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SAFER-f Patient Flow Medicine Bundle

About


The SAFER-f Patient Flow Bundle is a combined set of simple rules for adult inpatient units to use to improve patient flow, prevent unnecessary waiting for patients, decrease length of stay (LOS), and improve patient outcomes. If all elements of the SAFER-f Patient Flow Bundle are undertaken on a regular basis, patient care experiences will be improved by reducing unnecessary waiting.

Evidence suggests that implementation of the SAFER bundle elements together optimizes impact1,2,3.

 

Implementation of the SAFER-f Patient Flow Bundle can be:

  • Through bullet/board rounds1,3,4,5
    • Daily, before noon, including the most responsible health care provider (MRHCP) that is multidisciplinary team (MDT) informed.
    • Assess patient and prioritize patients ready for discharge.
    • Discuss reasons for delayed patient flow.
    • Patients with LOS > 6 days are reviewed weekly with senior leaders.
    • Should be efficient—limiting discussions that are focused on key information that lasts 1-2 minutes per patient. Lengthy discussions. or “storytelling” should happen outside of bullet rounds.
    • Consider social and environmental factors to facilitate discharge.
  • In combination with Red to Green2,3,4,5,6
    • Red to Green identifies wasted time in a patient’s journey.
    • A Green day is a value-added acute care day—everything planned or requested gets done, care that only can be provided in an acute care hospital bed is provided and the care provided progresses the patient towards discharge.
    • A Red day is a day with little or no value-added acute care—a planned intervention does not occur, the patient is waiting for transition to next stage of care, or the care delivered could occur in a non-acute setting.
    • Can be tracked using a visual management system—each patient starts the day as red and discussions at bullet rounds can determine if the care plan for the day will be a Red or Green day for the patient.
    • If it is going to be a Red day for the patient, discussions during bullet rounds can examine what would it take to make this a Green day.
    • Tracking Red day reasons over time helps to identify areas on which to focus improvement efforts.