A systematic review to identify the challenges to achieving effective patient flow in public hospitals

Abstract

This systematic review aims to uncover the challenges related to patient flow from a whole public hospital perspective and identify strategies to overcome these challenges. A search in Medline, Emcare and PubMed was conducted and 24 articles published in English, from 2015 to 2020, were selected in relation to patient flow challenges and strategies. Analysis of the articles was completed using a thematic approach to identify common themes in relation to the area of focus. Strategies from the literature were then aligned with the challenges to inform areas of potential improvement in relation to patient flow. The themes generated included Teamwork, Collaboration and Communication; Public Hospitals as complex systems; Timely discharge; Policy, Process and Decision‐making; and Resources‐capacity and demand. The key finding is that a whole system approach is required to improve patient flow in public hospitals. When effective patient flow is achieved, demand and capacity are matched, increasing patient access to the health service and enabling the resources required to provide high quality patient care. The findings will create a better understanding of improving patient flow in public hospitals.

Streamlining patient flow and enhancing operational efficiency through case management implementation

“…This resulted in a successful reduction of waiting times for elective admissions and the ED boarding time and increased hospital operational efficiency. The role of bed management in improving patient flow and hospital operational efficiency has been confirmed in several studies 36 37…”

Patient flow in emergency departments: a comprehensive umbrella review of solutions and challenges across the health system

“…This category includes studies on throughput time, patient outcomes, provider satisfaction, older adults' experience in the ED, and ED patient care processes [ 7 , 30 , 32 , 33 , 35 , 36 , 55 , 57 , 59 , 63 – 74 , 76 , 78 , 79 ]. The third category encompasses studies related to challenges specifically related to patient flow [ 15 , 29 , 39 ].…”

“…The number of criteria met varied across the reviews, with the minimum being 5 out of 11 [ 60 ] and the maximum being 11 out of 11 [ 57 , 64 , 66 , 68 ]. Among the assessed reviews, one scoping review was determined to be of low quality [ 60 ], nine were categorised as moderate quality [ 13 , 27 , 34 – 36 , 58 , 73 , 74 , 77 ], and the remaining 27 were deemed high quality [ 7 , 15 , 29 – 33 , 39 , 43 , 55 – 57 , 59 , 61 – 69 , 71 , 72 , 75 , 76 , 78 – 80 ]. Notably, all reviews met criteria 8 and 11, which pertain to the appropriate methods used to combine studies and the recommendations for policy and/or practice supported by the reported data.…”

“…The “modification of staffing patterns” [ 7 , 13 , 31 , 72 , 75 ] and the “exploration of motivation and payment models” [ 4 , 36 , 64 , 65 , 69 , 75 ] were addressed in five studies. In addition, training for healthcare workers received attention in four studies [ 29 , 35 , 72 , 78 ]. It was observed that most interventions focused on the "within-ED" phase solutions, involving actions taken while patients were in the ED.…”

Optimising Patient Flow from the Perspectives of Key Stakeholders

“…Patient flow can be defined as the movement of patients through the entire healthcare facility [1] encompassing arrivals, admissions, and discharges. In an ideal state, a hospital's capacity is perfectly matched to its demand, allowing patients to flow through the system seamlessly [2]. Suboptimal patient flow, on the other hand, can lead to adverse outcomes for patients and organisational inefficiency.…”