Hospital capacity management: insights and strategies

Introduction

Letter from the Authors

About the Authors

Chapter 1 Hospital Priorities

Chapter 2 Bed Assignment

Chapter 3 Inpatient and Outpatient

Chapter 4 Emergency Department

Chapter 5 Types of Hospital Beds

Chapter 6 Capacity Management Strategies

Chapter 7 Discharging Patients

Chapter 8 Surgical Short Stay Unit

Chapter 9 Hospital Capacity Management Metrics

Chapter 10 Complex Care Patients

Chapter 11 Integrated Patient Care

The PCAT (Patient Centered Admission Team)
Efficient Patient Transfer
Team-Based Care
Standardized Discharge Process
An Emergency Department PCAT Model: Hot Zone
30-Day Readmission Discussion and Strategies
Chapter 12 Additional Capacity Management Programs (Proceduralist Program)

Chapter 13 Discharges before Noon

Achieving Discharges before Noon
Chapter 14 Leveling

Chapter 15 Ancillary Demand Level Staffing

Chapter 16 Surge

Chapter 17 Starting a Patient Flow Team

Chapter 18 Optimal Hospital Operational Strategies

Chapter 19 Process Improvement

Chapter 20 Conclusion

Hospital Capacity Management: Insights and Strategies details many of the key processes, procedures, and administrative realities that make up the healthcare system we all encounter when we visit the ED or the hospital. It walks through, in detail, how these systems work, how they came to be this way, why they are set up as they are, and then, in many cases, why and how they should be improved right now. Many examples pulled from the lifelong experiences of the authors, published studies, and well-documented case studies are provided, both to illustrate and support arguments for change.

First and foremost, it is necessary to remember that the mission of our healthcare system is to take care of patients. This has been forgotten at times, causing many of the issues the authors discuss in the book including hospital capacity management. This facet of healthcare management is absolutely central to the success or failure of a hospital, both in terms of its delivery of care and its ability to survive as an institution. Poor hospital capacity management is a root cause of long wait times, overcrowding, higher error rates, poor communication, low satisfaction, and a host of other commonly experienced problems. It is important enough that when it is done well, it can completely transform an entire hospital system.

Hospital capacity management can be described as optimizing a hospital’s bed availability to provide enough capacity for efficient, error-free patient evaluation, treatment, and transfer to meet daily demand. A hospital that excels at capacity management is easy to spot: no lines of people waiting and no patients in hallways or sitting around in chairs. These hospitals don’t divert incoming ambulances to other hospitals; they have excellent patient safety records and efficiently move patients through their organization. They exist but are sadly in the minority of American hospitals. The vast majority are instead forced to constantly react to their own poor performance. This often results in the building of bigger and bigger institutions, which, instead of managing capacity, simply create more space in which to mismanage it. These institutions are failing to resolve the true stumbling blocks to excellent patient care, many of which you may have experienced firsthand in your own visit to your hospital. It is the hope of the authors that this book will provide a better understanding of the healthcare delivery system.