GE Healthcare Optimizing Patient Transport Xavière Michelot M. Shafi Hussain
A 365-bed hospital s experience shows how simple changes like a right-sized wheelchair fleet and better processes can reduce costs, enhance care quality, and increase operating efficiency. Patient transport, seldom explored in clinical literature, is a critical hospital process. Where transport is dysfunctional, waiting lines expand; patients, families, and staff complain; nurses waste time; and productivity is lost everywhere. A seemingly simple function like deployment of wheelchairs can have major impacts for good or ill on care productivity and cost. A study at one 365-bed hospital found that the time staff members spent searching for wheelchairs to transport patients cost $73,000 per year. That s not counting costs for rooms kept empty, rooms occupied too long, and imaging equipment kept idle because patient transfers were delayed. Although the problem seems simple, solving it is not, as multiple functions and people are involved. A sound solution includes three basic steps: Assess the extent of the problem. Right-size the wheelchair fleet to fit demand. Optimize the transport process to use the equipment optimally. This approach, followed at the above-mentioned hospital with help from a team of productivity consultants, helped eliminate transport delays, save money, improve care quality, and boost operating efficiency. Phase I: Assess the problem The hospital staff and volunteers were spending excessive time daily looking for wheelchairs the storage areas near the exits, although full at 7 a.m., would be empty several times a day. To estimate the cost of this time, the team studied areas where the problem was most acute: the transportation department, the Emergency Care Center (ECC), the heart center, and surgery. They found that about 10 hours per day were lost looking for wheelchairs. Phase II: Right-size the fleet To assess the fleet, the team first took a physical inventory. They found 69 wheelchairs in the main building. The next question was whether the current inventory would suffice. To answer, the team estimated transport needs per unit, based on patient volume, patient type, and transport duration. For each unit, they asked: How many patient admissions, discharges, transfers, imaging and surgery procedures, family visits, and outpatient procedures are there on a typical day? Are there any variances on high-volume days? What percentage of those events require wheelchair transportation? How much time did each transport need involve, counting actual time in transit and waiting time (for procedures or visits)? The team estimated a need for 507 wheelchair hours per day. Based on calculations that accounted for periods of peak activity, they calculated a need for 26 more wheelchairs (a total of 95) to cover the demand efficiently assuming all processes worked smoothly. Phase III: Optimize the process Process optimization began with a layout of all processes pertaining to wheelchair usage. A dedicated work group conducted process mapping sessions and found that the main hitches in the process were too many people touching the wheelchairs, too few wheelchairs, and inadequately formalized storage areas. Key observations: There were no formal chair storage areas except near the three exits. No single person was responsible for restocking the formal and informal storage areas. There was no specific process for non-staff users (such as visitors and sales representatives) to check out wheelchairs. Security was only informally involved in keeping the chairs within the hospital. Cleaning was left to transport aides, although they were not the only ones using the chairs. Most patient transport for diagnostic imaging occurred in the morning, for discharges in the afternoon, and for outpatient visits in the middle of the day.
The most obvious issue lack of wheelchairs near the exits highlighted the need for a process to help bring them back automatically. Using the process maps, the work group identified three major reasons staff members could not find wheelchairs when needed: Chairs were hidden or hoarded (multiple informal storage areas). All formal storage areas were empty. Chairs were leaving the building (such as to doctors offices and senior care facilities). The central issue was accountability: Too many people were touching the wheelchairs, especially at the exits, because they were so easily available there. After discussing many possible approaches, the team devised a three-part solution: Process changes. Wheelchairs are now divided into two categories. Those equipped with IV poles belong to the storage areas near the exits; other wheelchairs belong to designated storage areas on the floors. Staff, volunteers, and visitors are strongly encouraged to limit wheelchair use to patient transport and to take wheelchairs back to the designated storage areas. Training and information. The staff has received online training in the new process, and volunteers have taken face-to-face training. Visitors and sales representatives are informed of the process through signs set up near the exits. Changes to storage areas. At two of the three exits, wheelchairs have been removed from the entrance and stored in a separate area. Chairs are available for visitors to sit on while they wait for a wheelchair. On top of two existing storage areas on the floors, five more smaller storage areas have been made official. To facilitate the transport aides work, a new large storage area has been created on their home floor. Reaping rewards The hospital s experience shows that there are three requirements for a well-functioning patient transport process: a right-sized wheelchair fleet, limits on visitor access to wheelchairs, and staff and volunteers sensitive to the issue and trained to follow a defined process. The solution deployed was working effectively a year after implementation. The staff reports: Significant reduction in lost wheelchairs Minimal time lost searching for wheelchairs Significantly greater staff and patient satisfaction with transport The hospital COO and CNO remarked that in the past they had to purchase new wheelchairs every year and did not think they could solve the problem. They now understand the value of the process improvement exercise. Meanwhile, the hospital has selected wheelchairs as one of the categories of equipment to be tracked using its new Real-time Location System (RTLS) enabling staff to pinpoint the nearest wheelchair at any time and further curtail searching. Patient transport issues are unique in that they tend to involve most units and departments, affect most patient-related processes, and have a direct impact on patient satisfaction. Beyond the transportation department, optimizing the function requires teamwork among nursing, security, volunteers, materials management, and hospital management.
To address patient transport in a hospital, it is necessary to resolve conflicting staff and management perspectives. The typical staff attitude is: This is too complicated let s just buy extra wheelchairs and mark them as our own. The typical management attitude is: We can t restrict access to wheelchairs our patients won t be happy. Neither attitude solves the problem. The staff needs to see that capacity is not the central issue but that processes are, and that processes can be improved. Management needs to see that part of the fleet or all of it must be for staff use only. The solution adopted in this case study illustrates the point: Although the staff wanted to remove wheelchairs from storage areas near the exits to keep visitors from using them, management was against the idea, as it might antagonize patients and families. They found a middle ground: Some wheelchairs are staff-only, and others (those with IV poles) are accessible to visitors. It is difficult in the long run to maintain an optimal process that requires staff engagement and motivation. It is easy to fall back into old habits of hiding and hoarding wheelchairs, or simply to lose the necessary discipline. As soon as the consultants leave, attention must turn to process maintenance, ideally through a dedicated (in most cases, rather light) governance structure. Simple process changes are easier to test, implement and sustain when the hospital is equipped with a Real-time Location System (RTLS). This technology makes hiding and hoarding nearly impossible and also can help identify pinch points limiting overall performance. Finally, one cannot assume that the full transport savings potential will be realized simply by optimizing the wheelchair fleet and processes. Further action is needed to reallocate the time saved toward the more important objectives related to providing quality healthcare. Patient transportation: Leading practices in process optimization Here is a look at the benefits (and challenges) of common practices hospitals have used to optimize patient tranport and make the best use of available wheelchairs. 1. To make sure wheelchairs come back to their storage places: Make transport staff responsible for refilling storage areas up to PAR levels. Transport aides are trained to take back wheelchairs to the storage areas, following PAR levels in each area. (Some argue that this takes transport too much time and that broader staff involvement is needed.) Have volunteers and admissions staff collect IDs from visitors and accompanied outpatients borrowing wheelchairs. After hours, the remaining IDs can be left with security. (This can be impractical in facilities where many visitors enter through one door but leave through another, or where after-hours security is not present at each exit. It is also difficult to enforce in small-community hospitals where security is usually not an issue.) Place barriers and signs in storage areas to inform visitors of the procedure to follow. Involve volunteers more actively in wheelchair collection. Volunteers ask outpatients if they will need transport after their procedures. If not, they return the wheelchair after taking the patient to the destination. If yes, they make an appointment for pickup and return the wheelchair to storage in the meantime. 2. To limit the number of people touching the wheelchairs: Have nurses always call transport staff before transporting by themselves or letting the families transport. Nurses may handle transport themselves if transport staff does not arrive within 15 minutes. (Transport department capacity can be a limiting factor.) Have nurses call transport when finished using a wheelchair rather than store it on their unit or leave it behind. (Transport staff may not have time for this extra task; it may make more sense to keep the nursing staff involved.) Equip storage areas with badge swipers and have staff swipe when taking a wheelchair and when returning it. (This implies having enough storage areas to keep all wheelchairs.) 3. To limit disappearance of wheelchairs outside the facility: Purchase less-sturdy wheelchairs. (Such chairs would be less prone to removal but would break down more often.) Set up coin-operated locking mechanisms. (This implies having enough storage areas to keep all wheelchairs.) Attach stationary IV poles to the wheelchairs. This is convenient and cheap; poles can be attached to wheelchairs allocated to exit storage areas for easy identification. This also prevents loading of wheelchairs into cars or trucks and makes them more difficult to take outside. Purchase wheelchairs that are more difficult to hide or hoard, such as units that do not fold. This works for exit areas and, in particular, at night. In the storage areas on the floors, foldable chairs are usually more convenient. (These wheelchairs are expensive, especially when compared with attaching IV poles to the existing fleet.) 4. To optimize storage: Eliminate wheelchair storage near the exits. This keeps visitors from removing wheelchairs without asking the volunteers first. Keep a few wheelchairs behind the volunteers desk for use in helping outpatients, inpatient admissions or visitors. (This might prove impractical due to space constraints.) Set up official storage areas on each nursing floor for wheelchairs to be used for discharges. Set up a central storage area where transport staff can take and leave wheelchairs used for all transfers. Set up PAR levels for each storage area; e.g., central storage, storage on nursing floors, storage behind volunteers desks.
Authors Xavière Michelot is a consultant with the GE Healthcare Asset Management Professional Services team, which supports optimization of clients medical assets management. She has served as assistant professor in the Departments of Healthcare Management of HEC-School of Management and Sciences Po, Paris, and is co-author of a book on diagnosis-related group (DRG) payment systems in Europe. M. Shafi Hussein leads the Central and West Region practices within the GE Healthcare Asset Management Professional Services organization that provides hospitals and healthcare providers with tailored clinical asset management strategies and solutions to optimize capital and operational expenditures. Shafi has more than 15 years experience as a management consultant working with health and life sciences organizations, leading strategic planning, transformation and capability development programs. Shafi began his career as a research scientist focusing on transplant immunology and has authored several articles published in peer-reviewed journals. GE Healthcare 3000 North Grandview Blvd. Waukesha, WI 53188 U.S.A. 2012 General Electric Company All rights reserved. GE and GE Monogram are trademarks of General Electric Company. GE Healthcare, a division of General Electric Company www.gehealthcare.com/solutions