Bed Management and Patient Transfer

1
Bed Management and Patient Transfer

• Presentation to Institute for Healthcare
  Improvement, November 1, 2005
• Randolph W. Hall
• Epstein Department of Industrial and Systems
  Engineering
• University of Southern California

2
Patient Flows

• Movement of patients through a healthcare system
• When the system works well, patients flow like a
  river
• When it fails, patients flow like a reservoir
• Unless patient needs to remain in the system for
  health reasons, reservoirs are bad, rivers are
  good
• A queue represents the accumulation of patients
  awaiting service (examination, test, treatment,
  etc.)
• A queue could also be a specimen awaiting
• analysis, a request awaiting a file transfer,
  etc,

3
The Bed Cycle

• Empty, waiting to be cleaned/prepared
• Empty, cleaning/preparation
• Empty, waiting for arrival of next patient, or
  waiting for return of patient
• Occupied, admitting incoming patient
• Occupied, patient waiting for tests, treatment,
  medication
• Occupied, patient receiving treatment, test,
• Occupied, patient recovery, monitoring,
• Occupied, patient waiting for discharge to occur
• Occupied, patient being discharged
• Occupied, patient waiting for transportation

4
Classification of Activities

• Necessary, not compressible without medical
  advances recovery/monitoring
• Necessary, but compressible discharge
• Not necessary waiting for tests

5
Meaning of Utilization

• Bed assigned/reserved for specific patient
• Bed physically occupied by patient
• Bed physically occupied, and patient is not
  waiting
• Bed physically occupied, and patient receiving
  treatment, in recovery, being monitored,
• What of Time is Bed Spent in Most Productive
  Activities?

6
Patient Cycle Length of Stay

• Registration, admission
• Waiting, not occupying bed
• Waiting, occupying bed
• Receiving treatment, test,
• Recovery, monitoring,
• Discharge
• What of Stay is Spent in the Most Productivity
  Activities?
• What is Length of Entire Cycle?

7
Strategies

• Communication
• Discharge known by housekeeping
• Bed availability known to bed control
• Patient requirements known to bed control
• (gender, ICU, isolation, )
• Medical condition accurately known by receiving
  ward, in advance of arrival
• Nursing loads known to bed control

8
Strategies

• Coordination of Activity/Scheduling
• Load leveling for nursing staff consideration of
  shift changes
• Bed control able to make correct/timely
  determination
• Housekeeping responds rapidly and efficiently
• Transportation responds rapidly and efficiently
• External activities coordinated pharmacy,
  surgery, radiology
• Various discharge entities synchronized
• Synchronization of admissions/discharges by time
  of day

9
Utilization, Admission and Discharge

• Beds Available Beds at Start Discharges
  Admits
• Depends on
• Discharge pattern for day
• Admission pattern for day
• Ability to make bed available once patient is
  discharged
• Utilization (Total Beds Beds Available)
• Beds
  Available

10
Sensitivity Analysis Parameters

• Time Discharge Begins
• Time Discharge Ends
• of Patients Admitted in Peak
• Start of Peak Admissions
• End of Peak Admissions
• Length of Stay
• Midnight Occupancy

11
Discharge 9 to 5Peak Admit 11 am to 10 pm75
Admits in Peak4 Day Length of Stay95 Midnight
Occupancy
12
Same Pattern 3 Hour Lag Before Bed is Available
13
Synchronized Discharged/Admit
14
Outcomes from Good Bed Management

• Minimal time waiting for assignment and transfer
  to appropriate bed
• Few boarders
• Highly productive bed utilization
• Highly productive length of stay
• Correct/appropriate placement of patients
• Efficient staff utilization (minimal idle time
  appropriate assignment of staff to jobs)
• Satisfied patients