Patient Flow: 'Getting On Board and Out of the Hallway'

The following article is reprinted with permission from Western Pennsylvania Hospital News.

Many emergency medicine departments in [Pennsylvania] and throughout the country are experiencing overcrowding and heavy resource demand.

An unfortunate result of this overcrowding is the practice of "boarding," or  holding a patient in an ED because no beds are available after they have been admitted to the hospital. Boarding directly affects the ability to deliver optimal care because it requires ED medical personnel to tend to those patients while also addressing the needs of emergent cases.

This practice is of concern to ED medical and administrative directors. It is also of concern to state officials from the Pennsylvania Department of Health. This past summer, DOH Secretary Eli Avila issued a memo to all Pennsylvania hospital CEOs and governing board members asking them to self-monitor boarding and informing them that patient boarding would become an on-going focus of the DOH’s survey processes.

The memo said a pilot survey earlier this year yielded 857 reports of the use of emergency department hallways to manage patient overflow.

This doesn’t portend well for the future. Overcrowding is expected to increase with the advancing age of the Boomer generation and the anticipated influx of the newly insured under health reform. However, hospital expansion will be less of an option for dealing with those increases because of increasingly lean budgets and expected cuts to Medicare and Medicaid reimbursements.

There are, however, proven operational solutions that can bring emergency department overcrowding under control and reduce or eliminate the need for hallway boarding, while adding volume in the ED and throughout the facility.

New advances in tracking technologies enable hospitals, combined with the practical expertise needed to redesign the patient flow process and overcome cultural obstacles to change, can free up as much as 20 percent more bed space by squeezing wasted time out of the process of moving the patient from admissions to placement, and ultimately, discharge.

TeleTracking Technologies, which invented patient flow automation and continues to lead the market, is now developing advances which will allow hospitals to manage much of their physical operation in absolute real-time.  

Real-time capacity management, as it is called, integrates RTLS (Real Time Location System) technology with TeleTracking’s popular patient flow software. Under the guidance of TeleTracking’s Avanti process improvement experts, who all have extensive hospital experience, installation of real-time capacity management allows staff to immediately identify and address operational problems that are impeding patient flow, such as discharge notification, timely and efficient room cleaning, timely assignment of empty beds, and timely transfer of patients into a clean room. RTLS also enables staff to know the exact location of mobile medical equipment throughout the entire facility, reducing or eliminating search time.

By moving patients to the right place at the right time, real-time capacity management can help hospitals to provide better, safer care, eliminate overcrowding and realize substantial increases in revenue, without adding beds or expanding facilities.

A 2011 report in the Annals of Emergency Medicine notes that a one-hour reduction in the average emergency department boarding time could result in millions of additional dollars per year in revenue for hospitals that implement active bed management strategies.

Case in point:  A health system  based in eastern Pennsylvania, is one example of a multi-location system that was experiencing overcrowding in its hospitals and emergency medicine departments.

To address this problem, the hospital embarked on an extensive process redesign that resulted in the automation of the entire bed turnover and patient placement process. After implementing a suite of real-time bed, transport and patient-tracking software, the flagship hospital’s bed turnaround time– the time from discharge until a room is clean and ready for the next patient – went from 210 minutes to 60 minutes at one of its sites, to 45 minutes at another of its locations, and 37 minutes at its nearby campus.

Another case in point:  On the other side of the state at a Pittsburgh hospital, administrators redesigned the way it cares for emergency patients. In part by deploying tracking technology, they reduced the wait time from when patients walk in the door until they are taken to a treatment room from 49 minutes to an impressive five minutes.  Instead of remaining in the emergency waiting room, patients are taken to one of 46 exam rooms and met by a treatment nurse who takes the necessary information including insurance, reason for being there, etc.  

It has made a huge difference in the way this community hospital operates its ED, which now treats more than 60,000 patients a year.  Recently, the hospital announced record operating margin and credited its focus on “processes to be more efficient” as a key reason.

Patient flow has become a critical operational issue for hospitals and patients. The new emphasis on the hallway boarding issue shows that this matter is now high on the agenda of both the Pennsylvania Chapter of the American College of Emergency Physicians and the PA Department of Health, which collaborated on the pilot boarding study earlier in the year.

The practice of patient boarding also will be an issue under health care reform, which will measure hospital performance not only by quality of care, but by new and still-to-be defined efficiency measures that determine reimbursements. With all that is at stake, hospitals cannot afford to overlook the proven solutions that real-time patient flow automation offers.

For more than two decades, TeleTracking Technologies, the world leader in automated patient flow, has applied proven principles of logistics management to hospitals and health systems to enhance patient care, improve financial performance and gain competitive advantage. Its industry-leading software and consulting services create an enterprise-wide platform, or “operational backbone,” that connects patient flow to patient care for better outcomes. TeleTracking solutions reduce overcrowding, cut costs, generate revenue, fight the spread of infection, manage assets, accelerate patient transfers and provide a wealth of data for continual operational improvement and business development. It provides process planning and patient flow redesign through its consulting division, Avanti Patient Flow Services, and real-time asset and patient tracking through its TeleTracking RTLS Division. For more information visit

Related Articles on ED Overcrowding:

Pediatric Patients Less Likely to Get Efficient, Urgent Care in Crowded ERs
No Waiting Room, No Wait? A New ED Model at Washington's Swedish Medical Center
5 Ways to Improve Emergency Department Overcrowding

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