Patient Flow Initiative: A Collaborative Quality Improvement Journey at Yale-New Haven Hospital

Jweinat, Jillian; Damore, Peter; Morris, Victor F.; D’Aquila, Richard; Bacon, Sandra M.; Balcezak, Thomas J.

doi:10.1016/s1553-7250(13)39058-8

Cited by 31 publications

(43 citation statements)

References 7 publications

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“…As part of hospital-wide throughput improvement efforts, minimizing ED length of stay was prioritized (30), prompting admission of intermediate-risk ED patients to the ICU if no SDU beds were available. Medicine ward patients with clinical deterioration requiring SDU or ICU transfer were prioritized over similar ED patients, as respiratory and nursing support were limited on the wards.…”

Section: Icu Triage Policymentioning

confidence: 99%

“…We observed substantial improvements in admission wait times and overall bed availability with faster transfer times out of the ICU and SDU, regardless of unit sizing. For example, reducing TTT from current levels to 1 hour-which would involve centralized quality improvement effects affecting all patient flow from ED presentation to hospital discharge (30,45)-generated improved wait times equivalent to building one to two additional ICU beds, a costly solution that would only temporarily relieve congestion without added patient benefit (46,47). Moreover, reduced TTT was the only simulated scenario that achieved ICU bed occupancy levels below 70%, which is an increasingly important metric as the demand for ICU beds continues to grow.…”

Section: Original Researchmentioning

confidence: 99%

“…including additional transfer staff, greater coordination between the ICU and wards, and improved timeliness of hospital discharges, without increasing the risk of delays for ED patients awaiting admission to wards or early discharges for non-ICU patients (17,18,30). Given the established link between delays in ICU admission and increased risk of mortality (3,4), admission wait time is a clinically supported performance metric for our model (48).…”

Section: Original Researchmentioning

confidence: 99%

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A Conceptual Framework for Improving Critical Care Patient Flow and Bed Use

Mathews

Long

2015

Annals ATS

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Rationale: High demand for intensive care unit (ICU) services and limited bed availability have prompted hospitals to address capacity planning challenges. Simulation modeling can examine ICU bed assignment policies, accounting for patient acuity, to reduce ICU admission delays.Objectives: To provide a framework for data-driven modeling of ICU patient flow, identify key measurable outcomes, and present illustrative analysis demonstrating the impact of various bed allocation scenarios on outcomes.Methods: A description of key inputs for constructing a queuing model was outlined, and an illustrative simulation model was developed to reflect current triage protocol within the medical ICU and step-down unit (SDU) at a single tertiary-care hospital. Patient acuity, arrival rate, and unit length of stay, consisting of a "service time" and "time to transfer," were estimated from 12 months of retrospective data (n = 2,710 adult patients) for 36 ICU and 15 SDU staffed beds. Patient priority was based on acuity and whether the patient originated in the emergency department. The model simulated the following hypothetical scenarios: (1) varied ICU/SDU sizes, (2) reserved ICU beds as a triage strategy, (3) lower targets for time to transfer out of the ICU, and (4) ICU expansion by up to four beds. Outcomes included ICU admission wait times and unit occupancy. Measurements and Main Results:With current bed allocation, simulated wait time averaged 1.13 (SD, 1.39) hours. Reallocating all SDU beds as ICU decreased overall wait times by 7.2% to 1.06 (SD, 1.39) hours and increased bed occupancy from 80 to 84%. Reserving the last available bed for acute patients reduced wait times for acute patients from 0.84 (SD, 1.12) to 0.31 (SD, 0.30) hours, but tripled subacute patients' wait times from 1.39 (SD, 1.81) to 4.27 (SD, 5.44) hours. Setting transfer times to wards for all ICU/SDU patients to 1 hour decreased wait times for incoming ICU patients, comparable to building one to two additional ICU beds.Conclusions: Hospital queuing and simulation modeling with empiric data inputs can evaluate how changes in ICU bed assignment could impact unit occupancy levels and patient wait times. Trade-offs associated with dedicating resources for acute patients versus expanding capacity for all patients can be examined.

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Section: Icu Triage Policymentioning

confidence: 99%

Section: Original Researchmentioning

confidence: 99%

Section: Original Researchmentioning

confidence: 99%

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A Conceptual Framework for Improving Critical Care Patient Flow and Bed Use

Mathews

Long

2015

Annals ATS

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“…There was a trend toward an earlier median time of discharge, comparable to other EIDD interventions. 4,10 This increase in EIDD proportion occurred in the setting better coordination of discharge day activities, specifically early-in-day administration of the final methylprednisolone dose. Preparation for this early dose administration was made at time of admission through order entry using the developed intervention order set.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Delays in hospital discharge can also affect patient movement from critical care and postoperative care units, and if persistent, lead to cancellation of elective admissions and procedures and the diversion of patients from emergency departments. 3,4 There are, however, many barriers to EIDD from the hospital. [5][6][7] Studies on facilitating EIDD have focused on systematic preparation for discharge beginning prior to the anticipated discharge date, involving members of the care team (including physicians) as well as patients.…”

Section: Introductionmentioning

confidence: 99%

Facilitating Early-In-Day Discharge for Multiple Sclerosis Patients Treated With Intravenous Methylprednisolone

Probasco

Hawley

Burnett

et al. 2015

The Neurohospitalist

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Background and Purpose: Delays in patient hospital discharge affect care value through costs of prolonged length of stay and barriers to patient flow within the hospital. We sought to facilitate early-in-day discharges (EIDDs) without extending length of stay for inpatients with multiple sclerosis admitted for acute exacerbations and treated with intravenous (IV) methylprednisolone. Methods: We developed a standardized admission order set, a provider checklist, and a patient checklist to better coordinate in-hospital care and discharge planning for patients with multiple sclerosis admitted for IV methylprednisolone treatment. The order set allowed providers to enter an accelerated dosing schedule of methylprednisolone, as appropriate, to ensure administration of the final dose of methylprednisolone in the morning on the anticipated day of discharge. We compared a prospective intervention cohort to a retrospective, preintervention baseline cohort. Results: At baseline (N ¼ 25), 12.0% of patients were EIDD compared to 40.7% of intervention patients (N ¼ 27; P ¼ .03). In all, 85.2% of intervention patients compared to 64.0% of baseline patients were discharged on the same day as last methylprednisolone treatment (P ¼ .11). No difference was observed in median length of stay and 30-day readmission rate between groups. Conclusions: Use of a standard admission order set as well as provider and patient checklists can facilitate EIDD and hospital bed availability without compromising care quality for a select group of neurology inpatients.

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Facilitating Early-In-Day Discharge for Multiple Sclerosis Patients Treated with Intravenous Methylprednisolone: A Quality Improvement (QI) Project

Probasco¹

2016

Resident’s Handbook of Medical Quality and Safety

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The Safe Patient Flow Initiative: A Collaborative Quality Improvement Journey at Yale-New Haven Hospital

Cited by 31 publications

References 7 publications

A Conceptual Framework for Improving Critical Care Patient Flow and Bed Use

A Conceptual Framework for Improving Critical Care Patient Flow and Bed Use

Facilitating Early-In-Day Discharge for Multiple Sclerosis Patients Treated With Intravenous Methylprednisolone

Facilitating Early-In-Day Discharge for Multiple Sclerosis Patients Treated with Intravenous Methylprednisolone: A Quality Improvement (QI) Project

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