Use Pull Systems to Improve Flow

In a pull system of service, the timely transition of work from one step in the process to another is the primary responsibility of the downstream (i.e., subsequent) process — for example, the intensive care unit (ICU) orchestrating the transfer of the patient from the emergency department (ED). This is in contrast to most traditional “push systems,” in which the transition of work is the responsibility of the upstream (i.e., prior) process — for example, the ED trying to “push” patients into the ICU. Pull systems can be created whenever a patient is being moved from one point of care to the next. This is particularly important when the patient is being transferred from one care setting to another. Smooth communication and cooperation are keys to pull systems for patient transfer.


Be a Bed Ahead: Pull Patients from ED to Inpatient Unit

The Be-a-Bed-Ahead system addresses the delay in moving patients from one point of care to the next, for example, from the emergency department (ED) to the inpatient unit. Under the system, inpatient units anticipate demand (by measuring demand over time) and have a bed ready into which a patient can be moved (“pulled” rather than “pushed”) as soon as the demand occurs.


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