Patient flow is a behind-the-scenes dance that happens in hospitals.
It’s the art of matching patients with the right clinical team to ensure they get the expert care they need.
A new project at both Juravinski Hospital and Cancer Centre (JHCC) and Hamilton General Hospital (HGH) is looking at how we can do this better. It focuses on general internal medicine (GIM) patients.
“Our GIM flow project aims to keep all internal medicine patients grouped together on specific units, rather than on multiple units across the site” says Natasha Mohammed, who is leading the project at HGH. “By doing so, this means we can keep patients, families, and their healthcare teams in the same area and effectively collaborate on their plans of care.”
Keeping patients together
GIM, which commonly includes patients with pneumonia, diabetes, cardiac issues, and chronic obstructive pulmonary disorder (COPD) to name a few, is the largest group of adult patients at Hamilton Health Sciences (HHS). This population tends to have a longer average stay in hospital, and may be transitioned to other units as hospitals get busier.
“Communication definitely improves the quality of care we provide”
The model is exploring a new way of providing care. By co-locating patients together, physicians, nursing, and allied health staff, like physiotherapists, have more interaction together, and with patients and their families. This improves communication which can boost patient outcomes and improve their overall experience.
“Communication definitely improves the quality of care we provide to patients,” says Dr. Samir Raza, physician lead for the JHCC branch of the project. “Being on the unit creates more opportunities to discuss patient care plans as well as having more impromptu meetings with families. If we’re around more, they get to know us and feel more comfortable approaching us.”
Seeing strong results
The project has a lot of moving parts. Care team rounds take place on the unit each morning to discuss expected discharges, patient status updates, and care plans. As most patients are referred from the emergency department (ED), the unit charge nurses then meet with ED staff and site administration managers to determine how many patients will be transferred to the units. The project has been a success so far thanks to collaboration and dedication from all parties.
“This is making everyone’s roles a little easier”
“Prior to launching, about 25 per cent of our patients were located together. Now, only weeks after rolling out the project, we’re already above 75 per cent on our units which is amazing. All staff involved are very enthusiastic about it and encouraged by these numbers so far,” says Diane Lioris, the JHCC site lead.
Providing excellent patient care
Another early result is the impact on reducing staff fatigue.
“Geographically locating patients is making everyone’s roles a little easier. Staff are less overwhelmed and are more engaged. We’re all here to provide excellent patient care and there’s a general feeling that we can really deliver this now,” Natasha says.
For physicians who used to spend a lot of time commuting between multiple units to visit patients, this model has cut down on their travel time. It’s also helped improve other operational practices.
“With physicians on the units more and in transit less, it has reduced the volume of pages that need to be sent. That’s been a positive result,” Dr. Raza says.
The HHS Sustainability team is helping turn this initiative into what hospitals call “standardized work” – an easy-to-replicate process that can be rolled out in any unit to bring a consistent experience for patients and staff. This will continue over the coming months, working toward a reduction in patient length of stay and improved operational efficiency.