Patient Flow: Every Hour Counts

Problem Statement

The term ‘patient flow’ refers to the ability of healthcare systems to manage patients effectively and with minimal delays as they move through stages of care.

The consequences of poor flow are well known.

• Emergency departments become crowded, stressful and unsafe.
• Patients are admitted as ‘outliers’ to wards that are not best suited to manage their care, which delays discharge and can result in worsened clinical outcomes.
• Ambulatory care services, clinical decision units, and even catheter labs and endoscopy units may fill with patients waiting for ward admission.
• Inpatients are moved between wards to make room for newcomers.
• Staff are overstretched and routine activities slow down dramatically.
• Clinical outcomes are measurably worse, particularly for frail older people, who suffer more harm events and may lose condition due to extended periods in hospital beds.
• Patients’ and carers’ time is wasted due to delays and slow care processes, and their experience of care is adversely affected.

Failing to achieve system-wide flow leads to suboptimal care and adds no value. Waits and delays for treatment have the potential to be harmful to patients’ physical and emotional wellbeing, while also increasing the burden on clinicians and hospital staff.  

Making significant and sustainable improvements to patient flow requires recognition of the interdependent nature of every aspect of the system, and an understanding that problems are not necessarily solved where they are experienced.

What are we trying to achieve?

Our patients and staff deserve the best care we can provide, and this is what drives the Every Hour Counts portfolio of work, which has the aim ‘to improve patient flow to optimise the quality of care, the experience of care, and the experience of caring, whilst improving the efficiency of the system.’

With an increasing patient population, compounded by poverty and obesity, it is vital we address patient flow through our hospital and more broadly, including outpatients and community care. This requires expertise, focus and teamwork.

Recognising that our system is overburdened, and that we have a goal of achieving health equity for our people, it is essential that we improve and create processes and systems that support the organisation to make the right decisions in a timely manner.

We are already working on improvements that will contribute to optimising patient flow, including:

• reducing demand
• matching capacity with demand
• redesigning the system.

What have we done?

The following programmes of work have been implemented and will enable any successes to be scaled across the organisation and wider health system. The programmes are based on our learning, and selected to gain greater impact and results in a timelier fashion.

Acute flow

• Emergency Department patient flow
• Bed utilisation
• Proactive discharge planning
• Optimising access to community services
• Rapid and consistent access to diagnostics

Ambulatory flow

• Outpatient redesign
• Booking and scheduling review