Nurses can’t control the number of beds in their hospital or the number of patients seeking access on any given day. But they can do a number of things to improve bed availability and reduce the length of stay. Here’s our patient flow checklist for nurses.
Advocate for proper patient placement including participation in multi-disciplinary rounds to understand patient needs and contribute vital patient assessment information.
Collaborate with internists, surgeons, and case management to make sure the patient is moving toward discharge.
Work as part of a team to achieve the patient’s daily goals and coordinate the care to ensure the patient receives everything he or she needs to achieve an early discharge.
Facilitate transfer of ICU patients to step-down when they no longer meet ICU admission criteria. Don’t keep patients in the ICU for the physician’s convenience. In step-down, patients still receive cardiac monitoring. Since they don’t need the ICU nurse-patient ratio or central line monitoring, patients are more ambulatory in step-down, get on the path to discharge and the ICU bed is available for someone else needing that level of care.
Know the status of your patients and whether an observation patient becomes an in-patient. Be familiar with observation criteria and ensure that patient status is correctly recorded; collaborate with case management on conversion of obs to in-patient status as appropriate (ordered clinical interventions support in-patient status by making the case that a patient needs in-patient bed care).
Reduce the length of stay by adhering to infection prevention protocol in the ICU, such as ventilator-associated pneumonia and bloodstream infection bundles and hand hygiene, and prompting progressive mobility.
Allow the receiving nurse the opportunity to ask questions when transferring patients and use a standardized “hand-off” reporting tool (no-delay nurse report).
Collaborate with social services/case management early in the patient stay if the patient needs a place to go at discharge or if potential socioeconomic or transportation problems exist that could delay a discharge or result in a re-admission.
Be part of the solution by acting as the coordinator of care.
With all the changes coming as a result of healthcare reform, there are many things your institution can do to deal with an increase in new patients – such as shifting to more outpatient services, reorganizing ED procedures, and implementing automated real-time capacity management software. In the meantime, nurses can meet the care needs of their patients and be proactive instead of reactive with steps such as these to keep patients moving in a timely fashion on their way to recovery.
What would you add to this patient flow checklist?