Could engineering processes and techniques help hospitalists with some of the inherent frustrations of their practice—scheduling, staffing, admission surges, prioritizing which patients to see first?
Jonathan Turner, PhD, an industrial engineer who works as a healthcare engineer with the division of hospital medicine at Northwestern University Medical Center in Chicago, led a workshop on applying techniques such as queuing principles to hospitalist practice on Wednesday morning at the Society of Hospital Medicine’s annual meeting, HM12.
One of those principles is Little's Law which, applied to hospitals, calculates length of stay as the hospital’s census divided by its admission rate, reflecting the rates in and out and waiting times within the hospital.
“A lot of hospital administrators talk about reducing lengths of stay, when what they really want to do is increase admissions without increasing beds,” said Dr. Turner. You could reduce length of stay without actually affecting admissions, he added, which would result in unused capacity. At the same time, as capacity approaches 100% percent, negative consequences such as longer wait times and reduced quality may dilute the gains in efficiency. A better target, he said, may be closer to 85% percent of capacity.
One workshop participant relayed how his hospital struggled with delays in processing admissions. He took Little’s Law to his administration and made the case for additional staffing. The administration agreed to an additional hospitalist FTE, since the alternative was back-ups, and shifts were adjusted to times of greatest need. Currently, on 85% of days at the hospital, there are no delays in admissions.
“We talked about how difficult it is to predict caseload,” said Turner at the end of the workshop. “We can look at spikes and seasonal differences, but it may be easier to see patterns if you start peeling off subsets of your patient population.”