What Are They and How Can You Navigate Them?
Is setting standards and measuring your patient placement performance a top priority? If you
work in hospital administration, we bet (and hope!) your answer is a confident “Yes.”
As you know, the goal for efficient patient placement is to reduce or eliminate delays in transferring patients from clinical intake areas, such as the ED and PACU, to nursing unit beds, thus improving medical care (by avoiding extended stays in the ED beds or in the hall in a nursing unit) for the patients and freeing up needed beds in the ED.
But there are challenges that have to be overcome in order to meet this goal. First, there must be easy access to real-time operating data about patients and beds for clinical and bed access staffs throughout the process. Second, management must make decisions as to how to handle several difficult issues that arise during the process, and those decisions are better made with real-time data. And third, management must also find a way to accurately measure the performance of clinical and bed access staffs in completing their segments of the process.
Challenges & Possible Solutions
Overwhelmed Clinical Staff:
The clinical staff is responsible for collecting characteristics and bed needs for ED and PACU patients that are being admitted to the hospital, and making that information available for the bed access staff. If a hospital is relying on a manual system to communicate information, clinical staff will have to rely on the paper generated by the admitting doctor.
Solution: Real-Time Info & Automation:
The technology that we offer at PFS includes key hospital-defined patient characteristics and bed needs, facilitates the collection of the data, either electronically or manually, and makes it easy to see in real-time.
We have also added a counter that displays the elapsed time from admission of the patient to the bed request, making it easy to track the performance of your clinical staff during this early segment of the patient placement process.
Ill-Equipped Bed Access Staff:
Staff from hospitals both large and small can quickly become burdened by an influx of patients if they are ill-equipped to carry out the patient placement process. The bed access staff is responsible for selecting from among the incoming patients to place and finding an appropriate available bed for that patient. Sometimes the staff doesn't have all the information they would like about patient characteristics or about the current status of appropriate beds.
In addition, management must establish a procedure about how to measure the performance of the bed access staff when all appropriate beds are occupied at the time the placement request comes through. On the one hand, it seems unfair to measure the performance of the bed access staff when no appropriate beds are available. On the other hand, part of their job may be to assess whether there are existing patients in appropriate beds that might be moved to other beds in order to free up space. But what if that is not possible? Should they be penalized? We think there is a better way.
Solution: Tools for Efficient Bed Selection & Real-Time Reports
Once the placement request is entered we want to help the bed access staff by providing operating data that they need, and then measure the time it takes them. Our system displays key patient information in a grid to help in the selection process, including: name, gender, medical service, date/time admitted, and date/time bed requested. The system also displays the status of all appropriate beds either in a selected nursing unit or throughout the hospital.
We also provide a counter to measure elapsed time from the bed request or from the time that a bed became available to pending placement. How does management make the decision as to which measurement to make?
We can provide data as to what percentage of attempted pending placements occur when all appropriate beds are occupied, and how much longer pending placements in those situations take than ones where a clean bed is available. Or, when a dirty “in process” bed is available. This kind of information will inform hospital management regarding the proper steps to take to keep staff sane and patients happy (Note: If you’d like to learn more about how our process helps with Patient Satisfaction, check out our blog post on the Rising Importance of Patient Reviews.)
Problems with Patient Transportation:
We’ve used this illustration a lot when discussing the potential issues surrounding patient transportation, but that’s because it is so relevant to the problems all hospitals face with this process.
Patient transport begins once a bed has been selected for a pending placement and ends once
the clinical staff has gotten the patient out of the ED or PACU and into the bed in the nursing unit.
Potential complications during this part of the patient placement process:
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The bed selected for the pending placement may not be clean and ready to be occupied.This presents a tension between the desire to get the patient out of the ED or PACU and issues related to patients having to wait in hallways of the nursing units until the bed is ready.
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Solution: Fixing this issue comes down to making a wise management decision, which depends on an assessment of relative risks for patients hanging around in ED or on stretchers in unit hallways. The PFS system can provide information as to which is actually occurring, so management can make an informed decision.
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The patient may not be ready to leave the ED or PACU even though a bed is ready.A patient can be admitted while still requiring further stabilization in the ED, which may not be complete when a clean bed has been identified. Or, it might occur if the patient's condition becomes worse or they discover additional medical issues, such as a contagious agent. The solution is a medical one.
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Solution: Our system provides continuing, real-time information about the bed status so that the clinical staff will know when the patient can be moved.
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Confusion over when to begin measuring the elapsed time for patient transport.The last step in the patient placement process is to transport the patient to the nursing unit. Obviously, the patient will not be transported before medically ready. There are several possible starting points from which to measure elapsed time for this segment: when the pending placement is made, when an appropriate bed becomes ready (the turn process has begun), or when an appropriate bed becomes clean.
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Solution: This is the crux of the issue when it comes to measuring patient placement performance and it is directly tied to where patients are placed while waiting for a clean bed on the nursing unit: ED or nursing unit hallway?
Measuring Patient Placement Performance: An Ongoing Discussion
We have provided our recommended solutions to overcoming the challenges presented by measuring your patient placement performance, but we are aware that different hospitals have different needs and methods. We welcome further discussion, feel free to let us know your thoughts in the comments.
