Changes for Improvement
Convene an AM Bed Huddle
The AM bed huddle is a planning tool for improving patient flow. The team discusses and acts upon admissions, discharges, and transfers within the hospital. The team defines specific problem areas and takes actions to solve the problems. Unit directors from the following areas attend the huddle or send a representative: each surgical unit; each medical unit; emergency department (ED); operating room (OR); surgical center; post-anesthesia care unit; cardiac catheter and specials lab; and intensive care units (ICUs). In addition, the following individuals generally attend the huddle: vice president of nursing, medical chief of staff, and medical director of the ICU.
- Give each unit representative approximately one minute to describe his or her unit by sharing the following information, where applicable: current census; anticipated discharges; anticipated admissions; anticipated transfers from within the hospital (including ED, OR, and other units within the hospital).
- Limit the meeting to 10–15 minutes and stay focused on the purpose of the meeting.
- Use the bed huddle as a strategizing meeting with a highly structured agenda for efficiency and effectiveness.
- Enlist the chief of staff and ICU medical director to act as a buffer between the bed team and the physicians.
- Use the bed huddle to make decisions regarding the cancellation of elective surgery and procedures depending on demand from the ED and other services.
- Use a unit-assessment-tool-based color to efficiently communicate needed information to the bed coordinator and others in a minute or less.
Institute a Centralized Bed Authority
The centralized bed authority (or "bed czar") is a person or location responsible for processing all admissions and transfers. Key responsibilities of the centralized bed authority include: active participation in daily bed meetings, convene AM bed huddles; oversee placement of admitted and transfer patients in beds; visit units to identify available beds with staff assigned to them and assess staff capacity to safely take additional admissions; communicate with units about placements and anticipated needs; and serve as a conduit for all physicians admitting patients. The centralized bed authority in most effective when it is incorporated into an overall system for managing real time demand and capacity.
- Assign a person to act as the centralized bed authority for each shift in smaller hospitals (fewer than 200 beds).
- Assign a location or group of individuals to act as the centralized bed authority in larger hospitals (more than 200 beds.
Institute Multidisciplinary Rounds
Mulitidisciplinary rounds include representatives of the various departments involved in patient care. The makeup of the team conducting multidisciplinary rounds varies from hospital to hospital but often includes the following: nurse manager, staff nurses, pharmacists, social workers, nutritionists, case managers, pastoral services, and discharge planners. Discussing patients’ predicted discharge dates during multidisciplinary rounds helps ensure that all departments are planning together around the anticipated discharge date and time for improved patient flow. Potential issues around placement or transfer may also be addressed during rounds.
Develop Admission and Discharge Criteria
Eliminating delays in sending a patient from the emergency department (ED) to the next level of care requires that each department or area coordinate with one another. Each must see itself as part of the same overall system. A potential barrier to moving patients from one point of care to another is the availability of beds in the receiving unit. When medical staff move patients from the ED to the intensive care unit (ICU) and/or telemetry beds, one way to ensure that a bed is available in these units is to establish and review regularly their discharge criteria. Availability of beds on the receiving unit can be increased by adhering to the agreed upon criteria (e.g., by not keeping patients in the ICU or telemetry longer than is necessary).
- Use multidisciplinary rounds to evaluate whether patients meet the established discharge criteria.