How to Significantly Reduce Inpatient Admission Times and Improve Patient Satisfaction

Admitting a patient to inpatient care is a complex process that, unless carefully managed, can lead to long delays in service and a poor patient experience. Waiting for admission paperwork, or for a bed to be assigned can be frustrating for anyone. But for patients who are sick, or for an exhausted mother with a crying baby who needs to be admitted, wait times can become emotionally and physically difficult as well.

Thibodaux地区医疗中心对患者满意度的一贯关注为这家拥有185张床位的社区医院赢得了自1998年以来每年的Healthgrades®杰出患者体验奖™。该医院位于新奥尔良西南方向，距离新奥尔良只有一个小时的车程。不出所料，当Thibodaux的领导最近分析医院的住院病人的入院过程时，他们从病人的角度出发，并决心减少入院等待时间。使用集中的过程改进方法，可以发现浪费的领域，暴露出诸如冗余数据收集和不一致的过程等问题，这将需要创新的解决方案。2022卡塔尔世界杯赛程表时间

Integrating concepts from the Health Catalyst improvement methodology into its own Lean Six Sigma processes, and with the support of professional services from Health Catalyst, Thibodaux deployed a systematic set of solutions to significantly improve the admission process.

ADMISSION PROCESS TIED TO SATISFACTION, REIMBURSEMENT

Each year, American hospitals conduct 35.4 million admissions, according to the American Hospital Association. Of those, 16 million occur through the emergency department (ED), suggesting that more than 19 million are direct admits.¹直接承认可以是有计划的，也可以是计划外的。例如，当病人被安排进行常规手术时，就会发生计划性直接入院。Unplanned direct admits can happen when a sick patient presents at a physician’s office, for instance, and the physician decides to admit them directly to the hospital rather than send them through the ED.

直接入院的优点是提高了患者流量，缩短了急诊科等待时间，改善了患者体验，提高了护理质量和连续性。²However, admitting a patient to inpatient care, whether planned or unplanned, is a complex process that requires careful coordination among physicians, nurses, registration staff, and others within the organization. Ineffective admission processes can lead to long wait times for patients, staff frustration, and a negative patient experience, as well as communication and handoff problems that can impactpatient safety和质量。

特别是，长时间的等待与患者满意度下降有关。无论病人是在他们的医生办公室等待，在急诊科，还是被送进医院，都是如此。事实上，等待5分钟和等待30分钟的区别是病人满意度显著下降了15%。³The tight correlation between wait time and patient satisfaction is important not only to maintaining customer loyalty but also because patient satisfaction scores have been used in determining hospital reimbursement from CMS since 2012.

早在那之前，Thibodaux就已经开发出一种通过“医疗商城”为患者提供服务的创新方法。其医疗中心提供多项门诊服务，如当日手术、消化系统疾病中心、心脏血管中心和心脏康复设施。

锡博多每年有1000多名患者直接就诊，其中很多都来自其医生办公室。当医院的领导意识到低效和冗余的流程会导致病人从医疗中心入院时出现不可接受的长时间延误时，他们开始着手解决这个问题。

UNCOVERING GAPS IN THE ADMIT PROCESS

Thibodaux在改善住院病人入院过程中的第一步是评估他们目前的入院实践，并确定需要改进的差距或领域。该项目是医院首席执行官格雷格·斯托克(Greg Stock)直接提出的一个要求的结果，他的愿景是改善入院过程中所有相关人员的易用性。斯托克要求流程改进团队对入院流程进行分析，重点是提高工作人员的易用性，减少患者的等待时间，并为医生创建更简便的入院流程。

After carefully reviewing the process with frontline staff, Thibodaux identified three primary areas of concern, similar to those found in hospitals nationwide: 1) the process was cumbersome and mostly manual; 2) there were several breakdowns in communication along the admission pathway; and 3) the process was not patient-centric.

Cumbersome manual process

While Thibodaux had invested millions in its EHR and other information technologies designed to improve patient care, the hospital’s inpatient admission process was still entirely manual, involving documentation on paper and faxing. This led to errors such as lost faxes, and to cumbersome processes such as multiple phone calls to track down information while patients waited. The manual process also led to inefficient handoffs, redundant data collection, as well as delays in getting necessary information, doctor’s orders, and bed assignments so care could be initiated.

Communication breakdowns

他们观察到的另一个问题是，病人经常在没有医嘱或事先没有通知的情况下出现在入院台。然后，他们必须等待入院协调员找到他们入院所需的信息，并分配床位，以便开始护理。即使在病人到达之前就收到了订单，也很少包含所有必要的信息。因此，工作人员浪费时间打后续电话，并在返工。此外，入院电话通常是由医生办公室的非临床人员打来的，他们无法提供确定患者视力所需的信息，也无法确定他们的最佳位置。

Non-patient centered process

In addition to problems with communication and efficiency, Thibodaux’s inpatient admission process generally was not designed with the patient at the center. Rather than moving swiftly through the admit process to receive care, patients had to wait for orders to arrive, for a room to be assigned, or for paperwork to be filled out. In addition to waiting, family members sometimes had to leave their loved one at a time of need to complete necessary paperwork. Patients and family members had to spend prolonged time in a public waiting area when they were unwell, tired, or anxious.

MAPPING OUT A SOLUTION

Once Thibodaux’s leaders had identified the issues with the hospital’s existing inpatient admit process, they established an interdisciplinary core team tasked with improving admission times. The team consisted of members from case management, customer service, organizational engagement, patient care services and nursing. Integrating concepts from the Health Catalyst improvement methodology into their own Lean Six Sigma processes, and using the support of professional services from Health Catalyst, Thibodaux’s core team leveraged a data-informed prioritization process to identify their project, baseline, and aims.

The team started by mapping out their current admit process and analyzing problem areas using fishbone diagrams to drill down into root causes and possible solutions. The team knew that it was critical to ensure the right people in the right roles were engaged in creating solutions, therefore throughout the improvement process, the team called in additional team members with special expertise, such as admissions, information technology, and engineering.

The team’s original aim statement set a target of reducing admission time by 20 percent. But they soon decided to further challenge themselves by adopting a more aggressive stretch goal—one that they felt would be impactful enough to be recognized by the patients and families, and that would improve patient experience in a demonstrable way. They eventually settled on the ambitious aim of reducing inpatient admission time for direct admits by 30 percent and improving the corresponding balance metric of patient experience to the 99th percentile.

A MULTI-PRONGED APPROACH TO IMPROVING THE INPATIENT ADMISSION PROCESS

锡博多的管理层多年来一直在培养一种持续改进和以病人为中心的医疗文化。That organizational mandate gave the core team the support they needed to implement solutions to the admissions process in three key areas:

• 省去了纸张处理。
• 与合作伙伴合作。
• Putting the patient first.

A better way: eliminating the paper process

The team’s first priority was to explore viable alternatives to paper forms and faxes. Partnering with their IT colleagues, they were pleased to learn that their current computer system would support the development of online processes. Working with Thibodaux’s IT analysts, the team developed an online “short form” registration process, which contains all of the information required to preregister a patient, assign a bed, and alert others that a patient will be admitted. Eliminating the use of faxes also removed a lot of stress and inconvenience for the staff who no longer had to wonder whether a fax made it to its destination or whether the right fax had been received.

在自动化方面更进一步，该团队还实现了一个在线床板，当病人入院时提醒其他人。今天，当一个病人来到接待台时，他们就被期待着，接待人员在他们的电脑上调出所需的信息，省去了不必要的等待和电话。在取消了手动流程后，Thibodaux立即体验到了效率和等待时间的提高。

Collaboration and education improves admission process

The next step was to improve the quality of the information coming from the admitting physicians’ offices. To that end, the admit coordinator reached out to physician clinic managers, and reeducated them regarding appropriate completion of forms and which patient-specific information they must share when calling to admit a patient. The admit coordinator also shared a checklist of key information needed to admit a patient that could be posted near the nurse’s desk. This information helps to determine if the patient meets the criteria for admission, what their acuity is to make sure they get admitted to the right unit, and whether they have special needs, such as making oxygen available when they arrive.

一旦诊所的工作人员了解到他们的病人到达医院后发生了什么，以及如果他们没有正确的信息，他们需要等待多长时间，工作人员就会有动力去帮助他们。这种合作改善了从诊所接收到的数据的质量，通过减少不必要的电话来追踪丢失的信息，加快了入院过程，并让病人相信住院病房正在期待他们。

Putting the patient first

Once the team had resolved the key issues slowing the admission process prior to the patient’s arrival, they focused on improving the registration process post-arrival. The old registration process required the patient to sit at an admit desk located in the public lobby while the registration was completed. The team wanted to do away with this process and complete registration at the point of care, speeding the patient to the floor as quickly as possible. Additionally, studies have shown that switching to bedside registration improves patient satisfaction.⁴

With mobile, or “bedside” registration, the admit clerk accompanies the patient to their room and completes the registration process there. This eliminates a source of waiting, gets the patient and family comfortably out of the public area, and enables care to be initiated as soon as the patient arrives.

To switch to mobile registration, Thibodaux needed a way to transport the patient to the room while carrying a computer and scanner. They reached out to their engineering department and presented them with the problem. Ultimately, Danny Hebert, a member of the hospital’s maintenance crew, eagerly accepted the challenge. Hebert built an innovative mobile registration cart (see Figure 1) that was attached to the back of a wheel chair, yet still light enough for a registration clerk to push wherever the patient needed to go, included a back-up battery system, and a removable top that enabled clerks to place the laptop on a bedside table or counter in order to face the patient bed while they filled out the registration information.

由于有了移动推车和跟踪患者的注册流程，患者家属不再需要离开亲人身边完成文书工作。病人生病时不再需要在公共等候区等候。这减轻了注册人员和患者的压力和沮丧。

The success of the new process was demonstrated recently when a patient arrived at the hospital by ambulance to be admitted to the intensive care unit (ICU). The patient had been pre-registered prior to arrival, and was assigned to a bed. When the patient came through the door, the ICU nurse was waiting for her, and she was immediately transported to her room. Registration staff were in the ICU waiting with the mobile registration cart, and worked with the family to complete the registration while the nurse worked on admitting and treating the patient.

Many patients have commented positively on the new mobile registration process. The registration staff unanimously supports the new process, convinced that they are contributing significantly to an improved patient and family experience.

RESULTS

Thibodaux’s commitment to patients, use of proven process improvement methodology, innovative solutions, and collaborative interdisciplinary teamwork paid off in an impressive reduction in admission times, surpassing the team’s stretch goal of 30 percent:

• Decreased average inpatient admission time by 40 percent – from a median of 43 minutes to a median of 26 minutes (see Figure 2).
• Ranked 99th percentile for patient experience during the admission process and speed of admission.

By redesigning its inpatient admit process, Thibodaux has improved patient and family experience, reduced staff stress and frustration, and improved communication and handoffs at every stage of the process.

“在大多数情况下，病人入院的登记方面一直被认为是乏味和重复的。我们的办案人员对我们创新的新工艺感到很兴奋，病人也很满意。我们觉得，在门口迎接病人并把他们带到房间进行紧急护理，给予病人充分的关注，加强了我们的团队把病人放在第一位的努力!”

– Sheri Sothern
Patient Access Manager

WHAT’S NEXT

Thibodaux计划通过持续的教育和与社区提供者的合作来维持通过新的住院病人接收过程所取得的成果。医院还计划将改进后的流程扩展到急诊室的患者入院。从长远来看，Thibodaux正在努力实现完全电子化的入院和登记流程，为患者提供更快、更有效的登记体验。

参考文献

1. Vogelsmeier, A. & Despins, L. (2016).A Room Without Orders.Patient Safety Network.
2. Hostetter, M. & Klein, S.(2013)。In focus: Improving patient flow-in and out of hospitals and beyond.Quality Matters.
3. Stempniak, m(2013)。目前正在努力减少医院等待时间。Hospitals and Health Networks.
4. 教育管理。(1997)。Switching to bedside registration increases patient satisfaction.9(3), 25-30.

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