Disruptive capacity constraints in hospital emergency departments are a serious barrier to providing timely, appropriate care to patients. Bed shortages and delayed transfers to lower levels of care can cause congestion in the ED and procedural areas, and negatively impact patient satisfaction overall. In 2017, St. Francis Hospital & Heart Center identified capacity as a barrier to addressing the needs of the community and the mission and values of the organization. In response, they created the interdisciplinary Clinical Progression Program.
The goal of the Clinical Progression Program is to improve patient throughput with an evidence-based, interdisciplinary clinical care coordination approach. The care team works together to ensure timeliness of care, identify and resolve barriers to clinical progress and prepare patients and families for discharge. Opportunities were identified by comparing facility length of stay to the CMS geometric mean LOS for high utilization diagnosis-related groups. An interdisciplinary workgroup identified the greatest opportunity for improvement as care coordination and communication with medical staff. Physicians, nursing leaders, care managers and physical therapists were invited to participate in planning prior to the start of the program to ensure buy-in of all stakeholders. Additionally, program leads were assured of full support from the hospital’s senior leaders.
Cases with barriers to discharge are identified early through close collaboration with care management and physicians. Cases with persistent barriers are discussed with hospital administration and physician leaders at the daily patient flow meeting, frequently accomplishing resolution. The daily flow meeting provides real-time data on LOS, census, bed turnover, patients with discharge orders who are delayed, ED admissions and door-to-floor time. Roll call of high-volume attending physicians offers assistance with barriers to discharge. Dashboards display the most current data pertaining to patient flow and have become embedded in daily hospital operations.
The Clinical Progression Program resulted in a reduction in LOS of greater than one day, from 5.94 in 2017 to 4.93 in 2019. By improving throughput, the Program allowed for prompt movement of patients from critical care units, relieved ED holds and created flow for a 10% increase in admissions with improved patient satisfaction.