Does your health system have a patient flow problem?

Admitting there is a problem is the first step toward finding a solution.  When was the last time your facility assessed patient flow within the organization and to external providers? If it has been a while, you are likely missing a serious opportunity not only to improve patient satisfaction but also to save serious dollars that can directly impact your bottom line.

The 2012 Patient Flow Challenges Assessment survey conducted by the American Hospital Association (AHA) Solutions and Hospitals in Pursuit of Excellence (HPOE) finds hospitals investing in patient flow improvement initiatives that span process, staffing, and systems—and reporting positive results from their efforts.[1] According to Tony Burke, CEO of AHA Solutions, “Patient flow directly impacts a health care facility’s overall performance and can also play a strong role in patient satisfaction.”[2]

Looking at your patient flow could potentially save you hundreds of thousands of dollars.  Timely discharges to community-based services across Calgary, Alberta is generating annual system economic efficiencies of over $10M annually.  At the Fraser Health Authority in British Columbia improvement in coordinating patient discharges to the community is projected to generate over $1.5M in cost efficiencies.  Better coordination and accuracy of referrals resulted in the Rotherham Trust, UK, achieving cost efficiencies exceeding $2.4M annually.

At the core of improving patient flow is the ability to better manage existing resources or capacity and to forecast future capacity needs.  Patient transfer, for example, is operationally inseparable from capacity management, because proper patient placement depends on what beds and other resources are available.  Gaps, delays, or mistakes in placing patients in the right bed, with the most appropriate specialist, or with the right level of care, can have serious negative clinical, operational, and financial impacts.

Capacity management is much more than just the timely allocation and provisioning of physical beds.  Urgency, prioritization, patient choice, and quality of care requires that patients be matched with the right bed, with the right level of nursing care, with access to the right specialists, diagnostics and treatments—as quickly as possible.

Getting patients into the right bed or treatment facility, the first time, improves health outcomes and patient experience, and reduces overall length of stay.  The ability to make fast, informed decisions about patient placement—from transfer, admission, and internal transport, to discharge—is an important factor in achieving many hospital objectives, including higher Hospital Consumer Assessment of Healthcare Providers Systems (HCAHPS) survey ratings, reducing unnecessary re-admissions, and making the most efficient use of all health system resources.

The financial benefits of being able to quickly, efficiently place patients in the right treatment path the first time are compelling.  They include:

  • Added capacity—Without physically expanding, through more efficient utilization and faster turnover of existing capacity and less “bed hiding” from delayed updating of availability
  •  Increased revenue—By providing care for more patients, without adding resources
  • Reduced costs—By optimizing use of hospital resources and proactively managing length-of-stay
  • Improved staff productivity—By cutting the time teams (transport, emergency, transfer, nursing, EVS) spend looking for data and minimizing “work queuing”
  • Improved patient health and satisfaction—By reducing wait times and timeliness of definitive care
  • Shorter length-of-stay / Fewer readmissions—Through right level of care and coordinated discharge processes

Healthcare reform will increasingly tie reimbursement to hospital quality of care metrics such as HCAHPS and other still-to-be defined efficiency measures.  Beginning October 2012, hospitals faced maximum financial penalties of up to 1% of Medicare/Medicaid reimbursement for excessive readmission of patients in less than 30 days.  In 2014, the maximum financial penalties double to 2% of Medicare/Medicaid reimbursement.[3]

The solution lies in economy of scale and governments are commanding acute changes in health delivery to get there.  The number of manual patient referrals exchanged every day between healthcare providers is astounding.  These inefficient and labor-intensive methods result in unnecessary cost, delay, error, and frustration.  As more people engage with health systems more often because of demographic shifts and health complexities, patient referrals will continue to rise.

Automated patient flow practices such as eReferral delivers the critical change needed to achieve real benefits for patients, their families, overworked front-line workers, and health systems.  Our recent white paper, The Healthcare Executive’s Guide to Streamlining Patient Flow for Successful Patient Outcomes, looks at current referral practice and how the eReferral solution dramatically improves patient flow to: Reduce cost; Increase productivity; Align with clinicians; and Maximize ROI.

The checklist below summarizes the requirements health executives should consider when planning for and developing an eReferral strategy for their system.  Initiatives can be shaped to appropriate size and complexity and can include new prerequisites from the list as projects expand.

  • Current physician’s directory and a means to maintain it
  • Platform for asynchronous communication between PCPs and Specialists
  • Consensus with PCPs and Specialists on triage information
  • Agreement between Specialists and PCPs on clinical pathways
  • Preliminary check for eReferral appropriateness
  • Ability to transmit images and embedded attachments with referral
  • Ability of PCPs to flag urgent referrals
  • Support for eConsultation and established compensation policy for Specialists
  • Central Intake function
  • Impact on administrative support staff
  • Co-existence with traditional process during transition period
  • Patient/physician feedback mechanism for flexible Specialist appointment scheduling
  • Integration with all Physician, Specialist and hospital clinical management systems into the larger EMR/EHR picture.
  • Specialist-approved clinical pathways for each specialty area
  • Mechanism for Specialists and PCPs to review eReferral status
  • Consideration of referral flows to community agencies
  • PCP ►Specialist feedback mechanism to report usefulness, clarity, and uptake of Specialist advice
  • Impact of other area initiatives
  • System structured to collect/report wait times
  • System contributes to overall wait list management plan
  • System contributes to resource management/bookings
  • Inclusion of business intelligence functionality to provide information regarding the entire referral pathway along the care continuum

Technology is allowing health systems to leap into the future.  The days of slow, inefficient fax and phone referrals are coming to an end.  With eReferral, physicians can now call up, fill out, and send referral form templates electronically and track it all in electronic medical records.  Doctors are seeing significant increases in patients getting the tests and screening necessary for prevention and to manage chronic conditions.  eReferral is eliminating unnecessary work and increasing productivity resulting in reduced costs, improved patient care, and rising levels of public satisfaction.

To learn more about what you can do to improve patient flow download The Healthcare Executive’s Guide to Streamlining Patient Flow for Successful Patient Outcomes.



[1] AHA Solutions and Hospitals in Pursuit of Excellence (HPOE).  “Results and Report of the 2012 Patient Flow Challenges Assessment: Hospitals Consider Patient Flow Essential to Care and Competitiveness.” 2012

[2] AHA Solutions press release, January 26, 2012. http://www.aha-solutions. org/press/01.26.12-pfca-report-launch.shtml?source=prindex

[3] http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPP

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