Ideally, a visitor to a hospital or other healthcare facility never needs to think about patient placement. This important process involves the logistical infrastructure and actions that come together smoothly to help make the patient’s “visit” effective, efficient, and even pleasant from start to finish.
While the patient may not realize the significance of placement, important coordinated behind-the-scenes efforts manage this work process to make it seamless. A smooth transition can help ensure patient comfort and safety. It can also help to keep health care facility costs down and quality performance up. High patient satisfaction and effective operational performance drive sustained or increased facility usage and desirable bottom-line results.
Like any process, patient placement can be optimized and standardized using an operational excellence approach.
What is involved in patient placement?
Placement begins from the time the patient walks in the door, or even before that if the patient is pre-admitted or being transferred from another facility. The process continues until the patient is discharged to go to another facility or return home. Between these endpoints, the patient is seen by multiple healthcare professionals, undergoes many tests and utilizes numerous services of the facility. The placement process is optimized when quality and timeliness at and between each of these touchpoints is optimized. This involves effective operational processes, smooth transitions, and excellent communications.
Let’s take a look at some of the general steps in patient placement.
Patient placement at admissions
Every patient has different needs. Upon arrival, the capabilities of the facility—availability of staff, services, and beds or other rooms—are matched with the needs of the patient.
A patient placement coordinator uses diagnostic, triage or other information in conjunction with medical staff to outline a plan of care that determines where the patient will be assigned, matching this to a department or nursing unit, and estimating a discharge date. Once that assignment is decided, patient transport must operate efficiently to deliver the patient to the right bed in the right nursing unit at the right time. After the patient is in the right spot and acknowledged by that unit’s staff care begins.
The placement process becomes quite complex when patient volume is large or highly variable in length of stay or plan of care. Inevitably, any medical series on television will have a haunting episode of a patient left on a bed in a hospital hallway slowly dying because the patient was “someone else’s problem.” That extreme situation may occasionally happen in real life. More often, inefficiencies cause long wait times and delayed treatment, contribute to errors, and create on-the-job stress for medical staff.
While we may not want to compare human patients to manufactured widgets, some of the same capacity planning, routing and queuing models, and flow optimization methods that have been very successful in manufacturing can be tailored for patient placement application. At any given time, patients are in different steps of the process, in different locations, and with different levels of quality requiring staff attention. Metrics such as number of patients, patient wait time, length of stay, room turnover time, and patient satisfaction are very similar to metrics for product flowing through manufacturing.
The logistical elements of the patient flow process can be optimized in concert with excellence in medical and bedside activities. Logistics software specifically designed to track and manage patient placement can be helpful for optimization of patient flow.
Patient placement at shift change
To some extent, patient placement is an issue at every staff shift change. Incoming staff members need to be brought up to speed quickly on the status of the patients in their unit, highlighting new arrivals, changes in care for continuing patients, and readiness for discharge.
Effective cross-shift communications are vitally important to help prevent errors or oversights in medical care. One way these important communications can happen is with the use of a “huddle,” as sports teams, manufacturing operations, software developers, and other organizations have found effective for their own shift changes. A standard work approach is used for a brief meeting at the start of each shift.
At least daily a “bed meeting” takes place to confirm the census of patients and available beds. These counts are used by the coordinator to plan capacity, continuing through the next day and feeding into manual or software patient placement logistics systems.
Patient placement for services
In addition to the in-patient bed or room assignment, patients undergo procedures and tests away from their rooms. They may be taken to the x-ray department for varied scans. They may have surgical procedures in operating rooms, followed by stays in a recovery area to come out of anesthesia. They may be taken to an intensive care unit where they will have round-the-clock medical observation.
All of these areas also need to be monitored for occupancy and availability as well as length of stay. This information feeds into the overall patient placement plan to optimize scheduling and avoid double-booking and “hurry up and wait” situations for patients or staff.
At the end of treatment, the patient placement process transitions to a patient discharge process. Integrating the process and discharge metrics across all dischargeable patients feeds back into availability of beds and rooms for new patient placements. Efficiencies here help guarantee readiness for individual patient discharge and reduce wait time to ensure patient satisfaction. Communicating effectively with the patient to set expectations is a critical part of this step.
Where to begin…
We can think of the patient flow in a medical facility as passengers on a long-term cruise. Some passengers have special needs that require attention from varied staff members. Some will take excursions to different points of interest. Some will disembark at interim ports and new visitors will get on, needing room assignments. The patient placement coordinator is the cruise director charged with efficiently managing the varied arrivals, activities, and itineraries for patients so everyone has a safe and enjoyable cruise.
We’ve recommended an approach for optimizing other parts of the healthcare operation: assess and align, implement projects, deploy a tactical plan, and measure operational processes and KPIs (key performance indicators). This AIDM model works for patient placement as well.