Patient Throughput

Breaking Down Barriers to Timely and Effective Care

Discharge Optimization Helps Drive Better Outcomes

Quality of Care, Patient Safety, and Health System Performance Are at Stake

Acute care represents the largest source of revenue for most hospitals and health systems, as well as having the greatest impact on patient outcomes. Not surprisingly, a lot of time, energy, and resources are focused on increasing inpatient transfers and admissions. But these efforts often are sabotaged by discharge delays which increasingly stem from unwieldy referral management processes to post-acute care (PAC) or behavioral health facilities.

The adverse impacts are far-reaching. Besides frustrating patients, family members, and caregivers, throughput bottlenecks can reduce quality of care and limit the health system's ability to admit new patients, negatively affecting the organization's financial performance.

In recent years, throughput has deteriorated significantly, driving up average length of stay (ALOS) and compromising effective care orchestration: the ability to deliver healthcare services precisely when needed, in the most appropriate setting.

Quite simply, to prevent throughput bottlenecks, health systems must address shortcomings in the discharge process. The good news is, it's possible to streamline and accelerate inpatient discharges through a multifaceted solution involving three overarching and complementary strategies:

  • Adopting proven processes and protocols
  • Implementing purpose-built technology
  • Empowering staff and reducing their administrative burden

UNDERSTANDING THE WHOLE STORY

At first glance, a number of possible barriers to patient throughput present themselves. Insufficient capacity is one of the most commonly cited culprits, along with inadequate system load balancing. COVID-19 has played a role during the past few years although patient throughput issues were present prior to the pandemic and likely will continue long after the end of the public health emergency.

Factors Contributing to Acute Care Discharge Delays

  • Manual, paper-based PAC referral systems
  • Lack of visibility to system-wide capacity and performance
  • Siloed departments and disjointed processes
  • Lack of data insights on PAC network acceptance, denial, and performance trends
  • Inconsistent discharge standards
  • Prior authorization delays by third-party payers
  • Patient transportation hold-ups
  • Inability to efficiently manage numerous PAC placements for complex patients

PAIN, RISKS, AND COSTS AT ALL LEVELS

Who feels the pain when patient throughput is impeded? The question might be better framed as: Who doesn't feel the pain? Consider the impacts at every stakeholder level:

  • Patients are at risk for negative health outcomes and dissatisfaction with the provider.
  • Families and other care assistants feel helpless and stressed knowing where their patients are - and where they should be.

Missed Referral Opportunities

Increased Avoidable Inpatient Delays

  • $288K FOR 100 AVOIDABLE DAYS PER YEAR

Clearly, patient throughput bottlenecks touch every aspect of healthcare, from the welfare of patients and caregivers to the financial viability of the health system. Given the complexity and magnitude of the problem, how are health systems knocking down the barriers to patient throughput?

Effective patient throughput helps ensure patients receive the right care, in the right place, at the right time. But with increasing complexity in the patient journey, coupled with growing difficulty in achieving timely discharges, reaching this goal has become more elusive. Today, breaking down throughput barriers must be multifaceted involving processes, technology, and above all, people.

Adopting Proven Processes & Protocols

From health systems that are overcoming patient throughput barriers, a number of best practices have emerged, including:

  • Measurement and obtaining a clear patient journey to eliminate bottlenecks
  • Multidisciplinary rounds conducted early in the day to proactively identify the needs of patients and keep them moving on the pathway to discharge
  • Laying out a clear pathway to discharge with a backup plan, embraced by the entire care team and communicated to the patient

Cross-departmental collaboration

  • Breaking down silos through technology-enabled information sharing
  • Advance transportation arrangements
  • Use of discharge lounge

Revamping the referral management process

Including adoption of an automated system enabling faster, more standardized transitions to rehab, skilled nursing, and other PAC facilities and services.

Boosting acceptance rates

Delays in PAC discharges create one of the biggest barriers to patient throughput. In fact, for patients who need post-acute care, ALOS has increased 24% since 2019. This has prompted health systems to make sweeping changes to the full scope of their referral management practices.

For a growing number of health systems, the transformation involves technology that removes paperwork and manual tasks from the process while simplifying patient transfers to a curated set of PAC facilities. The technology goes hand in hand with best practices, which include:

  • Identifying high-performing PAC providers to include in your curated network
  • Securing agreements with PAC providers to ensure they will accept challenging cases
  • Offering to educate PAC providers about how to use your PAC technology platform
  • Holding meetings with PAC providers to discuss expectations and opportunities for improvement, backed by performance data

Technology: Think Holistically

Taking control of patient throughput can start with referral management improvements, and is maximized when also addressing demand and capacity within the larger context of care orchestration. The choice of a technology platform should empower this holistic approach.

As a starting point, the technology should be purpose-built for care orchestration and usable across all care settings, enabling systemwide control, communication, and visibility. Other IT systems, such as electronic health records (EHR) and bed management, simply don't address patient throughput and other facets of effective care orchestration.

The Right People, Strategically Deployed

Even in the face of severe staffing challenges, many health systems have demonstrated an ability to hire and retain high-quality staff who are fundamentally important to eliminating discharge delays and accelerating patient throughput. These individuals possess strong communication skills, high emotional intelligence, innovative problem-solving skills, and are deployed in strategic ways.

Enabling these efforts, social workers and care managers are equipped with proven technology streamlining PAC placements. This reduces administrative tasks, eliminating paper- and fax-based transfer requests, and enabling them to work at "top of license".

With all elements of an effective patient throughput initiative working in sync, the positive impacts are felt across the entire healthcare ecosystem.

PATIENT TRANSITIONS

Less downstream congestion translates to more efficient transitions and transfers. For patients who are acutely ill or injured, this means faster access to advanced, potentially lifesaving medical care.

SYSTEM CAPACITY

Effective patient throughput can significantly reduce ALOS, freeing up beds, staff, and resources to accommodate more incoming acute-care patients.

PATIENT OUTCOMES

Patients who receive timely healthcare services experience better outcomes.

STAFF PRODUCTIVITY

Improving patient throughput can significantly drive both revenue enhancement and cost savings.