Effect of Patient Flow in Healthcare
Effect of Patient Flow in Healthcare
December 4, 2023
Joy Stepinski, MSN, RN-BC
Recently I visited a Boston hospital. Several nurses commented that their emergency department (ED) has been bursting at the seams since 2020. I was not overly surprised, yet at the same time, I felt saddened. One nurse described his daily circumstance as the “current era of healthcare.” Patients arrive to the emergency department (ED) and many remain there for days, awaiting an inpatient bed. In healthcare, this issue affects patient flow and causes a host of other problems.
Patient flow relates to the movement of the patient from arrival until discharge. For example, the patient arrives to the ED and is triaged. Once stabilized after receiving emergency care, he is either discharged home or admitted to the inpatient unit. Admission to the new unit depends upon the discharges that already occurred there. This allows the bed to be available for the next patient. However, when the ability to discharge patients from the inpatient units cannot meet the demand of patients needing beds, major backup occurs. As a result, patient care is deeply affected.
Why is patient flow so important? According to one author [1], inefficient flow leads to poor patient outcomes, including increased risk of death. Among the causes are inadequate communication among staff, long wait times, patients leaving without waiting, extended patient stays, and boarding patients (the term for admitting patients although no bed is available). Boarding can pose a big risk because often patients do not receive the appropriate care. The proper resources may be lacking, and the staff may not be equipped to meet the needs required.
Furthermore, patient volume in the ED has risen by 30% over the past 10 years [2], due to the closure of hospitals and sicker patients. Among wealthy nations, the United States has the highest rate of people with multiple chronic conditions [3], the lowest life expectancy, and the highest rate of avoidable death. Engaging in a healthy lifestyle is imperative to avoid the necessity of the healthcare system!
References:
1. NEJM Catalyst. (2018). What is patient flow? https://catalyst.nejm.org/doi/full/10.1056/CAT.18.0289
2. Mohr, N. M., Wessman, B. T., Bassin, B., Elie-Turenne, M. C., Ellender, T., Emlet, L. L., ... & Rudy, S. (2020). Boarding of critically ill patients in the emergency department. Critical Care Medicine, 48(8), 1180-1187.
3. Gunja, M. Z., Gumas, E. D., & Williams, R. D. (2023). U.S. healthcare from a global perspective, 2022: Accelerating spending, worsening outcomes. The Commonwealth Fund. https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022