When patients get stuck: A systematic literature review on throughput barriers in hospital-wide patient processes

Hospital productivity is of great importance to policymakers, and previous research demonstrates that improved hospital productivity can be achieved by directing more focus towards patient throughput at healthcare organizations. There is also a growing body of literature on patient throughput barriers hampering the flow of patients. These projects rarely, however, encompass complete hospitals. Therefore, this paper provides a systematic literature review on hospital-wide patient process throughput barriers by consolidating the substantial body of studies from single settings into a hospital-wide perspective. Our review yielded a total of 2207 articles, of which 92 were finally selected for analysis. The results reveal long lead times, inefficient capacity coordination and inefficient patient process transfer as the main barriers at hospitals. These are caused by inadequate staffing, lack of standards and routines, insufficient operational planning and a lack in IT functions. As such, this review provides new perspectives on whether the root causes of inefficient hospital patient throughput are related to resource insufficiency or inefficient work methods. Finally, this study develops a new hospital-wide framework to be used by policymakers and healthcare managers when deciding what improvement strategies to follow to increase patient throughput at hospitals.

An analysis of the concept of patient flow management

AIM

To analyze the concept of patient flow management.

BACKGROUND

Patient flow has a significant impact on the provision of patient care. The term "patient flow" is widely used, but the related concept of "patient flow management" has been poorly defined. The ability to differentiate and clarify the term patient flow management has implications on strategies to improve patient flow.

DESIGN

Rodgers evolutionary method of concept analysis.

DATA SOURCE

Literature published between 2000 and 2021 in the PubMed, CINAHL, and Business Source databases.

REVIEW METHODS

Inductive analysis of the literature was performed to identify the usage and features of the concept.

RESULTS

Patient flow management is defined as the application of holistic perspectives, dynamic data, and complex considerations of multiple priorities to enable timely, efficient, and high-quality patient care. Patient flow management requires the identification of a patient, care processes, a flow manager, and frontline staff. It has profound consequences on patient, staff, and hospital system outcomes.

CONCLUSIONS

Literature should more carefully delineate between "patient flow" and "patient flow management." Effective patient flow management increases the speed and quality of patient care, improves employee satisfaction, and reduces healthcare costs. Strategies to improve patient flow management should focus on understanding the role and interventions of flow management nurses.

Challenges and potential improvements in hospital patient flow: the contribution of frontline, top and middle management professionals

PURPOSE

This study aims to describe and understand the contributions of frontline, middle and top management healthcare professionals in detecting areas of potential improvement in hospital patient flow and proposing solutions.

DESIGN/METHODOLOGY/APPROACH

This is a qualitative interview study. Semistructured interviews were conducted with 22 professionals in the orthopedic department of a 250-bed academic teaching hospital. Data were analyzed through a thematic framework analytical approach by using an a priori framework. The Consolidated Criteria for Reporting Qualitative (COREQ) checklist for qualitative studies was followed.

FINDINGS

When dealing with a hospital-wide process, the involvement of all professionals, including nonhealth professionals, can reveal priority areas for improvement and for services integration. The improvements identified by the professionals largely focus on covering major gaps detected in the technical and administrative quality.

RESEARCH LIMITATIONS/IMPLICATIONS

This study focused on the professional viewpoint and the connections between services and further studies should explore the role of patient involvement. The study design could limit the generalizability of findings.

PRACTICAL IMPLICATIONS

Improving high-quality, efficient hospital patient flow cannot be accomplished without learning the perspective of the healthcare professionals on the process of service delivery.

ORIGINALITY/VALUE

Few qualitative studies explore professionals' perspectives on patient needs in hospital flow management. This study provides insights into what produces value for the patient within a complex process by analyzing the contribution of professionals from their particular role in the organization.

Identifying logistical parameters in hospitals: Does literature reflect integration in hospitals? A scoping study

In order to improve the quality and efficiency of hospitals, they can be viewed as a logistical system in which integration is a critical factor for performance. This paper describes the results of a scoping study that identifies the logistical parameters mentioned in international research on hospitals and indicates whether literature reflects system integration. When subsystems collaborate in order to accomplish the task of the entire organization, there is integration. A total number of 106 logistical parameters are identified in our study. In addition, the flow type – patients, materials and staff – and hospital subsystems were registered. The results presented in international literature show that logistics is highly fragmented in hospitals. Studies also show integration, although this takes place mainly within the subsystems of hospitals. A multi-agent perspective on hospitals is proposed, following the view that both integration and differentiation are essential for effective organizational performance. Given the widely recognised importance of controlling hospital costs and the potential of logistics to help in this process, it is important to gain more knowledge of hospitals as network organizations, as well as knowledge regarding the degree of integration and the logistical parameters that are required for better hospital performance.