In healthcare today, hospitals are being asked to do more
with less. Workflow is the execution and
automation of a process where tasks and information are passed from one person
to another for action, according to a set of rules (Emanuele & Koetter,
2007). Business process management (BPM)
involves delivering the right work, to the right person, at the right
time. In healthcare, using an efficient
and successful workflow will result in favorable patient outcomes (Emanuele
& Koetter, 2007). The healthcare
industry is a challenging environment in which to introduce BPM. This slow adoption is due mostly in part to
the technology constraints noted in the healthcare environment. The healthcare industry is just now beginning
to be able to capture all of the necessary data needed to improve workflow
processes. The advent of the electronic
health record has made this opportunity to collect and analyze the necessary
data a reality.
One of the
most critical challenges in the hospitals today is the management of the
patient admission and discharge process in the acute care setting (BioMed
Central, 2012). Institutions not able to
effectively manage this process face increased staff time in planning and
assigning patients to beds and increased costs through alternative placement of
patients when beds are not ready and available when needed. Applying technology
at Highland hospital has addressed many of these workflow issues, but one
continues to torment the bedside nurse and this involves assigning the pending
discharge beds to incoming patients prior to the actual patient being
physically discharged from the room.
This practice causes confusion and chaos for each nurse involved in the
admitting and discharging of patients. Once an admission is pended to a room, the
charge nurse will then assign that patient to a particular nurse. The responsibility of the nurse is to then
review the patient’s history in the EHR, allowing the nurse to be understand
the goals of care for that assigned patient.
The problems arise when the admitting department changes plans. Often what will occur is that there will be a
decision to place a different patient in that bed, adding additional work for
the admitting nurse in the form of having to review a different patient’s
record. Waste also occurred in the form
of time and effort because the originally assigned patient’s chart was reviewed
prior by the same nurse. This change is done the admitting staff and causes
time wasted and extra work for staff on the unit when new rooms must be set up
for patient arrivals.
A key
challenge in bed management is to make sure that the process of assigning beds
is done in a way that makes sense and is efficient (Interfaces, 2013) There must be an overall understanding of the
process from both sides of this equation; the admitting department is managing
patient flow and time to bed metric. The
nursing units are managing nurse workflows and patient satisfaction
metric. Each must be able to look at the
big picture in order to decide upon a workflow that will be able to meet the
goals of all concerned. Care must also
be taken understand the workflow processes done at the unit level. When this is done, there is a better
understanding of what the impact is for the units at the bedside in terms of
managing the admission data and chart review. Communication is key, and all
stakeholders must be prepared to understand and provide the necessary feedback
when necessary.
References
Workflow Opportunities and Challenges in Healthcare. Retrieved
August 4, 2015 from: http://www.researchgate.net/profile/Laura_Koetter/publication/252065707_Workflow_Opportunities_and_Challenges_in_Healthcare/links/552290170cf2f9c13052e464.pdf
Standardizing Admission and Discharge Processes to Improve
Patient Flow: A Cross Sectional Study. Retrieved August 4, 2015 from: http://www.biomedcentral.com/1472-6963/12/180/
Retrieved August 4, 2015 from: http://pubsonline.informs.org/doi/abs/10.1287/inte.2013.0701
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