By Mike Fuller, Regional Director of Marketing, InterSystems.
We all want to avoid bad experiences particularly for patients, whether it is from delays in their treatment, unavailable information, or from people falling through the gaps between different care settings.
The cause of many of these bad experiences is often suboptimal patient flow. Patient flow is a pervasive problem – from general practice to hospitals, in the community, and especially when crossing care service boundaries (post-code or otherwise). Beyond a patient’s experience, it typically has a wide range of negative operational consequences: from worse care outcomes, overcrowded hospitals, and long waiting lists, with the hospital waiting list in England reaching a record high of 7.4 million in the UK as of June 2023. It can also lead to poor utilisation of expensive resources, such as theatres and diagnostic imaging scanners. These negative experiences can often undermine and lead to a loss of public trust in the NHS system as a whole.
At its basic level the proper management of patient flow is the logistical matching of resources with current and future demand, which for many care providers is still hard to achieve. Instances of poor patient flow are arguably more prevalent than ever today as evidenced by increasing delays in ambulance response times, and urgent and emergency care. For example, the NHS A&E Attendances and Emergency Admissions data showed that in May 2023 alone, there were 122,000 four-hour delays from decision to admit to admission in A&E departments, with 31,500 of these being delayed by over twelve hours.
That’s why improving patient flow is an urgent requirement for healthcare, both inside and outside of hospitals, and across adult, child, social, and mental health care. It is a pressing priority for the integrated care boards (ICBs).
Closing the gaps in care responsibility, shared risk, costs, and patient experiences are among the reasons why ICBs were created. The upside to good patient flow management is that not only does it free up resources, but it also provides rich planning data to help ensure the right patients are in the right place with the things they need. So, how is best to optimise patient flow?
Traditional initiatives to tackle patient flow tended to focus on individual services or specific segments of the population. There is a growing consensus that this is not enough, as a system-wide holistic approach analyses and synchronises with several dimensions of care service and resource availability, patient access and compliance, and many more. This offers the quick wins from relieving service bottlenecks that can fuel change and innovation.
Every ICS and the service within them must find its own way forward as there is no one application that can fix patient flow, despite some vendor claims. Rather, what’s needed is a systematic methodology that can help address these challenges across the whole ICS.
A 2022 report by the Health Foundation found that “the pandemic has driven increased demand for health care, growing waiting lists, and a substantial elective care backlog, while impacting negatively on staff wellbeing and absence.” All this is, of course, likely to contribute to further backlogs and bottlenecks across the wider care system – and will, by extension, put a further block on patient flow.
The drivers behind this increased demand for healthcare services are societal in nature, and beyond the direct control of clinicians and healthcare leaders more generally. Yet, there is nevertheless much that healthcare can do to improve patient flow across the ecosystem.
Today, some care providers are investing in patient flow management solutions. Yet, access to the right, good quality data that is delivered efficiently is critically important in this context as otherwise these solutions will fall at the first hurdle.
Interoperability between systems is the key ingredient. Poor patient flow is about much more than just hospital care, and queues at the Emergency Department, even if these attract the most publicity. Good patient flow is most effective when managed for the whole healthcare ecosystem. Systems, processes, and workflows need to be connected, with data flowing seamlessly between and across them. Healthcare information systems are increasingly moving online, and more ICSs are adopting electronic health records to ensure patient information is securely accessible at any time in the healthcare journey and shared as appropriate from one unified platform.
When you couple data management systems with the latest advancements in automation and artificial intelligence you get can some unexpected benefits. Armed with these kinds of solutions, ICBs can move people quickly through the healthcare system; and make sure – both that they are at the right place at the right time, and that they are properly looked after when they are there. They can shift their precious clinical resources from managing volumes of incoming work to focusing on the quality of care being delivered.
To ensure this happens, every practitioner in the patient’s care circle needs to be able to look at all of patient’s relevant data. Data needs to flow in parallel with patient flow in the end-to-end patient journey and follow the patient after they’ve been discharged. That’s where healthcare information systems that deliver interoperability and the ability to share health information within and between facilities and organisations really come into their own. This approach gives clinicians the time to draw on all the data they need to make the best possible decisions and achieve the best possible outcomes for patients. At the same time, it helps to ensure a more streamlined flow of patients throughout the system in acute care but also through the wider healthcare ecosystem. Previously this meant accessing an individual’s shared care record, perhaps via a portal, however this has left many in early generation formats, with data locked in unstructured documents or blocks of human readable files not suited to automation.
To overcome this, internationally recognised interoperability standards such as the Health Level 7® Fast Health Information Resources® (HL7 FHIR®) standard has helped to ensure a shared convention for data access and reusability with far greater agility and resilience over time. This allows data to flow between systems, and prevents data becoming stuck in data warehouses, data lakes, and consequently data swamps – providing more opportunities for decisions to be supported by data and AI augmented automation.
When decisions are made in this way, it isn’t enough to just allow the technology to make them – they must be transparent and explainable. Clinicians and patients must be able to observe and understand the how and why a decision has been reached. Allied to this, is that the systems also must provide full and rich audit trails, so that clinicians and administrators in healthcare can understand when things go wrong, why they went wrong, and therefore avoid similar issues in the future.
Beyond the technology, key stakeholders across the patient flow need to have the freedom to intervene and take action to streamline and accelerate the flow when and where required. Staff need the access and latitude to be able to step in to move processes forward to tackle any bottlenecks as they emerge.
The chain of clinicians across the flow need visibility, connection, and communication. It is not uncommon to see care professionals fully focused and professionally executing their specific piece of the puzzle, and yet the experience between them for the patient can be disconnected. Even if the systems that the care circle use are interoperable, the technology does not on its own close the gaps in care, because care is more than a process.
Complementary policies and workflow founded on shared data, risk, and funding must be present to support the end-to-end patient flow. Even these also often require that clinicians talk freely to each other within and outside of their individual care discipline and or setting. The bottom line is that sustainable change requires the consistent behaviour of all staff and patients across organisations and care settings that is supported by clear communications at every stage.
Getting the formula right
Ultimately, as this article has highlighted, the thorny issue of patient flow is not an easy one for healthcare providers to solve by themselves. Rather it is a story of collaboration, with good data management and interoperability being key to success.
Data needs to be flowing through the relevant systems. All the systems that are in place need to be interoperable and speaking the same language to ensure accurate data ends up in the right place in the healthcare ecosystem at the right time. This in turn enables clinicians to improve the decision-making process and help patients flow through the system better both in acute care but also across the complete healthcare ecosystem.
Get patient flow right, and the benefits multiply. Bottlenecks will free, resources will have better utilisation, and care decisions will be timelier, and will ultimately lead to improved outcomes and experiences for patient, care givers, and the organisations that bring them together.