How to cite this paper:
Optimizing Patient Flow: Moving Patients Smoothly Through Acute Care Settings.
IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2003. (Available on
Because waits, delays, and cancellations are so common in health care, patients and providers assume that waiting is simply part of the care process. But recent work on assessing the reasons for delays suggests otherwise.
Optimizing Patient Flow is part of a series of innovative programs developed by the Institute for Healthcare Improvement to help hospitals improve the care they provide patients. With the Optimizing Patient Flow program, IHI offers new perspectives on the impediments to timely and efficient flow of patients through acute care settings. The program offers a model for evaluating patient flow, testing changes for improvement, and measuring results.
IHI and approximately 50 hospitals have been working together to evaluate what influences the smooth and timely flow of patients through hospital departments, and to develop and implement methods for improving flow. Specific areas of focus include reducing waits for inpatient admission through emergency departments, achieving timely and efficient transfer of patients from the intensive care unit and the post-anesthesia care unit (PACU) to medical/surgical units, and improving flow from the inpatient setting to long-term care facilities.
While few hospital areas are designed to achieve optimal flow of patients, the emergency department, intensive care unit, and operating rooms and their related pre- and post-care areas tend to be major bottlenecks because they are non-interchangeable resources. Reducing delays and unclogging bottlenecks depends on assessing and improving flow between and among these departments, and throughout the entire system, rather than in isolated departments.
IHI believes that the key to improving flow lies in reducing process variation that impacts flow. While some variability is normal, other variation is not and should be eliminated. Hospitals working with IHI have tested a range of changes to reduce process variation and improve flow. These changes are described in this white paper.