Organizations have historically focused throughput efforts on reducing avoidable inpatient length of stay. Some hospitals have already maximized throughput gains in this area.

But organizations that still have room for improvement in this area should start here before moving on to more time-intensive strategies. This strategy is the fastest way to relieve capacity pressure. It creates breathing room for leaders to go after more time- and resource-intensive opportunities later. And starting with quick wins can engender support from frontline clinicians for more complicated patient flow initiatives in the future.

If you can answer “yes” to all four questions below, you’ve maximized throughput gains in this area and should move on to the next strategy. If not, considerimplementing the three tactics in this section at your organization.

Questions to ask yourself

• Do clinicians estimate date of discharge for at least 80% of patients within 24 hours of admission?
• Do the estimated and actual date of discharge match at least 70% of the time?
• Are fewer than 5% of bed days due to medically stable patients waiting on outstanding tasks or medical orders?
• Do at least 80% of patients leave the hospital within 2 hours of receiving a discharge order?

Three tactics to reduce avoidable inpatient length of stay

1. Plan for discharge on day one.
   Estimate each patient’s date of discharge and proactively surface barriers to meet that date. This is the most impactful step organizations can take to reduce length of stay.
   
   
2. Streamline interdisciplinary communication to support ontime care plan execution.
   Larger care teams lead to delays in care planning and execution—unless interdisciplinary communication is built into clinician workflow.
   
   
3. Empower clinicians to overcome common transition delays.
   “Last mile” discharge delays, or barriers to leaving the hospital after the discharge order has been written, can add up to a lot of extra time. Organizations need to know their most common discharge delays and equip clinicians with the tools to overcome them.

The most efficient way to improve throughput is preventing an avoidable admission altogether. There is considerable opportunity across the care continuum to ensure that only those who need acute care are admitted to inpatient beds.

If you can answer “yes” to all three questions below, you’ve maximized throughput gains in this area and should move on to the next strategy. If not, consider implementing the two tactics this section at your organization.

Questions to ask yourself

• Can less than 5% of ED presentations be seen at an alternative site of care?
• Does my organization fall below state average for hospitalizations due to ambulatory care-sensitive conditions?
• Do clinicians feel comfortable discharging ED presentations to a subacute site of care rather than admitting?

Two tactics to direct patients to the most appropriate site of care

One part of directing patients to the most appropriate site of care is expanding outpatient access, so patients can present to subacute care sites directly. But acute care organizations can proactively re-route patients from the hospital to the right site of care, by implementing the tactics below.

1. Treat non-emergent patients in subacute sites of care.
   Divert patients who don’t need acute care before they enter the ED. This is primarily achieved by working with community partners, such as the local justice department and first responders.
   
   
2. Shift away from hospital admission.
   Once a patient presents in the ED, admit only those who truly need acute care. This is easier said than done. Often ED clinicians are not confident patients will receive the care they need outside the hospital and admit patients who do not need acute care as a precaution. Leaders can correct this impulse by creating care pathways within the ED to connect non-acute patients with the right subacute care.

Even with flow processes that work well for most inpatients, there are some groups of patients with a disproportionate financial impact. There are two reasons for this. First, clinicians may struggle to advance care plans for patients with complex clinical and social needs, resulting in expensive episodes of care. Second, inefficient processes for routine, high-revenue procedures add up to a significant missed opportunity for revenue.

If you can answer “yes” to all four questions below, you’ve maximized throughput gains in this area and should move on to the next strategy. If not, consider implementing the two tactics in this section at your organization.

Questions to ask yourself

• Do clinicians proactively identify highly complex patients whose care will require additional resources?
• Does my organization have dedicated care planning resources for these highly complex patients?
• Has my organization identified the DRGs with the greatest opportunity for standardization?
• Is my organization able to accommodate most scheduled surgical cases without cancelling or rescheduling?

Two tactics to segment financially impactful patient populations

Both of these patient populations require a different strategy to positively affect an organization’s revenue.

1. Create dedicated pathways for resource-intensive patient populations.
   A small population of high-need, complex patients requires a disproportionate amount of staff time and resources. Planning for these patients rather than around them helps clinicians efficiently advance their care plans, leading to gains in clinical quality and throughput.
   
   
2. Standardize predictable patient care for top-opportunity DRGs.
   Standardizing care has a powerful impact on throughput, cost, and outcomes. But care standardization takes a lot of effort. Focus your efforts on surgical efficiency first, then move on to reducing care variation for high-cost, high-volume DRGs.

An effective throughput approach is customized to an organization’s market and bottlenecks—both of which change over time. To sustain throughput gains, organizations will need built-in mechanisms to regularly recalibrate flow strategy.

If you can answer “yes” to all five questions below, share your story with us atnec@advisory.com. If not, consider implementing the two tactics in this section at your organization.

Questions to ask yourself

• Does my organization use data and staffing targets to predict and plan for seasonal surges in demand?
• Does my organization have protocols to manage short, unpredictable spikes in demand?
• Does my organization use real-time data to track inpatient bed availability?
• Does my organization use data to identify care delays across the facility and/or system?
• Does my organization use internal patient flow benchmarks to set goals and drive improvement?

Two tactics to anticipate and address emerging bottlenecks

Recalibrating your patient flow strategy should accommodate for both temporary fluctuations in volume and decisions about which long-term opportunities to address. You will need a different mechanism in place for each.

1. Predict and plan for point-in-time demand surges.
   Sudden increases in demand or seasonal trends can disrupt even the best patient flow operations. There are many surge plan options available, but they need to be hardwired to avoid unnecessary delays in care.
   
   
2. Centralize data and oversight to increase system-level line of sight.
   Centralizing oversight can help you execute on enterprise-wide data to more accurately direct resources and provide an integrated approach to tackling bottlenecks. Many organizations may not be ready for this approach—and that’s okay. But as throughput technology advances, this is where leaders will find their most impactful throughput gains.