Improving Patient Flow from the Post-Anesthesia Care Unit to Inpatient Bed: East Alabama Medical Center

East Alabama Medical Center (Opelika, Alabama, USA) reduces patient transfer time by as much as 80 percent through IHI Collaborative initiatives.
 
For patients who pass through multiple departments during a hospital visit — say, from the emergency department to x-ray to surgery to post-op to an inpatient unit — every “handoff” brings the possibility of delay. Streamlining the journey is known as improving patient flow.
 
East Alabama Medical Center (EAMC), a 314-bed acute care regional referral center located in Opelika, Alabama, was typical of most hospitals: delays in moving patients through the hospital were common. But as a member of IHI’s IMPACT network, EAMC knew that improvement was possible. And they were right: working to reduce bottlenecks, they have lowered the average transfer time from the post-anesthesia care unit (PACU) to an inpatient bed by 80 percent.
Graph_EastAlabamaMedicalCenter_MedianHoursTransferfromPacutoInpatient.jpg 
“I am responsible for looking at patient flow in the whole hospital,” says Laura Nelson, RN, manager of EAMC’s new bed-capacity center. The very idea of centralizing responsibility for the big picture of patient flow is novel.  But it is just the kind of rethinking that enables people to break old habits and create breakthrough improvement.
 
“We did a lot of PDSA cycles and tried a lot of different things to reduce our PACU-to-inpatient times,” says Nelson. “One of the things that has really made a difference is faxing reports to the receiving floor.”
 
The telephone has long been the standard means of transferring information about a patient when that patient moves to a new unit. “But nurses aren’t always able to come to the phone when you’re ready to report on a patient, so there is a delay until that nurse can call back,” says Nelson. Faxing the report is more efficient, but represents a significant culture change.
 
“Initially we had a lot of nurses who said they couldn’t get the information they needed from a piece of paper; they have to talk with someone. Now that they are used to faxed reports, they want everything on paper,” says Nelson. “Now we are working on faxing reports from the ER to receiving units.”
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