This year, surveyors to look for patient flow problems: Identify bottlenecks now. Hospital Peer Review. 2005; 30:1-5.

Are patients on gurneys in hallways a common sight in your organization’s emergency department (ED)? The growing problem of ED overcrowding is potentially dangerous to patients and has resulted in the new leadership standard on managing patient flow from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). This article uses three hospital examples to outline strategies for adhering to the JCAHO standard and improving patient flow in your organization.

Allen S. Getting with the flow helps hospital deliver service. The Boston Globe. January 25, 2005.

Elliot Hospital in New Hampshire was struggling with an overloaded schedule for surgical deliveries and labor inductions. However, just when hospital officials feared they might have to expand the obstetrics ward, they came upon one of the hottest ideas in health care — "flow management." 

Boston hospital sees big impact from smoothing elective schedule. OR Manager. Dec 2004;20(12):1-5.

When Boston Medical Center (BMC) accepted a $250,000 grant two years ago to address overcrowding in the emergency department (ED), it volunteered for a tough assignment — smoothing the elective surgical schedule. Research has shown, surprisingly, that in hospitals with strained capacity, the elective surgical schedule actually is a bigger source of bottlenecks on patient units and ICUs than emergencies. BMC has applied the research findings, and a year later the efforts are paying off.

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Hendrich A, Fay J, Sorrells A. Effects of acuity-adaptable rooms on flow of patients and delivery of care. American Journal of Critical Care. 2004 Jan;13(1):35-45.

Methodist Hospital, Clarian Health Partners, Inc., in Indianapolis, Indiana, tested whether the use of acuity-adaptable rooms would help improve the flow of patients, reduce medical errors, and increase staff satisfaction. Results included significant improvements in quality and operational costs.

Haraden, C, Rutherford P. We shouldn’t ask our patients to “hurry up and wait.” American Hospital Association News. 2004;40(4):15.

Full-page news article describing how modern management techniques can help patients move more quickly, efficiently, and cost-effectively through the health care system.

Haraden C, Resar R. Patient flow in hospitals: Understanding and controlling it better. Frontiers in Health Service Management. 2004;20(4):3-15.

This article addresses the issue that hospital delay is not inevitable and that there is a need to recognize it as essentially a flow issue. Based on work in 60 hospitals in US and UK, areas of importance are identified as: smoothing flow through elective surgery, reducing admission waits in emergency departments, patient transfer issues both with hospitals and also between inpatient and long term care facilities.

Horton SS. Increasing capacity while improving the bottom line. Frontiers of Health Services Management. 2004 Summer;20(4):17-23.

Baptist Memorial Hospital-Memphis had a capacity problem, or so they thought. After examining a situation that they considered virtually unfixable, they implemented high-leverage process changes resulting in significant improvements in patient flow. They learned that they did, after all, have the capacity they needed without adding any beds or hiring additional staff.

Miaster D. The psychology of waiting lines. Harvard Business Online. April 1984.

Discusses the experience of waiting and the factors that affect customers' tolerance for waits. Eight (testable) propositions concerning the psychology of queues are presented, together with specific managerial advice.

Rogers AE, Hwang W-T, Scott L, Aiken L, Dinges D. The working hours of hopsital staff nurses and patient safety. Health Affairs. 2004;23:202-212.

This article states that the risks of making an error were significantly increased when work shifts were longer than twelve hours, when nurses worked overtime, or when they worked more than forty hours per week.

McManus M, Long M, Cooper A, Litvak E. Queuing theory accurately models the need for critical care resources. Anesthesiology. May 2004;100(5):1271-1276.

The stochastic nature of patient flow may falsely lead health planners to underestimate resource needs in busy intensive care units. Although the nature of arrivals for intensive care deserves further study, when demand is random, queuing theory provides an accurate means of determining the appropriate supply of beds.