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Next-Generation Capacity Management, Volume 1

Best Practices for Smoothing Admissions

Topics: Capacity, Efficiency, Performance Improvement, Throughput

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After reading this study, members will be able to:

  • Rightsize units to ensure ideal number of beds
  • Manage observation patients in dedicated and non-dedicated units
  • Jump-start care of direct admissions through express admissions units
  • Maximize the effectiveness of patient flow coordinators
  • Optimize bed management software to enhance visibility of beds

Executive Summary

Hospitals continuing to struggle with capacity management

It is no surprise that throughput is a perennial priority for hospital executives across the nation. While many executives have targeted throughput reform efforts toward elevating efficiency in the ED, there is no ultimate return if the inpatient side of the house remains at a standstill. Now, with historically unprecedented economic stress affecting the industry, many hospitals have had to put construction projects for expansion on hold and are tasked with maximizing the return on their current resources. In other words, today’s mandate is to improve efficiency with existing beds and staff.

Two process-levers for expediting patient throughput

Clinical Advisory Board research has identified two principal loci for reform for hospitals attempting to improve the process piece of the throughput conundrum without adding physical capacity: smoothing admissions and choreographing the discharge process. As both are complex issues deserving their own discussion, this publication will concentrate on the first piece of the capacity puzzle—smoothing the admissions process. Truth be told, little about reforming the admissions process is new. The core challenges are the same as those in years past—inordinate pressure stemming from the ED compounded by the challenge of coordinating an admissions process with a large number of independently functioning parts. As such, the ambition of “getting the right patient in the right bed” remains nothing short of a daunting task.

Serious clinical and financial consequences

If unaddressed, the impact of a poor admissions process is dire. First, delayed time to treatment or patients receiving treatment in suboptimal locations, such as hallways, negatively impacts quality of care and patient satisfaction. In addition, admission into inappropriate units leads to unnecessary transfers, driving higher length of stay and burning up precious staff time that is, as always, better spent on providing patient care. Lastly, the Centers for Medicare and Medicaid Services are raising financial stakes with active targeting of inappropriate inpatient admissions through the recovery audit contractors, which has exposed hospitals to sizable revenue losses.

Members, learn more

Members of the Clinical Advisory Board can read on to access the full study.

Preamble - Facing Unprecedented Pressure

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