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• Optimizing Patient Flow: Moving Patients Smoothly Through Acute Care Settings
  In this white paper, IHI offers perspectives on the impediments to timely and efficient flow of patients through acute care settings.

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• "Extend the Chain": Work with Resources Outside of the Hospital to Improve the Flow of Care
  Working with resources beyond the hospital walls can greatly improve patient flow through the hospital.
• Decrease and Smooth Variation to Improve Flow
  Decreasing and smoothing variation improves quality and reduces cost, thereby allowing for appropriate resource allocation.
• Match Capacity and Demand to Improve Flow
  Appropriately matching the available capacity in the system to meet the demand for care is necessary to reduce delays, improve flow, and improve safety.
• Real-Time Demand/Capacity Management to Improve Flow
  Strategies for matching demand and capacity in real time can help hospital teams improve patient flow.
• Schedule the Discharge to Improve Flow
  Synchronize admissions and discharges by managing discharges efficiently.
• Use Pull Systems to Improve Flow
  When work is being transferred through a process, instead of pushing it from one step to the next, have the later step pull it from the previous step.

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• Acute Care Inpatient and Observation Patient Throughput
  Measuring the number of inpatient admissions per week over time will show how changes are affecting overall throughput.
• Hospital Flow Measurement Guide
  A measurement framework for measuring hospital flow/throughput across the system.
• Measures for Operational and Clinical Improvement in the Emergency Department
  These measures were developed as part of IHI's Learning and Innovation Community on Operational and Clinical Improvement in the Emergency Department and are useful for teams improving operational flow in the Emergency Department.
• Readmission Rate
  Percentage of admitted patients who return to the hospital within seven days of discharge.
• Time from ED to Inpatient Bed (median)
  Median time in hours from the decision to admit a patient from ED to the physical placement of the patient in an inpatient bed.
• Time from ICU to Inpatient Bed (median)
  The median time from when the patient is deemed ready for transfer from the intensive care unit (ICU) to when the patient is physically placed in an inpatient bed.

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• Getting Started: Operational and Clinical Improvement in the Emergency Department
  This getting started document, developed in IHI's IMPACT Learning and Innovation Community n 2006, provides guidance for establishing a team and setting aims to improve Emergency Department operations and clinical care
• Adopting a Service Operations Approach to the Evaluation and Management of Patients with Influenza-Like Illness in the Emergency Department in the H1N1 Era
  Materials developed by IHI to help hospitals develop a standardized approach to manage flow and maintain patient safety during an "every day" disaster, using an H1N1 outbreak as an example. Companion tools such as an implementation checklist and sepsis screening tool are also provided.
• Emergency Department Hourly Patient Flow Analysis
  This tool helps identify patterns in the time of day of arrivals and admissions to the emergency department.
• Surgical Admissions Case Demand Mapping Tool
  The Surgical Admissions Case Demand Mapping Tool helps identify capacity and demand trends and helps in planning for needed beds for elective surgical admissions.
• Admission and Discharge Criteria: Critical Care Services
  This tool provides an example of specific admission and discharge criteria for the accurate identification of patients requiring critical care services.
• Adult Intensive Care Unit Scope of Service
  This tool documents the responsibilities of and services provided in the adult intensive care unit, including specific admission and discharge criteria based on the Milliman Guidelines.
• Critical Care Unit Patient Placement Guidelines
  This tool details the policy used to provide standardized care for critically ill patients admitted to the critical care unit, including specific admission criteria.
• Intensive Care Unit Admission, Transfer, and Discharge Guidelines
  This tool details the policy used to ensure the appropriate utilization and resources of the intensive care unit and staff, including specific admission, transfer, and discharge criteria.
• Glossary of Flow Terms
  A glossary of common patient flow and general improvement terms.
• ED Fast Track Criteria
  Established criteria to help emergency department (ED) staff determine which patients are appropriate to send through the ED Fast Track — that is, patients with less serious conditions who can be treated more quickly and then released.
• AM Bed Huddle Worksheet
  A worksheet used to facilitate sharing of information during AM Bed Huddles
• Trigger Point Guidelines to Improve Bed Availability and Patient Flow
  Trigger Point Guidelines assist with efficient bed control to improve the efficiency of the flow of patients from the emergency room to the inpatient areas.

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• WIHI: The Right Care, Right Setting, and Right Time of Hospital Flow
  March 9, 2017 | Making sure patients get the right care, in the right place, at the right time requires a number of underlyi​ng system improvements, including well-designed hospital flow.
• WIHI: All Hospitals in Favor of Saving Money: Say “Patient Flow!”
  December 2, 2009 | A hospital CEO, a chief surgeon, and an operations management expert discuss how they applied the best improvement science available to address overcrowding in the emergency department, vacant operating rooms, a lackluster occupancy rate, stressed staff, and patients waiting around to be seen.
• Profiles in Improvement: Kevin Stange of Alaska Native Medical Center
  Kevin Stange of Alaska Native Medical Center (Anchorage, Alaska, USA) shares how he's engaged in improving health care.

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• What Is Reliability? (Part 1 of 5)
  IHI Executive Director Frank Federico provides an introduction to reliability, including a definition, some examples, and components of IHI’s proven methodology.
• How Can You Make Processes Reliable? (Part 2 of 5)
  IHI Executive Director Frank Federico discusses steps you can take to make your processes more reliable.
• What Is the Goal of Reliable Design? (Part 3 of 5)
  IHI Executive Director Frank Federico explains the goal behind reliable design — and why capability is just as important as reliability.
• Why Do You Need a Back-Up Plan? (Part 4 of 5)
  IHI Executive Director Frank Federico discusses why and when to create a back-up plan for a reliable process.
• How Can Data Drive Reliability? (Part 5 of 5)
  IHI Executive Director Frank Federico discusses the role of measurement and the role of leadership in achieving reliable designs.
• How Does HealthPartners Reduce Health Disparities?
  Dr. Beth Averbeck explains HealthPartners’ strategy for reducing ethnic, racial, and socioeconomic disparities in care.
• How Can You Apply Clinical Skills to QI?
  MIT senior lecturer and IHI Senior Fellow Steve Spear explains why he thinks seven steps needed to care for patients are essentially the same as those needed to fix systems of care. He also shares common trouble areas and gives an example of a successful improvement.
• Passport Exclusive: Perfecting Emergency Department Patient Flow
  In this video, Kirk Jensen discusses how to redesign a hospital emergency room that works better for your patients and your staff.
• Passport Exclusive: Improving Patient Flow in the Emergency Department
  In this video, Chuck Noon describes steps you can take to improve flow through your ED.
• What If We Flipped the Patient Discharge Process?
  At Sheffield Teaching Hospitals in the United Kingdom, an improver came up with the idea of assessing frail elder patients’ needs in patients’ homes instead of at the hospital. One PDSA cycle led to another, and another. Eventually, 10,000 patients got home 3 to 4 days faster in one year.