Increasing Hospital Efficiency

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What is throughput?

Throughput is a healthcare term used to describe the number of patients served in a hospital or a unit within a period of a week, a month, or a year. Since hospitals experience challenges of serving increased number of patients due to limited resources and inadequate number of medical staff, increasing efficiency is one approach of increasing throughput in hospitals. Hence, increasing the number of patients that a hospital serves in a given period is equivalent to increasing throughput. A hospital has several ways of increasing throughput. For example, a hospital can increase throughput by increasing bed occupancy. Occupancy rates in hospitals are always below 100 per cent with most hospitals having occupancy rates of about 65 per cent. Despite hospitals having low occupancy rates, they experience overcrowding because of inefficiencies that create artificial peaks and valleys of patient flow. Thus, increasing bed occupancy enhances throughput; that is, the number of patients a hospital can serve in a given period. Litvak and Bisognano (2011) posit, “Research has demonstrated that large gains in efficiency can be made through streamlining patient flow and redesigning care process” (p.76). Throughput can increase occupancy rates of hospitals by at least 15 per cent of their current occupancy rates. Therefore, increasing bed occupancy enables hospitals to use the same bed capacity and staff number while increasing the number of patients that it serves because of enhanced efficiency.

Why hospitals are overcrowded while its average bed occupancy is usually less than 70 per cent

Although bed occupancy rate is less than 70 per cent, overcrowding in hospitals occurs due to inefficiencies in the scheduling of elective admissions. Infrequent scheduling of elective admissions in hospitals creates peaks and valleys and causes a significant variation in bed occupancy. On days when there are many scheduled admissions, bed occupancy goes up, but on days when scheduled admissions are few, bed occupancy decreases. Normally, emergency admissions cause peaks and valleys because disasters and accidents are beyond the hospital’s control. On the other hand, schedule admissions are under the influence of the hospital, and thus should have minimal peaks and valleys. However, unplanned scheduling of admissions results in peaks, which causes overcrowding in hospitals. A study on Children’s hospital indicated, “Presumably controllable flow of patients scheduled to come in for elective procedures was in fact more variable from day to day and week to week than the unpredictable flow of patients being admitted as a result of emergencies” (Litvak & Bisognano, 2011, p. 77). Therefore, it suffices to say that uneven scheduling of elective admissions causes overcrowding in hospitals because they vary from one day to another depending on how hospitals schedule their elective admissions.

Physicians are to blame for overcrowding at the hospitals because they have preferential days when they schedule elective admissions. For instance, if physicians in various departments such as cardiology, orthopaedics, and gynaecology schedule their elective admissions on the same day, they will cause peaks, which increase bed occupancy and cause overcrowding. On days when there are no elective admissions, a hospital experiences valleys, which result into low bed occupancy and underutilisation of resources. Alternatively, if these departments schedule their elective admissions on different days, bed occupancy remains constant without causing overcrowding. Litvak and Bisognano (2011) observe, in Cincinnati Children’s Hospital Medical Centre, “surgeons typically scheduled elective surgeries unevenly on different weekdays” (p. 79). On days of elective surgeries, there is overcrowding because elective patients and emergency patients compete for bed occupancy in the hospital. Hence, physicians who schedule elective admissions are responsible for the overcrowding in hospitals.

Method used in measuring variability in hospital utilisation

One method of measuring variation in hospital utilisation is by surveillance of patient flow in a given period. Surveillance of patient flow is a good indicator of how a hospital utilises its resources in serving patients. Hospitals usually experience peaks and valleys in patient flow depending on the occurrence of emergencies. In normal days without any emergencies, the flow of patients in relatively constant over a period, as a hospital deals with various patients who have different illnesses. In cases of emergencies, hospitals experience peaks leading to increased utilisation of hospital resources, as there is increased workload and high bed occupancy rates. For outpatient department, there is increased number of patients and workload, which result into optimal utilisation of resources in the hospital. Hence, the occurrence of emergencies causes significant variation in utilisation of hospital resources because it causes peaks and valleys, a common phenomenon experienced in hospitals.

Moreover, surveillance of how elective admissions flow in a hospital can also indicate how variation in utilisation of hospital resources occurs. Elective admissions have a significant impact on the utilisation of resources at a hospital because they are the major cause of peaks and valleys, which hospitals are striving to eliminate. “Several studies have shown that these hospital admissions peaks and valleys have important damaging effects on the quality of care and patient safety and that they create an excessive workload for nurses” (Litvak & Bisognano, 2011, p. 78). In this view, increased workload to the nurses implies that elective admissions strain utilisation of resources in a hospital, which would eventually have detrimental effects on delivery of quality care. During off-peak periods, when elective admissions are few, patient flow is low, and thus there is underutilisation of resources in the hospital. Hence, surveillance of elective admissions provides a view of how patients flow in a hospital. The elective admissions significantly predict peaks and valleys, which normally occur in a hospital.

Discussion of two methods to improve hospital throughput without adding more beds

Reducing patient length-of -stay is one of ways a hospital can increase patient throughput. Through this method, a hospital hastens recovery of patients by improving the quality of care so that patients can recover within a short period. In most illnesses, the average length-of-stay is still very long, and thus a hospital can capitalise on reducing length-of-stay to increase patient throughput. For example, for Medicare patients, the average length-of-stay for patients with heart failure decreased from about 8 days to 6 days in 2006 (Litvak & Bisognano, 2011). Hence, decreasing the length-of-stay in many illnesses is one way to increase patient throughput in a hospital.

Expanding staff is another way of improving patient throughput in a hospital. Insufficient number of staff is one of factors that have contributed to overcrowding in hospitals. The number of nurses and doctors determines the ability of a hospital to serve extra patients in a given period. When nurses and doctors are few, a hospital has the capacity to serve few patients, but when they are many, the capacity of the hospital to serve patients increases proportionately. Therefore, a hospital should employ more nurses and doctors to increase patient throughput.

Other two mechanisms used to improve the throughput in inpatient

Even scheduling of elective admissions in a hospital is one mechanism of enhancing throughput in a hospital. Uneven scheduling of elective admissions causes overcrowding in a hospital due to peaks and valleys that it creates. According to Litvak and Bisognano (2011), even scheduling of elective admissions improves patient throughput for “doctors and nurses were able to focus on more patients in less time and the staff benefited from having more regular schedules” (p.79). Even scheduling of elective admissions is also beneficial because it reduces stress among nurses and doctors, thus improving patient safety.

Separating elective admissions and emergency admissions in another mechanism through which a hospital can enhance patient throughput. Usually, when a hospital performs elective and emergency admissions in the same ward, there is a likelihood of overcrowding. After Palmetto Richard Hospital faced the problem of variable admission of patients, “the hospital streamlined its patient flow by performing scheduled and emergency surgeries in different operating rooms” (Litvak & Bisognano, 2011, p. 79). The mechanism enabled the hospital to increase surgical volume by 3 per cent while decreasing non-elective surgeries by 38 per cent.

Discuss the following aspects for avoidable readmissions

What is avoidable readmissions

Avoidable readmissions are readmissions that a hospital can prevent from occurring among patients. Usually, after a hospital treats patients, there is a probability that some patients might experience relapse of the conditions they were suffering from or emergence of other complications. Such patients require readmission to receive secondary treatment because the primary interventions they received earlier failed or worked partially. The number of avoidable readmissions normally reflects the quality of healthcare a hospital is providing to the patients. “As the proportion of readmissions deemed to be avoidable decreases, the effort and expense required to avoid one readmission will increase” (Walraven, Bennett, Jennings, Austin, & Forster, 2011, p.391). Since avoidable readmission is a parameter that gauges the quality healthcare, which a hospital is providing, healthcare providers always strive to reduce the rate of avoidable readmissions in various healthcare institutions.

Cases associated with avoidable readmissions

Patients with chronic obstructive pulmonary disease (COPD) have a higher chance of readmission because of miscommunication among nurses, physicians, and patients. COPD requires strict adherence to medication dosages and frequency of medication. Miscommunication among medical staff results into medical errors such as providing wrong dosage or offering inaccurate information to patients. Transmission of information from one healthcare provider to another is imperative in enhancing the quality of healthcare because it determines accuracy medical records (Langabeer, 2007). Failure to provide correct dosages or instruct patients with COPD on how to use their medications is the major cause of high readmissions associated with the condition.

Moreover, amongst patients with chronic conditions such as diabetes and hypertension, the major cause of readmission is poor planning of discharge and lack of follow-up schedules. When physicians fail to plan well for the discharge of patients with chronic conditions, there is a high chance that nurses can discharge these patients without providing them with essential medications and homecare interventions. Additionally, physicians in conjunction with nurses may not provide a follow-up schedule to monitor progression of patients after discharging them. According to McLaughlin and Hays (2009), poor or lack of follow-up procedures is responsible for increased cases of avoidable readmissions in healthcare institutions. This scenario is common in patients with chronic diseases because they require treatment and management interventions, which are only effective if nurses and physicians guide patients during follow-up monitoring.

Mechanisms/strategies to overcome occurrence of avoidable readmissions

A hospital can prevent the occurrence of avoidable readmissions using various strategies such as provision of quality healthcare during the first admission of patients, planning of patient discharge well, providing sufficient post-discharge follow-up, and enhancing efficiency of coordinating outpatient and inpatient healthcare providers. In the first strategy, healthcare providers should ensure that they provide the best care possible to patients during the first time of their admission in the hospital. Quality care ensures that patients receive optimal care to cure their conditions. Planning to discharge patients well is the second strategy, which ensures that when patients leave hospital, they are in a better position to recover and with essential instructions regarding their medications and homecare. The third strategy entails the provision of sufficient post-discharge follow-up as it plays an important role in monitoring progression of patients during recovery. If the prognosis is unfavourable, nurses and doctors can note in advance and recommend for an alternative therapy. Enhancement of coordination between outpatient and inpatient healthcare providers promotes understanding of patients’ conditions, thus improving their care through concerted efforts. If healthcare institutions employ the above strategies, they will reduce the rate of avoidable readmissions significantly.

Explain the statement “capacity drives unnecessary and inappropriate use of hospital resources” give two examples from the literature

Capacity drives are approaches that aim at increasing the capacity of a hospital by using additional resources. Capacity drives are “unnecessary and inappropriate” because they do not focus on optimising the available resources; instead, they focus on expanding the available resources. Although hospitals do not use available resources optimally, capacity drives do not help them to optimise, thus unnecessary. For example, expanding staff is a form of capacity drive aimed at increasing the capacity of the hospital to serve more patients in a given period. However, increasing the number staff implies that hospitals have to incur additional expenses yet the capacity is operating under suboptimal level. Litvak and Bisognano (2011) posit, “Pressures on hospital payments and operating margins make it unlikely that hospitals will dramatically increase their payrolls” (p.77). Expanding medical staff is very expensive and thus does not help hospitals to cut their cost while optimising their resources.

Another example of capacity drive in the literature is expansion of hospital capacity. Hospitals can increase their capacity by setting up new structures and increasing the number of beds to keep abreast with the increasing number of patients. Expansion of hospitals capacity is very expensive, as it requires millions of dollars, which hospitals cannot afford. Hospitals are grappling with the challenge of budgeting few funds, and thus do not have excess funds to afford capacity expansion. Litvak and Bisognano (2011) observe, “Each of the additional hospital bed requires approximately $1 million in capital costs and more than $250,000 per bed annually for operating costs” (p. 77). Since hospitals normally operate at occupancy rates that are below 70 per cent, expansion of the capacity does not improve efficiency. Hence, expansion of hospital capacity does not translate into improved healthcare, but rather it increases the cost of running hospitals and encourages underutilisation of health resources.

References

Langabeer, J.R. (2007). Health care operations management: Quantitative approach to Business and logistics. New York, NY: Jones and Bartlett.

Litvak, E., & Bisognano, M. (2011). More patients, less payment: Increasing hospital Efficiency in the aftermath of health reform. Health Affairs, 30(1), 76-80.

McLaughlin, B., & Hays, J. M. (2009). Healthcare operations management. Chicago, IL: Health Administration Press.

Walraven, C., Bennett, C., Jennings, A., Austin, P., & Forster, A. (2011). Proportion of hospital Readmissions deemed avoidable: A systemic review. Canadian Medical Association Journal, 183(7), 391-402.

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