Managing Capacity and Hospital-Wide Patient Flow with Daily Bed Huddle and Bed Meeting
“If we could just… – (fill in blank with) – ‘get our patients out by noon’ or ‘get the physicians to round early’ or ‘get discharge orders earlier’ we could improve our patient flow.” I don’t disagree with any of these concepts, and if you can actually accomplish all three simultaneously, you may be successful in improving patient flow in some units, but not hospital–wide.
Most all hospitals now have Bed Managers, Bed ‘Czars’, or House Supervisors that are responsible for overseeing patient flow and movement throughout the hospital. Those lucky enough to be in these roles beat their head against the wall on a daily basis establishing and continuously updating plans and forecasts that will create capacity to meet both the scheduled and the anticipated unscheduled demand for that day.
Managing capacity is a hospital-wide initiative. It cannot be the silos of the Emergency Department (ED) or the Post-Anesthesia Care Unit (PACU) working independently. It also cannot be a group of units or service line units working independently. The ED and PACU departments can certainly work on their own internal patient throughput bottlenecks, but when the disposition of a patient from the ED or PACU warrants a bed, then the internal goals or metrics the ED or PACU track, will be in jeopardy.
Improving patient flow must be a hospital-wide endeavor. Daily unit bed huddles with the Care Coordination/Case Management, the Unit Manager, and the Charge Nurse, that reviews lists of all known discharges, and puts in place a plan that will expedite the discharge as early in day as possible, is what will provide necessary information to the Bed Czar and assists in managing hospital-wide patient flow.
In addition to becoming more knowledgeable in predicting available capacity of a unit (current available beds + discharges and transfers moving off unit), the Unit Manager can also learn to predict expected demand. This can be accomplished easier for a surgical unit, especially if most of the admissions are scheduled (just look at the daily scheduled admit list. The prediction of expected demand can also be accomplished by medical units that review previous registration/ADT history and the source of patient admission (ED or Transfer). All of these historical trends and sources will assist the Unit Manager in their daily prediction of capacity and demand.
Predicting this information for a time interval of 8am to 2pm, when many bottlenecks begin to occur is a great start. If capacity can meet demand during this ‘rush hour’ time interval, then as the other discharges and transfers leave unit after 2pm, this will most likely make room for the ED afternoon and evening rush for beds. If expected demand exceeds capacity during this time interval, it is up to the Unit Manager/Bed Huddle team to establish a plan to meet the need.
Bed Managers do this by reviewing all discharge patients and what may be accomplished within their control, in order to expedite an earlier discharge – before 2pm. If it is calling Respiratory Therapy for earlier Home O2 evaluation, or Physical Therapy for Home PT Evaluation, the Unit Manger and Care Coordination team, from the Bed Huddle, make the plans that morning before 9am. The information is brought to the hospital-wide Bed Meeting, usually at 9am, with the plan. All units and necessary ancillaries (Radiology, Non-Invasive Cardiology, Physical & Respiratory Therapy leadership) are present for 15 minute debriefing.
All units report, but those units unable to establish plan to meet their demand during the time interval, will be the focus of support from the Bed Manager/Bed Czar. Staffing concerns and requests should not be discussed at this meeting since it is not the focus. Those units with available capacity and ‘sister’ clinical competencies and level of care will in time step up to the plate and help.