Feature Content

Feature: navigating the challenges of patient flow in clinical settings

Content by Access.

Patient flow is fundamental to the continuum of care and a smooth patient journey. Once acute care is no longer needed, a patient should be discharged to a safe, appropriate setting where they can continue to recuperate.

Whether they are transferred to a care home, a community space, or discharged to a virtual ward – where they can recover more quickly and comfortably within the familiarity of their own homes – there are lots of practical ways to care for patients outside of hospital that do not sacrifice on safety or quality.

Despite these alternatives however, hundreds of thousands of patients remain or remained in hospitals far longer than needed, and these delays in discharge have a ripple effect on the quality of operations, clinical capacity, and patient experience.

In this article we look at the depth of patient flow challenges and how we can only make a difference if we take an integrated, system-wide approach, using the innovative digital tools already available to us.

Mounting pressures and record-high demand

In a recent article published by the Royal College of Physicians, Dr Sarah Clarke emphasised how record-breaking demands on hospitals from last year still add to the NHS’ ongoing pressures. The latest NHS performance data revealed that January 2024 was the month with the highest-ever number of emergency department attendances. Over 177,000 patients endured waits exceeding 12 hours in A&E, and bed occupancy rates reached 94 percent despite the extra 5,000 core beds assigned.

While doctors have diligently addressed demand, and waiting lists for treatment and diagnostic tests have decreased, patients still face extended wait times for treatment, averaging 15 weeks. These alarming statistics have been amplified by seasonal demands and the residual effects of the pandemic.

What causes delays in patient discharge?

High demand, lack of capacity, information errors, and a lack of availability and access to social care, are all obstacles that prevent patients from being discharged from hospital in a timely manner. Even though an individual may no longer fit the criteria to be hospitalised, they may still occupy a bed due to being unable to access the support, care, or the continued treatment they require at home or in another suitable care setting.

Without these resources or the ability to execute the next steps in treatment plans, patient flow becomes bottlenecked, causing existing pressures to intensify and slower recovery times for patients. GP surgeries, A&E, radiography departments, outpatient clinics, and endoscopy units are all battling a backlog of patients and long waiting lists due to high demand and limited capacity.

According to a Delayed Discharges From Hospital  report from Nuffield Trust published last year, patient discharges were slowed by 7+ days because they either needed further assessment, were waiting for a short-term bed elsewhere, or they were waiting to be treated at home.

Failing to properly organise commissioning services where housing, transport and social care arrangements are concerned also hold people in acute care longer than needed.

Bridging the gaps: harnessing the power of technology

Technology has become a powerful and reliable enabler in improving patient flow management. Innovative Patient Flow Management solutions increase the expected discharge rate by 83 percent on average and offer real-time views of bed availability.

This ability to monitor the number of beds and patients coming in and out of hospitals enables clinical settings to manage supply and demand, reduce costs, and deliver the right care to the right patient at the right time.

“Access Patient Flow Manager (APFM) has been used extensively through the pandemic and is critical to both dynamic patient flow and forward planning. We have become very dependent on the real time information to allow us to optimise patient placement,” said Damian Gormley, CIO at Southern Health and Social Care Trust.

“We have a very limited number of side rooms and using the APFM information to show the infection status of all patients allowed us to make most efficient use of limited resources.”

When used correctly, technology can also streamline other tasks and resolve problems faster than most traditional care models. Improved communication enables multidisciplinary care teams to keep each other up to date, preventing the risk of duplicate services, providing alerts when a patient needs to be moved or when their care plan changes, and eliminating the need for time-consuming phone calls or unnecessary paperwork.

Our latest research found that ward managers spend up to three hours a day reviewing ward capacity and updating their trackers to reflect who is and was on their ward. With state-of-the-art solutions like Access Patient Flow Manager, systems are automatically updated whenever a patient is moved in or out of a ward. Not only does this speed up handovers and makes reporting easy, but it also cuts the need to review ward capacity from twice a day to just twice a week.

But solving patient flow challenges goes beyond just management of patient flow within hospitals. If we want to make a real difference, we need to harness the power of technology across the care continuum to get people home quicker and support preventative approaches to avoid admissions in the first place.

Commissioning software can automate provisioning processes, getting equipment, arrange transport, booking appointments with other clinical teams and other care needs arranged quicker and without manual processes. This gives people more options for their care and alleviates pressure on staff who otherwise spend time phoning external providers to find what services are available. It also saves money for ICBs as the best value options that meets the needs are always pre-selected. This can mean blockers stopping people from getting home can be removed and the discharge process sped up. The implementation of discharge hubs have undoubtedly improved the position but, to some degree they have simply moved the manual requirements from the wards to the hubs.  Automation can remove the problem almost entirely.

Technology-enabled care also provides a wealth of patient information and proactive insights. Thanks to wearables, remote monitoring devices, and smart alerts, care providers and families can continue to support patients at home or within their communities once they’ve been discharged. This prevents readmissions, reduces the burden on acute settings and enables patients to live independently for longer.

All these solutions can make a huge difference, but they also need to talk to each other. Coordinating care and solving patient flow issues will only work if we embrace true integration. Ensuring everyone has the information they need to support a person’s end-to-end care is vital, removing friction from their journey and reducing the burden on staff.

The role of integration in patient discharge

Addressing patient flow challenges is no easy feat, but a whole-system approach built on integration can yield better results than the current methods. When there is ongoing coordination between acute care facilities, community health services, and social care agencies, patient transfers from hospital to home or alternative care settings are smooth and frictionless.

Effective solutions designed to improve the discharge planning process and enhance patient outcomes include:

  • Better, coordinated leadership: the process of discharging patients is complex and requires excellent leadership and stringent oversight. Hospitals that appoint seniors and give them the authority to manage and alter processes when they aren’t working can and have achieved improvement in this area.
  • Interoperable systems: even in hospitals where EPR (electronic patient record) systems are used, information can still be miscommunicated, recorded in error, or left out entirely because staff collaborate using outdated systems and processes. This is why a secure, information-sharing system that all relevant providers have access to is integral to keeping records up to date, preventing data silos, and ensuring patients can be discharged safely.
  • Multidisciplinary discharge teams: patients can’t be signed off for discharge without the support of a multidisciplinary team. All discharge plans should include a dedicated, community-based multidisciplinary discharge team who all have the same access to the same information, along with clear responsibilities and skill sets that meet the unique needs of the patient.
  • Discharge planning nurses: embracing a multidisciplinary approach to discharge planning can also lead to the assignment of critical-led nurses. These individuals can help with the transfer of care and arrange referrals to services such as physical therapy, primary care services, or at-home aftercare, ready for when a patient leaves the hospital.
  • Carer and family inclusion: ensuring carers and family members are fully involved in the discharge process from the beginning settles any concerns or objections that may cause delays. If the patient is sent home, their carers and loved ones will need to be able to look after the patient and provide appropriate support.

How ICBs can play their part

From a preventative standpoint, Integrated Care Boards (ICBs) can always do more to improve flow and ensure good outcomes for patients. Whether this is working together to help promote community health initiatives, conducting data-driven research on local needs and priorities, establishing early intervention measures for chronic disease sufferers and high-risk patients via remote monitoring and social prescribing, or leveraging their power of influence to encourage tighter collaboration between primary care, community, and the voluntary sector. Such strategies can help to significantly reduce the burden on hospitals and acute care facilities while addressing some of the major population health challenges that weigh down the community.

ICBs also need to have a clear focus on collaboration across the care continuum. Ensuring that the solution is co-created by acute, community, local authorities and social care providers so that everyone is on board and working together rather than working separately.

Transformation through collaboration

Efficient patient flow management is imperative for optimising healthcare delivery and enhancing patient outcomes. Failing to discharge patients at the right time puts all healthcare providers in an operational deficit, making it hard to deliver timely and appropriate care.

Clearly something needs to change, but it can’t just fall on hospitals; there needs to be a collective effort across the board. Healthcare and social care providers need to work together to manage service demand, free up capacity, and allocate resources more efficiently to improve patient flow. This collaborative mindset, along with better organisation, appropriate oversight, and the right tools and reporting software, can all contribute to a smoother patient journey.

Access is committed to helping organisations overcome the hurdles that obstruct patient flow by equipping them with interoperable, cost-effective bed management solutions that promote a smoother patient experience. Get in touch with us today to find out more.