Patient Flow

    Hospital Patient Flow Optimization

    Situation

    The leadership team at a hospital in the Mid-Atlantic U.S. found themselves in a peak census situation several times a year where they did not have enough beds to accommodate the demand. With a daily average census of over 600 throughout the facilities, this issue would send the clinic into crisis mode which included crisis management committee meetings and micro-managing the transfers and discharges until the situation resolved itself.

    They did not have a way to effectively proactively study patient flow behavior during these peak times in order to evaluate potential solutions to reduce or eliminate the peak census states. Because of the many variables such as volume of arrivals, timings of arrivals, service line specialty of admitting physician, acuity level of patient at time of admission, bed capacity among the nursing units, transfer center's distribution of patients, patients' length of stay on each unit and patients' movement between nursing units, the leadership team faced difficulty analyzing their patient flow.

    Objectives

    • Quickly and accurately evaluate the impact of various operational proposals to improve patient flow

    • Experiment with the system behavior without experimenting with the actual system

    Hospital System Model<

    Results

    Using ProModel's patient flow analysis solution they developed the capability to get answers to patient flow what if questions in minutes versus days, weeks or months. They now have a flexible environment that is adaptable to answer future patient flow questions. They are expecting to see the following improvements from their first phase:

    • Length of Stay (LOS) reductions from their nursing unit discharge initiatives

    • Avoided the extra cost of just building extra PCU units

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    Perioperative Services

    Predictive Analytics Improves Surgical Division Room Utilization, Avoids Potential Expansion, While Maintaining Satisfactory Patient Wait Time

    Situation

    Patient Wait Time

    The Head of Emory Clinic Facility Operations received a request from one of Emory's surgical divisions' administrator for construction of additional exam rooms at the request of their physicians. In order to accommodate their patient volume, the physicians felt that they needed more than the current 3 or 4 rooms per physician. Before investing capital to expand the division, Facilities leadership requested an objective data driven analysis be performed.

    Current policy states that while a patient is in radiology, the treatment room is held for the patient, even though there is not a live patient in the room, causing reduced room utilization. Lower utilization of rooms means more patients in the lobby, increasing wait times. The primary objective therefore was to analyze how many rooms each physician needed to best utilize available rooms while maintaining or reducing current patient wait times. Clinic Leadership needed to account for the business side of healthcare yet not compromise the patient experience.

    Objectives

    • Identify and analyze system bottlenecks and performance metrics

    • Understand room utilization statistics and Radiology wait times and queues

    • Recommend room allocation and/or scheduling changes to improve room utilization in order to avoid facility expansion while maintaining a positive patient experience

    Results

    Considering different room allocation numbers for physicians, it was found that assigning 2 rooms per physician resulted in a 120 % increase in wait times
    while assigning 3 rooms per physician resulted in just a 28% increase in wait time from the current 4 rooms per physician setup.

    With the addition of more detail and further analysis to the model, Clinic Operations support determined room allocations needed to be adjusted by physician by hour of the day. The optimum room allocation recommendations were:

    • Dr. A - 4 rooms justified for majority of clinic days

    • Dr. B - 3 rooms for each session (AM or PM)

    • Dr. C - Schedule for entire day and share Pod with Dr. D (Wednesdays only)

    • Dr. D - 3 Rooms sufficient on Mondays and Thursdays

    This enabled the surgical division to increase patient volume enough in order to demonstrate to the physicians that additional rooms were not required, while still maintaining acceptable patient satisfaction standards.

    Additionally, they gained insight into the impact on patient experience from having both doctors and residents interact with patients. As an academic, or teaching hospital, this was extremely important.

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    Ambulatory Care

    Predictive Analysis of Emory Healthcare's Infusion Center Scheduling, Staffing and Resource Utilization to Improve Patient Flow

    "Administration, the Nurse Manager and Front End Supervisor all
    agreed that the model was a very fair
    representation of how the center actually operated."

    Situation

    Patient Waiting Time

    For Emory's Infusion Center, issues with how resources were being utilized, schedule strategy, and a short staff led to long waiting times during busy days and peak hours. According to patients, spending more than 30-35 minutes in the waiting room was undesirable.
    On top of that, their strategic plan forecasts a 9-10% increase in patient volume per year for the next three years. With such a complex and variable environment, they knew a simulation analysis would be the best way to find an optimal solution.

    Objectives

    • Model the present state of patient and resource flow to identify and analyze system bottlenecks and performance metrics including lobby wait time and chair utilization to ultimately improve overall patient satisfaction.

    • Obtain results from simulating operational scenarios including scheduling, staffing, and CPOE (computerized physician order entry), plus scenarios with estimated patient volumes over the next 3 years.

    • Make operational recommendations to reduce patient waiting times and increase operational efficiency.

    Results

    The first two recommendations implemented resulted in a 4% decrease in chair time and a 23.7% reduction of wait time in the lobby. They were as follows:

    • Extend normal business hours from partial weekend hours (Sat-Sun 8am-2pm) to full weekend hours (Sat-Sun 7am-7:30pm)

    • Run three bays on the weekend instead of two as initially planned

    Patients prefer weekend appointments, so expanding the weekend schedule not only helped reduce the stress on the system during the week, but also increased patient satisfaction.

    There are also plans to implement a re-organized schedule which would start the longer infusion appointments in the morning, and the 1, 2 and 3 hour appointments in the afternoon. Simulation results showed that chair times could be reduced by up to 13.7% and patient wait times by 35.76% from the current state.

    Reducing patient wait times was the primary objective of the project. The simulation helped identify solutions that would reduce wait times while, at the same time, improving patient satisfaction scores.

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    Patient Transfer

    Ensuring an Efficient Move into a Nine Story Inpatient Tower

    Situation

    Northwest Community Hospital, a 400 Bed hospital in suburban Chicago, is nationally recognized in Cardiac, Stroke and Gastrointestinal care. Their Existing Patient Tower dated back to 1958, all rooms were Semi-Private, in 38 Bed Nursing Units. They built a brand new 9 story patient tower called South Pavilion which added 200 beds, all of which are private. The challenge was how to most safely and effectively transfer the patients from the old tower to the new one.

    Hospital Building

    Objectives

    • Of course, of utmost importance was that the patients be moved safely,
      with no adverse medical complications.

    • They also wanted the move to be a positive experience for the patient
      and their families.

    • To minimize the inconvenience to patients, the move would begin after patients
      ate breakfast, at 8am, and should be completed in time for the last patients to be able
      to eat lunch by 2pm.

    • Of secondary importance, was to conduct the move with efficient staffing.

    Why Build a Simulation Model?

    • It was imperative that this move be successful. They only had one chance to do it right!

    • The only way they could "practice" was to do it via a simulation model.

    • The dynamic nature of the census required preparation for many different scenarios.

    • Moving patients lends itself very well to simulation. From a modeling standpoint, it is similar to a manufacturing or assembly process. The timing for the actual individual steps was very predictable.

    Patient Flow Model

    How the Model Influenced the Approach to the Move

    Original Intended Plan: Move one floor at a time, to keep better control over the move.

    • What the model showed: This would take about 13 hours, compared to the 6 hour window the move was expected to take.

    • Final Decision: a shotgun start would be the most effective approach

    Original Concern: Elevators were expected to be a significant bottleneck in the move process.

    • What the model showed: The elevators would NOT cause a bottleneck. The amount of time spent on the elevator was minimal, and so would be delays waiting for an elevator.

    • Final Decision: By designating elevators to specific floors, the amount of time spent waiting for elevators was minimized.

    Results

    The move was a success. It was completed by 12:30 pm (2 pm was the deadline) and had no significant issues.
    The Model predicted the completion time within 15 minutes.
    Management was very impressed with how much the simulation model helped, and by its accuracy – future projects should have increased support.

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    Custom Solutions / Custom Development

    Custom Hospital Patient Flow Analysis Technology

    Situation

    The leadership team at a hospital in the Mid-Atlantic U.S. found themselves in a peak census situation several times a year where they did not have enough beds to accommodate the demand. With a daily average census of over 600 throughout the facilities, this issue would send the clinic into crisis mode which included crisis management committee meetings and micro-managing the transfers and discharges until the situation resolved itself.

    Hospital System Model

    They did not have a way to effectively proactively study patient flow behavior during these peak times in order to evaluate potential solutions to reduce or eliminate the peak census states. Because of the many variables such as volume of arrivals, timings of arrivals, service line specialty of admitting physician, acuity level of patient at time of admission, bed capacity among the nursing units, transfer center's distribution of patients, patients' length of stay on each unit and patients' movement between nursing units, the leadership team faced difficulty analyzing their patient flow.

    Objectives

    • Quickly and accurately evaluate the impact of various operational proposals to improve patient flow

    • Experiment with the system behavior without experimenting with the actual system

    Results

    Using ProModel's custom patient flow analysis solution they developed the capability to get answers to patient flow what if questions in minutes versus days, weeks or months. They now have a flexible environment that is adaptable to answer future patient flow questions. They are expecting to see the following improvements from their first phase:

    • Length of Stay (LOS) reductions from their nursing unit discharge initiatives

    • Avoided the extra cost of just building extra PCU units.

    Contact us to learn more