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Tackling Patient Flow Bottlenecks

This article was originally published in ISSUE #14 of CONNECT magazine on 1 July 2024.


Access block is one of the most serious issues facing health systems in Australia and Aotearoa New Zealand, according to the Australasian College for Emergency Medicine (ACEM). In 2023, bed blockages across New Zealand hospitals resulted in an average wait of 63 minutes for ambulances to hand over patients to ward staff. 1 

Highlighting this severity, a recent study reported that if more than 10% of patients awaiting admission in an Emergency Department (ED) experience access block, new patients presenting to that ED have a 10% increase in the risk of death within seven days of admission. 2  It’s easy to focus on what is happening in the ED, but a wider lens across the health system reveals many factors contributing to patient flow bottlenecks.

One example, highlighted by Sarah Donnelly, charge nurse, Te Pae Hauora o Ruahine o Tararua MidCentral District, is bed management on inpatient wards. She presented on Miya Precision during Alcidion’s product forum in 2023 where she said that for many years, the team at MidCentral had to “walk around and find the charge nurse and say, ‘tell me what’s happening with your patients’ and then manually count the discharges on the hand-written whiteboard.”

This was time-consuming, inefficient, and risky because of the potential for miscounting and the likelihood that beds and patient status had already changed by the time this process was complete.

Instances like this cause a ripple effect that reaches across the entire healthcare ecosystem. The time it takes to track down the charge nurse causes delays in discharging patients from that ward. Those delays ripple back to patients in the ED waiting to be admitted, and even further to ambulance ramping. 

By that same token, it is then reasonable to assume that the introduction of a solution that creates positive benefits in one area, like releasing clinicians time to care on inpatient wards, will have its own ripple effects too. 

MidCental’s ‘ripple effect’ of benefits from adopting a patient flow management solution

MidCentral was the first healthcare organisation in the world to roll-out the Miya Precision platform to provide real-time patient flow information and bed management updates accessible via iPads at the bedside, workstations, and electronic patient journey boards (EPJBs). 

EPJBs play an important role in managing the flow of patients throughout an organisation by centralising patient information and making it accessible in real-time. These boards replace outdated manual tracking systems, providing a dynamic and interactive platform that integrates data from various sources, such as Patient Administration Systems (PAS), Radiology Information Systems (RIS) and Laboratory Information Systems (LIS).

In a study conducted by the Sax Institute, commissioned by the ACEM, two major factors contributing to persistent access block were identified.3 

  • Most hospitals are overcapacity with a mismatch of bed numbers to patients in need of healthcare services 
  • A widespread lack of integration across the interfaces between EDs and inpatient services

With Miya Precision and the electronic patient journey boards, MidCentral was able to tackle these challenges head on.

Sarah Donnelly likened their previous lack of visibility into bed availability for acute and elective patients to “licking your fingers, sticking it up in the wind and wondering ‘what way are we going today?’” It’s a strong anecdote that underscores just how difficult it is to manage – let alone improve – operations if clinical staff don’t have access to the right information, in the right place, at the right time. 

As demand for services grew, MidCentral quickly recognised the importance of “a digital solution to maximise capacity and eliminate blockages in patient flow to have that daily monitoring of hospital activity, better manage patients’ journeys, and provide that coordinated response across the hospital.” 

In 2018, the organisation introduced EPJBs in every single ward, from the ED to adult inpatient, mental health, rehab, women and children and more – totalling 30 boards all tailored to the unique processes and needs of each area. Organisational-wide views were also implemented into the Integrated Operations Centre (IOC), complementing the EPJBs, which are visible and on constant rotation on large screens in the IOC. Underpinned by the FHIR-based Miya Precision platform, these boards integrate data from nine different clinical information systems, consolidating all available information. 

“It essentially does the math for us instead of us having to do it in our head. It lets us know exactly how many beds we’re going to have left at the end of the day once everyone on the screen has gone in or out,” said Donnelly.

Image from MidCentral District’s Sarah Donnelly and Rachael Timutimu Digital Health Week 2023 presentation on Miya Precision’s role in improving patient flow oversight and staff allocation.

Beyond access block challenges, this implementation has helped the organisation streamline a number of workflows and processes. “We can now focus on streamlining referrals, eliminating unnecessary paper-based tasks, and creating real-time digital referrals for Allied Health input and other specialty clinical services.”

The snowball effect of benefits created from the implementation of Miya Precision has been studied by researchers and proven to extend to other healthcare settings and environments. In May 2024, an independent study was conducted on the implementation of Alcidion’s Miya Precision and EPJBs at Alfred Health in Melbourne. 4

An independent study at Alfred Health demonstrates EPJBs ability to improve patient flow in diverse healthcare environments

The Alfred introduced Miya Precision to address challenges with out-of-date or inaccurate information and delays in overall bed access due to a reliance on whiteboards, paper, and phone calls. This study hasidentified a wide range of benefits across the health system, attributed to this adoption of electronic patient journey boards. 

  • Efficiency in bed allocation: The study reported that the duration of calls related to the management of beds decreased by 67%, freeing up resources to take on additional work. 
  • Reduced Length of Stay: There was a 12.1% reduction in patient length of stay over 18 months, suggesting more efficient bed utilisation and patient throughput.
  • Enhanced Information Accuracy: The implementation eliminated a 25-40% discrepancy between patient information in the EMR and manual whiteboards, leading to improved patient safety and more accurate clinical updates.
  • Improved Discharge Planning: With the new system, 100% of patient records included an Estimated Date of Discharge (EDD), compared to only 60% before. This improvement aids in better discharge forecasting and planning.
  • Standardised Workflows: The number of workflow variations across wards reduced significantly from 30 to nine, making it easier for staff to move between wards without having to adapt to different processes.

Ready to tackle access block at your organisation? 

The success stories from MidCentral and Alfred Health showcase the ripple effects of benefits from an effective patient flow management solution. These examples highlight the power of data-driven decision-making and enhanced interoperability in addressing access block and improving patient care.

Your organisation can achieve similar results. If you work backwards along the patient flow journey to resolve issues like the ‘stranded patient’, ‘waiting for what’, and ‘discharge barriers’, you create a ripple effect that frees up capacity across the system.

If you’re ready to see the ripple effect of benefits at your own facility, get in touch

References: 

1. Newsroom. (9 October 2023). Under pressure: Verrall’s weekly reports show health system crunch in new detail.  https://newsroom.co.nz/2023/10/09/under-pressure-verralls-weekly-reports-show-health-system-crunch-in-new-detail/

2. Jones, P. G., & van der Werf, B. (2021). Emergency department crowding and mortality for patients presenting to emergency departments in New Zealand. Emergency Medicine Australasia, 33(4), 655–664. https://doi.org/10.1111/1742-6723.13699  

3. Frommer M, Marjanovic S. (2022). Access block: A review of potential solutions. Sax Institute. Access block a review of potential solutionsACEMhttps://acem.org.au › getmedia › Access-block-A-r…             

4. Alcidion. (7 May 2024). An Independent Study Shows the Ripple Effect of Benefits from Adopting a Patient Flow Management Solution. https://www.alcidion.com/news/an-independent-study-shows-the-ripple-effect-of-benefits-from-adopting-a-patient-flow-management-solution/