Clinical integration: A key to improving patient flow

In a healthcare system already dealing with capacity issues, the aging baby boomer population is bound to add additional strain, according to Kirk Jensen, MD, CMO of BestPractices, an emergency department and hospitalist staffing and management solutions provider affiliated with EmCare.

"The baby boomers are here," Dr. Jensen says. "The silver tsunami is upon us. One baby boomer turns 50 every 18 seconds, and one turns 60 every seven seconds. That equates to 10,000 baby boomers, or patients, per day….All these patients will need quality and accessible healthcare over the next couple of decades."

The most recent Physicians Foundation survey found nearly 80 percent of healthcare providers reported being either overextended or at capacity, further illustrating the current capacity and patient flow issues. However, in a recent webinar hosted by Becker's Hospital Review, Dr. Jensen and Mark Hamm, CEO of EmCare Hospital Medicine, suggested integrating clinical services with ED services can help optimize patient flow and clinical care.

Fragmented relationships between emergency medicine and hospital medicine physicians can result in bottlenecks in moving patients from the ED to inpatient units, contributing to patient flow issues. Dr. Jensen said these two groups of physicians should work together and align their incentives to improve patient flow issues and provide the best quality care.

While the ED is often seen as a culprit in patient flow issues, it is only one factor of many that impact flow and capacity. "Clearly, efficiency in the ED is important, but it is not the sole determinant of good patient flow," Dr. Jensen said. "Often times [the ED] is just the canary in the coal mine reflecting patient flow blockages further upstream within the hospital system."

Added Mr. Hamm, "The emergency department only flows as well as the hospital flows."

To address the types of issues that often lead to patient flow blockages such as slow throughput, poor collaboration and strained communication, Dr. Jensen said hospitals need to undergo a culture change that refocuses the hospital's process organization. "We are not talking about rushing patients through the hospital," he says. "We're talking about eliminating non-value added times, services and waits."

The two clinical groups need to align both their processes and their underlying goals to maximize patient flow efficiency initiatives, which can often be a main obstacle in achieving integration, said Mr. Hamm. "ED physicians work one way and hospitalist physicians work in another way," he said. "A lot of times incentives are different for the two different groups. If incentives aren't aligned and you don't have the right tools, it is difficult to get people to integrate the way you want them to."

While their incentives are different and need to be aligned, emergency medicine physicians and hospitalist medicine physicians have opportunities to contribute meaningfully and effectively to flow-efficiency initiatives within their departments. For example, emergency medicine can reevaluate triage communications and patient-centered processes to improve flow and patient experience. The hospitalist medicine side holds large potential to improve flow efficiency and patient satisfaction, as they are the ones who provide the majority of patients' clinical care, said Dr. Jensen, referring to hospitalists as the "quarterbacks" of hospital care since they interact with countless parties across the care continuum.

However the two groups integrate, the focus turns to becoming a value-based organization, said Dr. Jensen. "As we think through the key ingredients of value-based success, three things come to mind: Uniting ED and hospitalist services around shared goals and operations, optimizing patient throughput through systemwide collaboration and integration and focusing on providing quality."

Download the webinar presentation slides here.

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More articles on capacity:

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Nurses union says staffing levels 'unsafe' in Tri-City ED
80% of physicians overextended, at capacity, survey shows



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