Transitions are a linchpin of the health
care system and a point at which patients often fall through the cracks. When
transitions go poorly, we often see backlogs in the system. In hospitals, these
backlogs can manifest as long wait times to inpatient beds and patients
receiving care in unconventional spaces such as hospital hallways.
The priorities for the 2019/20 QIPs include two new indicators for the hospital
sector that are related to timely and efficient transitions in care:
- Time to inpatient bed measures the time
between the disposition decision in the emergency department (ED) and admission
to an inpatient bed or operating room. This is a mandatory indicator for
hospitals that have an ED and submit data monthly as part of the Emergency Room
National Ambulatory Initiative (ERNI) through CIHI. It aligns with current
requirements of the Pay-for-Results Program in the hospital sector.
- Number of inpatients receiving care in
unconventional spaces or ER stretchers
measures the number of inpatients in
unconventional spaces (including hallways and auditoriums) or ER stretchers.
Review the Indicator Technical Specifications for the 2019/20 QIPs to learn about how to
measure these indicators.
Performance on these indicators reflects
timely and efficient transitions through different areas of the hospital as
well as transitions through different sectors of the health system. Performance
may be influenced by many factors, including the availability of inpatient
beds, the patient population, and the hospital’s resources at the time of
Not all of the factors affecting performance
on these indicators are within the hospital’s control. However, there are some
factors that hospitals can address, in collaboration with other organizations
in the broader health care system, to improve on these indicators:
- Optimize patient flow throughout the
- Reduce avoidable readmissions to increase
- Address alternate level of care (ALC) rates
to increase bed availability for patients who need them
Related change ideas are described below,
along with sample progress measures and key resources.
1. Optimize patient flow throughout the hospital
Optimizing patient flow to provide the right care, in the right place, at the right time reduces the risk of suboptimal care and potential harm.
A key resource to improve patient flow is the Institute for Healthcare Improvement’s white paper, Achieving Hospital-Wide Patient Flow (2017). This white paper gives an overview of factors affecting hospital-wide patient flow and how they can be addressed, including a comprehensive list of specific change ideas.
Here are a few examples of specific approaches to improving patient flow:
- Assess the number of beds and staffing needed for each service to accommodate patient volume
- Use hospital-wide patient flow planning huddles and real-time demand and capacity problem solving
- Optimize scheduling of discharges, such as by maximizing morning discharges to free up beds for afternoon and evening admissions from the ED
- Use proactive discharge planning focused on patients’ medical readiness criteria for discharge
Check out these Quorum stories on addressing patient flow, particularly in the ED:
2. Reduce avoidable hospital readmissions to increase bed availability
Avoidable hospital readmissions are an important quality issue that is linked to integration across the continuum of care. Timely follow-up after hospital discharge can help prevent readmissions and improve patients’ health outcomes. It can also be helpful to focus on patients with specific health conditions for which readmissions are common (such as chronic obstructive pulmonary disease [COPD] or mental health and addictions).
Check out these Quorum stories on reducing readmissions:
3. Reduce ALC rate to increase bed availability
The ALC rate is a separate QIP indicator that is closely linked to the bed capacity in hospitals, and therefore affects performance on both of these indicators. A patient is designated as ALC when they are occupying a bed in a hospital waiting to receive care elsewhere.
A key resource to address ALC rate is the ALC Avoidance Leading Practices and Improvement Strategies for the Acute Care Sector by the Toronto Central LHIN.
Check out these Quorum stories on reducing ALC rates:
Visit Quorum’s Indicators & Change Ideas page for more information on time to inpatient bed and number of inpatients receiving care in unconventional spaces or ER stretchers.
What do you think of these approaches? Have any of these worked for you? Comment below to share what you think people should do to improve on these indicators.
This year’s Quality Improvement Plan (QIP) program focuses on a smaller number of priorities with an emphasis on critical issues that require a cross-sector focus. The priorities focus on three core themes: timely and efficient transitions, service excellence, and safe and effective care. Each theme includes a list of indicators that organizations are strongly encouraged to work on throughout the year.
This post is part of a series highlighting the new themes and 2019/20 QIP indicators. Visit the QIP 2019/20 tag to see the latest.