Flow of patients from the Emergency Department (ED) to an available inpatient unit bed will occur as soon as a bed is ready for admission, preferably by noon on a 24/7 basis.
Emergency Care Improvement Support Team (ECIST), NHS
Implementation of the RED to GREEN method (or an adapted method) to allow visual management of wasted waiting time for patients.
Completion of twice daily rounds (patient and board rounds) to assess progress.
Starting the day with an empty bed creates capacity for incoming patient flow, reducing time spent waiting for an inpatient bed, reducing hospital length of stay and occupancy.
Review of unit staff break times/hours of work for each role on inpatient unit team to increase availability to facilitate admission process.
Pulling unit appropriate patients from the ED, e.g. transfer patients who have had a stroke to a stroke or neurology unit rather than transferring them to a less appropriate unit and then have to transfer them again once a bed becomes available on an appropriate unit.
Examine internal processes within the unit/site to ensure existing processes are efficient, e.g. time to receive lab results or housekeeping staff’s capacity to prepare rooms for new patients. If inefficiencies exist, review these processes to identify areas for improvement.
Preparing patients for admission in the ED such as:
What assessment information can be gathered from the patient/essential care partners (ECP) in the ED?
Consider frailty assessment, goals of care, mobility assessment, delirium assessment.
When patients flow to inpatient units before noon, it allows for the multidisciplinary team to complete initial assessment the same day, which can assist with informing EDD (Estimated Date of Discharge) and CCD (Clinical Criteria for Discharge).
