Skip to 0 minutes and 6 secondsJOHN RASA: As a hospital CEO, what have you found the persistent challenges in dealing with delays and producing better outcomes in terms of timely care?

Skip to 0 minutes and 16 secondsDAMIAN ARMOUR: I think typically processes have been put in place in health care organisations not to deliberately become or be inefficient, but they naturally evolve and become inefficient for various reasons. At a point in time, if processes will be put in place to deal with certain capacity-- with certain capacity to deal with certain demand-- you apply a set number of resources and you set up your processes and systems to cater for that. Then, of course, population increases-- ageing becomes a factor. But the demand side of the equation increases, and therefore, those processes are put under stress.

Skip to 0 minutes and 52 secondsSo what you're needing to do fairly consistently is to review your processes in the context of the demand that's actually coming through the system. That will involve the need to look at the capacity. So if we took the emergency department, as an example, the capacity is effectively the cubicles that you've got within the ED itself. You would review the resources-- the nurses and the doctors that assist and treat the patients. As time passes, you have technology improvements that could perhaps come in and take an old paper-based system and make it a little bit more efficient.

Skip to 1 minute and 23 secondsAnd then you just review the workflow in that context to try and improve the actual process itself with the goal, obviously, of making sure that the patient experience is the best it can be.

Skip to 1 minute and 34 secondsJOHN RASA: Have you used any particular techniques in that analysis-- of looking at your capacity versus what the demand is on the system?

Skip to 1 minute and 42 secondsDAMIAN ARMOUR: Data to identify the activity that's been taking place-- not just overall, but are there particular points in time of the day or points in time of the week where the system is under most stress. And therefore, you can target the solutions to those particular points as to what the data leads you towards. We would use workflow mapping, so we would follow the patient journey from when they walk through the door to when ultimately they are treated and discharged home or discharged from the emergency department and look at opportunities where the data and the mapping tell you when the actual system's under stress and amend the process accordingly to hopefully smooth the flow.

What are the causes of hospital delays?

Delays in hospitals not only diminish patient experience, but also drive cost and process inefficiencies.

Patient flow is a critical concern for hospitals as optimised patient flows can reduce patient waiting times and lower costs to the hospital.

To enable streamlined patient flow, we need to ensure delays do not occur. So, what are delays? What causes them and what implications do they have?

Causes of delays

Delays are the result of a disparity between demand for a service and the capacity available to meet that demand.

Many factors can cause delays in a hospital or a health system. In this video, we’ll review some common causes of delays within hospitals, including:

  • low staff numbers across the hospital
  • delays in referred patients from emergency department being admitted
  • not enough inpatient beds to admit emergency department patients
  • delays in ordering diagnostic tests and receiving results
  • delays in decision making by the inpatient team
  • delays in discharge
  • inefficient clinical protocols and scheduling practices.

Whatever the cause of delays, they all compromise patient flow and affect patient outcomes by prolonging the length of hospital stays.

Implications of delays

It is known that extended hospital stays can lead to patient complications, including hospital-acquired infections.

Also, extended length of stays can add to hospital costs in terms of hospital beds, staff wages, investigations and housekeeping issues.

For example, this report commissioned by the Victorian Government in Australia identifies length of stay as the key driver of hospital costs impacting the capacity of the health system.

It’s worth taking a moment to remind ourselves that every dollar wasted is a dollar not going to patient care or staff, equipment or other resources. It also means that additional costs are passed on to healthcare consumers.

Your task

Watch the video to hear John discuss the causes and implications of hospital delays with Damian Armour, CEO at Epworth Geelong Hospital.

When you’re done, reflect on your own knowledge and experience of hospital delays and use the comments to share and discuss your thoughts with other learners.

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This video is from the free online course:

Hospital Operations: Improving Patient Experience

Deakin University

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