Patient Flow Through a Hospital. Bria Gottschalk Selena Kaplan Max Raynolds
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1 Patient Flow Through a Hospital Bria Gottschalk Selena Kaplan Max Raynolds
2 Introductory Information Industry information Establish and define the nodes Specify the paths Define the modes of travel on the network flow through the hospital via urgent and nonurgent admissions Identify mode path usage differences Spotlight congestion
3 U.S. Hospital Traffic Hospital Inpatient Care for 2002 Number of discharges: 33.7 Million Average stay: 4.9 days Emergency Department Visits for Million 22% seen within 15 minutes Average wait = 3.2 Hours 12% Result in Hospital Admission 1% Directly to ICU/CCU
4 U.S. Healthcare Expenditures 2001 Expenditures: $1.4 Trillion 14.1% of Gross Domestic Product Hospital Care: 32% $448 Billion Health Expenditures Using Public Funds 45% or $630 Billion
5 Assumptions We assume our facility has the technology to care for any patient, so we will not discharge from our hospital to one with higher technological functionality. Discharge means when someone leaves the care of the hospital, and is handled by individual departments, not by a single Discharge department. We assume no perishability on the network, so the demand on the links remains constant. We only included departments that admit and discharge patients. The following do not meet the above criteria: Radiology (x-ray, CAT scan, MRI), the Laboratory, or Radiological Therapies (i.e. for Cancer treatment, or Nuclear medicine).
6 Network Structure- Nodes Defined Admissions (Admit) Discharge (Disch), this is not a department Obstetrics (OB) Psychiatry (Pysch) Surgery (Surgery) Critical Care Unit (CCU) Medical Surgical Unit (Med/Surg)
7 Network Structure - Topology
8 Network Structure Paths 1-6 of 12 dw= (Admission, Discharge) P1= (a, c) Short term acute psychiatric care P2 = (b, d) Uncomplicated birth P3 = (b, i, k, d) Birth with Surgery P4 = (g, t) Day Surgery, no over night stay P5 = (f, m, p, q) Med/Surg to Surgery and back P6 = (f, l, n, q) Med/Surg to CCU and back
9 Network Structure Paths 6-12 of 12 dw= (Admission, Discharge) P7 = (f, m, h, j, p, q) Med/Surg to Surgery to CCU back to Med/Surg P8 = (f, l, j, h, n, q) Med/Surg to CCU to Surgery back to CCU to Med/Surg P9 = (g, p, q) Surgery to Med/Surg P10 = (g, h, n, q) Surgery to CCU to Med/Surg P11 = (e, n, q) CCU to Med/Surg P12 = (e, j, h, n, q) CCU to Surgery to CCU to Med/Surg
10 Modes Defined Mode 1 -- urgent admission (through the Emergency Department (ED)) Mode 2 -- non-urgent admission (through the Admissions Department)
11 A Vital Mode Difference Unused paths Unused in Mode 1 (Urgent) Path 4 (day surgery) Unused in Mode 2 (Non-urgent) Path 1 (acute psychiatric care) Paths 9, 10 (imply urgent surgery) Paths 11, 12 (imply sudden critical illness) (note that non-urgent cases can become urgent after admission)
12 Unused in Mode 1 (Urgent) Path 4
13 Unused Paths in Mode 2 (Non-Urgent) Paths 1, 9, 10, 11, 12
14 What is the problem? Congestion on the network leads to extended patient wait times and decreases network flow. In the hospital that may mean waiting in the Emergency Department (ED) or CCU or Surgery for a bed in med/surg.
15 Why does this happen? Some services are not interchangeable. E.g. Surgery and CCU Variation in both patient flow and needs. Different care requires different paths.
16 Where is the congestion? Pareto Chart of node Count Percent node q f h n g j b d e l m p a c i Other Count Percent Cum %
17 Most used links and frequency q 8 (pts leaving through med/surg) f 4 (pts admitted to med/surg) h 4 (Surgery to CCU) n 4 (CCU to med/surg) g 3 (admitted directly to surgery) j 3 (CCU to Surgery) b, d, e, l, m, and p, 2 a, c, i, k, and t, 1
18 Most Used Links
19 Conclusions Heaviest demand on the network involves interaction between med/surg, CCU and Surgery. One method used to ease demand on link q (the med/surg floors) is establishment and use of day surgery. This bypasses links p and q (med/surg) completely. (Path 4 in our model). Methods to ease Emergency Department congestion have included increased evening hours by physicians and creation of urgent care clinics for evenings and weekends.
20 Resources Center for Disease Control Statistics Articles Optimizing Patient Flow atientflowmovingpatientssmoothlythroughacutecarese ttings.htm
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