Patient logistics coordinator and effects on throughput
Advocate Christ Medical Center
Abstract
Background
When emergency department (ED) patients need an inpatient bed, but none is available because of limited throughput, the patients are considered “boarding” in the ED. Long ED boarding compromises patient safety, decreases care quality, overcrowds the ED, reduces patient satisfaction, reduces revenue, and increases the risk for patients to have hospital-acquired complications (McHugh et al., 2011). Although patient throughput is multifactorial, one evidence-based method for improving throughput is to focus on early morning discharges to help align the hospital’s capacity with its daily clinical demand (Durvasula et al., 2015). One evidence-based way to increase earlier discharges is to utilize interdisciplinary discharge rounds (Khanna et al., 2016).
Aim of Initiative
Advocate Christ Medical Center (ACMC) had a chronic problem with long ED boarding hours and challenges improving throughput. So, in 2019, nursing leaders created a new nursing position called the Patient Logistics Coordinator (PLC). The PLC uses evidence-based practices to create, facilitate, coordinate, evaluate, and improve throughput practices. Specifically, the PLC aimed to increase pre-11am and pre-2pm discharges.
Implementation Plan
The PLC implemented and runs daily (and as needed extra) interdisciplinary discharge huddles for the ED and inpatient units, sends census emails communicating ED capacity and blocked beds, coordinates with unit managers and the bed board, created and uses a discharge lounge, and collaborates with house supervisors to facilitate surge unit openings as needed. The PLC continually analyzes data and evidence to refine their practices.
Outcomes
Prior to the PLC role, ACMC adult pre-11am discharge rate was 3.5% and pre-2pm discharges were at 24.8%. As of May 2022, the pre-11am discharge rate is 9.2% and the pre-2pm discharge rate is 33.2%.
Implications for Practice
The PLC role helps integrate evidence-based practice to facilitate numerous methods for improving throughput to help all areas of the hospital.