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Patient Placement, Pull vs. Push and Hospital Operational Efficiency

Does your hospital employ a “push” or “pull” approach when it comes to patient placement?

That was the subject of the 4th session in our webinar series entitled: “7 Ways to Master Operational Efficiencies in Your Hospital” hosted by Maria Romano, Clinical Product Consultant at TeleTracking.

Pull vs. Push and the Effect on Patient Placement

The notion of pull vs. push is an important concept when it comes to effectively placing patients — and in order to understand the concept, one must first know the difference of the definitions.

  1. Push: to exert force on something or someone, typically with one’s hand, in order to move them away from oneself or the origin of the force (e.g., shove, press, thrust, force)
  2. Pull: to exert force on something or someone, typically by taking hold of them, to move towards oneself (e.g., to draw, tug, attract)

So why are these definitions important? The pull methodology significantly improves the flow of patients through the system and is based on principles of “lean methodology“, whereas the push methodology detracts from it. The pull methodology focuses on the the following principles:

  • Customer value
  • Value-stream analysis
  • Everyday improvement
  • Flow
  • Perfection

This type of methodology begins and ends with the patient who best defines and determines the value of care. To create value for patients, it’s important for hospitals to focus on improving flow, applying pull and striving for perfection.

The following chart outlines how pull vs. push affects patient placement:

Pull Methodology

Push Methodology

Patients being pulled through the hospital as a result of diagnosis Unable to keep up with the demand of patients related to a problem with the flow of patients moving from one point of entry to another
Patients are prepared with precision patient placement in less than 60 minutes from any portal of entry Results in:

 

  • Poor service
  • Long waits
  • Increased Morbidity
  • Increase nosocomial infections
Will receive the right services for the right reason at the right time Increased LOS
Healthcare workers are anticipating the next patient and preparing accordingly Increased readmissions
Decreased LOS  
Decreased readmissions  

We asked the audience to identify the main reason why their patients remain in beds after they’ve been discharged. The responses were split 50/50 between physician orders and “don’t know — can’t track it.” What roadblocks does your hospital face when discharging your patients?

How to Overcome Pull vs. Push Patient Placement Roadblocks

Romano stressed the need to set goals for the organization discharge process in order to overcome patient flow barriers.  New patient admissions should begin with discharges, and hospitals should utilize a centralized process to ensure that patients are discharged in Real-Time.

Also, all portals of entry need to use the “Ready to Move Timer” to hold employees accountable. Once a bed is cleaned and assigned, and the patient is clinically “ready to move,” the actual transfer into the bed is completely controlled by the organization and not dependent upon occupancy.  If confirmed discharge beds are assigned, the time from bed assignment should not exceed 30 minutes and SWAT teams should be deployed to ensure efficient room turnover. Furthermore, the recommended goal is less than 60 minutes for clean bed to assignment to transfer.

So how does the pull methodology relate to patient flow in your hospital?

  • “Pull” is a workflow process borrowed from LEAN methodology
  • “Pull” in a healthcare setting requires some adaptation, but the concept of anticipating the next unit of work and preparing accordingly is the same as any business setting
  • In the hospital setting, the “unit of work” is a patient admission which requires transfer to an assigned bed
  • Overcrowding resulting from capacity challenges can delay a bed assignment
  • Patients being pulled are smoothly transitioned in their care

Maria presented two success stories of TeleTracking clients who embraced the pull methodology for patient placement:

  • Advocate Lutheran General places 92% of all ED patients within the hour
  • Lakeland Regional Medical Center has seen an 80% improvement in patient placement delay times as a result of EVS turnaround times decreasing from more than 60 minutes to 40 minutes

Maria’s 6 Key Takeaways for Patient Placement, Pull vs. Push and Hospital Operational Efficiency

To end her session, Maria outlined 6 key takeaways in regards to patient placement and the importance of employing a “pull” vs. “push” methodology:

1. Implement a precision placement strategy (assign your beds in real-time)

2. Institute an “open-door” unit policy for all admissions and transfers at any time of day

3. Implement a ‘No Delay Nurse Report’ to streamline the admission process

4. Minimize bed changes by nurses — monitor frequently and report

5. Set a 60 minute target from patient bed request to bed placement

6. Hold accountability with two reports: Processing Time Analysis and Ready to Move

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