Improving flow requires testing changes in parallel in various parts of the organization, such as the flow of patients from the ED, ICU or PACU to an inpatient bed, as well as patients being discharged to a long-term care facility or home.

Example One: Make appointments for discharging patients.

Cycle 1: Test a discharge appointment with one patient on one unit.
Cycle 2: Expand the test to two patients on the same unit.
Cycle 3: Expand the test to more than one unit.
Eventually expand the test to patients with the most predictable discharge days.

Example Two: Use AM bed huddles to plan for patient flow.

Cycle 1: Limit discussion to addressing placement of scheduled surgical cases.
Cycle 2: Expand discussion to addressing placement of ED admissions.
Cycle 3: Expand discussion to addressing potential ICU transfers.
Cycle 4: Develop a standard agenda for the huddle and limit meeting time to ensure focus.

Example Three: Create a centralized bed authority.

Cycle 1: Draft job responsibilities and test with existing nursing supervisor for one shift.
Cycle 2: Refine job responsibilities and expand to two shifts with the same nursing supervisor.
Cycle 3: Expand to a second nursing supervisor for additional shift coverage.
Cycle 4: Refine job responsibilities and expand to cover all shifts for one week.