Planning for predictable emergency admissions to improve patient access and flow

TL;DR

A new hospital process reduced emergency transfers and improved patient flow by aligning inpatient capacity with demand.

Contribution

A two-phase inpatient flow strategy using flow beds and early discharges improved hospital throughput and reduced delays.

Findings

Flow beds reduced overnight transfers by over 50% in eligible cases.

Emergency Department length of stay and decision-to-admit times improved significantly.

Early discharges eliminated surgical cancellations due to ICU bed shortages.

Abstract

To implement and evaluate a new inpatient flow process designed to reduce overnight transfers, decrease Emergency Department length of stay, and improve overall hospital throughput.

A two-phase quality improvement initiative was conducted using the DMAIC (Define, Measure, Analyze, Improve, Control) framework. In Phase 1, "flow beds" were introduced to minimize overnight patient transfers and enhance staff and patient experiences. Phase 2 implemented an early morning transfer process from the trauma and neurosurgery intensive care unit to the trauma and neurosurgery inpatient ward, aligning intensive care unit capacity with anticipated daily demand. The effectiveness of the interventions was assessed using a before-and-after study design.

Flow beds were successfully created in over 85% of eligible cases, reducing overnight transfers to alternate units by more than 50%. Emergency Department length of stay and decision-to-admit times improved by 25% and 43%, respectively, at the 90th percentile (p < 0.05). Total inpatient length of stay decreased by 11% (approximately 1 day). In Phase 2, early trauma and neurosurgery intensive care unit discharges occurred in 50% of cases, eliminating surgical cancellations due to intensive care unit bed shortages during the study period.

Proactive inpatient flow strategies focused on demand-capacity alignment significantly improved Emergency Department and inpatient metrics, while reducing intensive care unit-related surgical delays.

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