OSF Saint Francis Medical Center is located in Peoria, a city of 120,000 in north central Illinois. A 710-bed academic medical center, our hospital serves patients from approximately 20 surrounding counties. Although built for only 30,000 patients annually, the Emergency Department (ED) sees more than 60,000 patients per year.

Like most American hospitals, each year, our patient flow challenges would build in complexity. As the hospital would increase capacity, each year, patient flow would increase at a faster rate. Patients were being held in the ED due to lack of inpatient beds and regional transfers were occasionally being deferred to other institutions.

I recently became part of a committee assembled to look at the current process for capacity and patient flow, and come up with potential improvements. We needed to create capacity and manage throughput and started by examining what patients need and who is contributing to patient admits - like surgery, radiology, etc.

The Reactive System

Under OSF Saint Francis' existing system for capacity management, the house supervisor was in charge of bed placement, and every morning there was a bed meeting with the charge nurses. Staff shared their bed needs at these meetings, but no one was ultimately held responsible for patient flow.

Although the bed meetings happened each morning, information such as the surgery schedule/needs shared at these meetings was available the previous afternoon.

This got us thinking about forecasting. If we looked at historical data, we could predict things like ED admits, which affect how many beds we would need the next day. We also knew the night before if certain patients were probably going home, or if there were patients on floors that could be moved. We quickly realized that we were not using the information available in a proactive manner.

The Proactive Approach

Utilizing Six Sigma methodology, a disciplined, data-driven approach for eliminating defects in any corporate process, our team analyzed the current system and developed a proactive patient flow plan. This problem was always pegged as an ED problem - but it is really reflective of inpatient services throughout the hospital. We needed to educate the entire staff that the best place for a patient is in a bed, and that is why we are doing this.

OSF Saint Francis first installed an electronic data tracking system to assist with capacity management. The Teletracking system gives us actual data - not guesses - on which we can base our patient flow predictions. We now have factual data to look at, so we can see where breakdowns are occurring.

A medical director of patient logistics ("Bed Czar") role was created to work with the medical directors over patient units to manage patient capacity. A new Patient Logistics Department was put in place to oversee the forecasting of future bed needs throughout the hospital and to manage the overall picture of patient flow (using the new electronic data system) throughout the entire hospital.

Impact and Lessons Learned

Some of the biggest challenges for our team will include changing the culture to more of a 'pull' system rather than a 'push' system. It is not about the individual patient units, it is about the patients. We need to keep that as the focus of our actions.

I recommend the electronic data system to other hospitals facing similar challenges, because the hard data it provides is important.

Although the forecasting and electronic tracking system has made the bed assignment process faster, since the system is just rolling out, its long-term impact on patient flow is not yet evident. My hope is that patients don not need to stay longer than necessary in the ED due to lack of bed availability in the hospital, and that they get in the right bed to begin with and don't have to be moved. Patient and family satisfaction is critical.

-------------------------------