An earlier article on this blog talked about physician rankings. In this post let’s look at hospital rankings.
America’s best hospitals
There are various agencies and organizations that rank, index and grade american hospitals. Some of the well know ones are US News, Thomson Healthcare (top 100) and more recenlty web 2.0 sites like HealthGrades. The idea behind these rankings is to provide consumers a guide map to choosing hospitals.
Methodology that these publications and agencies use range from internally developed surveys to benchmarking databases and others use information that is collected and published by United States Department of Health and Human Services. US news ranks by specialty as their goal is to identify facilities that excel at treating variety of illnesses within a specialty, as opposed to just few procedures. US News uses data from the American Hospital Association survey of its members.
Web 2.0 application – Finding a hospital near you
Recently we came across a web based application that lets you search for hospitals in your neighborhood (by zip code) and tells you how good the hospitals perform on a variety of process measures that the hospital compare database (Department of Health and Human services)tracks. The best hospitals have green stop lights and the worst has red. We tried this on Washington DC area hospitals and here is what we came up with. Check it out for yourself.
The benefits of improving patient flow go way beyond reducing wait times. While most healthcare administrators tend to focus on reduced diversions (in the ED), elopments, elective surgery cancellations, improving flow can positively impact quality of worklife for physicians, nurses and staff . This can in turn have a very positive impact on patient satisfaction and quality of care.
Here are top 5 tried and tested strategies used to improve flow.
1. Evaluate and monitor bed status in Med surg and Intermediate care units continuously – Don’t sweat the small stuff, the biggest bottleneck for patient flow is mainly in these units. In any acute care hospital, when you hear ‘we don’t have beds’ that usually means there are no monitored beds. So focussing on these units instead of the rest of the house helps. Also, these are the units where there are lots of activity during the day (usually not captured in midnight census which is used to measure occupancy usually). Increasing bed capacity in these units will help flow greatly.
2. Minimize transfers: Again this is counter intuitive but if you actually observe data you will see that transfer consume the most resources (beds, staff, environmental services etc). So do it right the first time and put patients in the right level of care. This can also reduce your insurance denials and impact finances positively.
3. Create an admissions unit to reduce stress on your ED: If your diversion hours in the Emergency Department and admission times are hitting the roof, you know you are in crisis. For quick relief create and admissions unit to keep the ED rooms/beds turning over quicker than usual. The admissions unit can focus on tracking and expedite flow to different units while the ED focuses on providing emergency care and evaluation.
4. Create a discharge lounge : Add a checkout lounge with a coffee bar and flat panel tvs to move patients waiting for a ride, so the valuable beds can be turned over to accomodate other patients. This will also impact patient satisfaction positively.
5. Airlines style surge staffing with demand: Use the airline model when it comes to staffing. Airlines tend to staff proactively during peak hours (and don’t worry about productivity in the short run).Also rememeber this does not only mean nursing staff. This applies to support staff as well. If you don’t have adequate environmental services staff for instance, there is not chance of beds opening up quickly on discharge. Moreover, support staff don’t cost much but are an asset in opening up beds.