Institute for Healthcare Improvement: Innovation Community: Improving Flow Through Acute Care Settings

Overview

Innovation Communities are groups of improvement-minded organizations working together and with IHI to explore new designs and novel solutions to improve care where best practices do not already exist or are not fully developed. Projects last for approximately 10 months under the guidance of an IHI panel of experts, and are open to IMPACT member organizations and previous participants in the Flow Domain only.

The Problem

The Solution

Acute care settings are plagued with waits, delays, and diversions. Hospitals are increasingly challenged to address Emergency Department (ED) overcrowding and diversions. Patient safety, hospital revenue, staff satisfaction, and patient satisfaction are all negatively affected when patients, information, and materials do not move through hospitals in a timely and efficient way.

Thus far, most attempts to improve patient flow have focused on the ED. However, system-level changes are required to solve the issues of flow. Looking upstream and downstream from "problem" hospital units is essential to making changes that will result in hospital-wide improvements. Most often, EDs divert patients because hospitals lack the space to move patients forward, and simply increasing capacity in the ED will not solve flow problems.

Understanding variability is key to making improvements in flow through the acute care setting. The variation inherent in surgery scheduling, for example, challenges hospital staff to find inpatient beds at varying times of the day.

In addition to reducing variability, establishing partnerships with other community resources such as long-term care facilities and outpatient clinics, is crucial to solving flow problems. Ensuring that the patient is receiving the appropriate level of care in the appropriate setting further increases efficiencies in the system.

Better models for flow can be found by looking outside of the health care industry. The trucking and airline industries, for example, have used resource allocation to better serve their customers, reduce costs, and improve safety.

Areas of Focus

Reduce the time for inpatient placement for patients admitted from the ED
Achieve timely and efficient transfer of patients from the ICU and post-anesthesia care unit (PACU)
Establish community partnerships to reduce admissions and meet the demand for long-term placement
Establish a patient transition process prior to discharge
Create a pull system throughout the hospital for admissions, transfers, and transitions out of the hospital
Reduce variation elective surgical admissions or separate the flow of scheduled and emergent/urgent cases

Aims

Participants will be asked to test changes aimed at achieving ambitious goals, such as:

Transitioning patients from the ED to an inpatient bed within one hour of the decision to admit
Scheduling at least 80% of discharges, with 80% of that number meeting the defined discharge/transition time
Reducing to zero the number of times the ED is closed to ambulance admissions
Increasing overall hospital throughput

To Participate

To join an Innovation Community, you must be a member of IHI's IMPACT network and have completed at least one successful improvement project within your organization. See IMPACT Network for more details about this exciting network of organizations collaborating for results.