Lately, I have been pondering patient flow and throughput. Not as a hospital administrator or efficiency analyst, but as an RN on a busy medicine floor. In my role, I spend a great deal of time smoothing ruffled feathers of clients upset by their perceptions of long, often uncomfortable, waits for empty hospital beds. I have experienced these same frustrations as a parent with a sick child.

Flow relates to each patient’s progression through the medical facility from the time of arrival (via ED, OR or admitting unit) until the patient is officially admitted to an acute care floor. It is the overall process including time, efficiency, hand-off reports and physical movement of the patient, from hospital door to formal admission on the floor.

On the other hand, throughput refers to a facility’s provision of one full “cycle of care” to any given patient. In other words, throughput occurs from the moment the patient arrives at the hospital door until that patient is officially discharged from the facility.

Obviously, the speed and efficiency with which patients travel through a facility will impact patient outcomes. Efficiency of flow affects satisfaction among patients and nursing staff. In our hospital, patient flow is facilitated by one hospital “bed assignment” representative. He is an experienced RN, administrator and congenial colleague. But he is not a magician.

I suspect that most floor nurses face the same harried flurries of greeting incoming clients and dismissing outgoing patients. In the midst of managing our own ongoing (frequently maxed-out) patient loads, nurses must somehow scramble to admit clients whenever they arrive on the hospital floor from ED, PACU or admission unit. We must also educate and discharge patients whenever the doctor signs their discharge orders.

Many patients reach the floor already agitated over their individual situations. To make matters worse, they are often coping with escalating discomfort from pain, dyspnea, nausea, or other distress. They are, after all, being admitted to the hospital!

After their arrival to the floor, patients and family members linger in newly assigned rooms, patiently (or impatiently) awaiting visits and orders from perpetually busy providers. As the length of time or level of distress increases, anxiety levels of patients and family members can quickly spiral upward.

I vividly recall my own feelings of helplessness a few years back, when my son was moved from ED waiting room to wheelchair to hospital bed, moaning and suffering the entire time. Although he was in obvious pain, he could not receive pain medication until he had been assessed and admitted to the hospital. Even after that point, we had to await official orders from the physician-on-call. So, together, we endured a seeming eternity until he was seen by a medical doctor, evaluated by the on-call surgeon, and eventually admitted for an emergency appendectomy. Meanwhile, I sensed the ED nurse’s frustration, because like me, she was unable to provide immediate relief. She had to wait for official orders from the doctor.

Can we ever be as efficient as other service industries, such as the airline industry and the Internet?

These days, patient flow and throughput are being addressed from multiple angles. One promising approach applies queuing theory to match bed demand (which is relatively random) with bed supply (which is relatively fixed). Although hospital capacity is theoretically fixed, bed supply can be difficult to estimate due to inevitable delays in discharging patients. In addition, bed assignments are frequently adjusted to comply with infectious disease screenings.

When staffing permits, our floor assigns one RN as an official Admission and Discharge nurse. This staffing arrangement helps ease the load on floor nurses and provides for continuity of patient education and transition to the floor. Everyone benefits.

Another enticing idea is to dedicate one area of the hospital as an official Discharge Resource Room (DRR). I recently read of a hospital who’s DRR has led to significant improvements in patient throughput. At the same time, the DRR enhances patient education possibilities at discharge. I recall that when my son was discharged from the hospital shortly after his appendectomy, we seemed to wait forever and then were suddenly pushed out the door, he in a wheelchair and me clutching a bundle of papers. I recall only a few words being uttered about follow-up care. The nurse was busy, the bed was needed, and we were eager to get home.

How does your hospital address flow and throughput? Do you think the health industry should employ queuing theory or other means of enhancing flow?