Webinar: 70 percent of our patient flow is acute

How do you improve the capacity scheduling in a hospital? In 2009, the Atrium Hospital in Heerlen experienced a stagnation of patients in the emergency section and steep costs. As the manager of the capacity department, was asked to tackle this problem.

Image: © Nationale Beeldbank

What was going on?

“The hospital was not in control in terms of bed capacity and the supply of patients at the time that I was appointed as manager of the capacity department. Although we could already dispose of an Acute Admission Department at the time, a ‘code red’ was - stagnation of the patients in the emergency section to the other wards - frequently applied. Of all of the general hospitals in the Netherlands, ours had the highest stay duration. Scheduled admissions sat in the waiting area at the Admissions office until a bed was released.”

How is the situation at present?

We are back in control, our stay duration is considerably shorter and the hospital no longer experiences the “phase red”. Scheduled admissions can be sent to the OR without delay. We managed to reduce the bed capacity by over 100 beds, which has resulted in a considerable saving in costs.

Things still get hectic now and again, of course: this morning, for example, extra efforts were needed in order to manage the flow of urgent cases. The difference compared to the past is that we are now ahead of the problem, we do not play the ball as long as we used to and we make timely adjustments.”

Which improvements have been implemented?

“We have put the emphasis on improving the flow of urgent cases. Whet many people do not realize is the fact that the majority of the admissions concern acute admissions; 70 percent of the admissions is acute. Which means that you can try to improve the 30 percent of scheduled admissions and adjust these in that way, but that will not yield the highest gain.

We have, incidentally, set up an admissions unit for the scheduled flow, a hospital acceleration lane of sorts; patients for whom an operation has been scheduled are admitted via this unit. We have staff that focuses fully on these patients; intakes must take place in a nursing ward in between taking care of the patients present and beds are not yet available. Now, the intake can take place in the admissions unit where the patients are prepared for the operation. And so a bed in a nursing ward will not be required until the patient leaves the Recovery.”

And which improvements have been made for the flow of urgent cases?

“An important aspect is that we now steer the situation on a day-to-day basis. We did not in first instance opt for a tactical steering for the period of a month or year. You have to be in control on the day itself, before anything else. Although it is often believed that the flow of urgent cases cannot be predicted, it can be on a macro-level. What you don't know is which patient will require which specialism and therefore which wards have to reserve a bed. But you do know that more patients present themselves in the winter months compared to the summer months and that Monday through Friday are the most hectic where it concerns the flow of urgent cases.

One important improvement that we have implemented concerns the daily consultation when all of the parties come together. The starting point i this respect is that the patient is to be in the right place at the right time. Parties consult on the ‘foreigners´, patients who should be in some other ward, only no bed is available there. Which patients are most suitable and does this require some other type of capacity? These decisions are made together. This also leads to a better understanding of one another. The consultations will not take long, usually not longer than 15 minutes.

That is one of the improvements that we have implemented. In the end, things are considerably better thanks to the sum of a number of things.”

Would you like to learn more about improving the bed capacity of a hospital? Paul Kuipers will discuss the subject during a live webinar on 18 September at 12:00h. You will have the opportunity to ask questions.