Patient flow should be built around patients' need

At Herlev Hospital in Denmark, the emergency department sees a number of solutions to improving patient flow. Among others are identifying a set of specifically described patient flow paths and improving doctors’ confidence in test results.

Improving patient flow is a hot topic in hospitals throughout the world. In Denmark, the acute reception at Herlev Hospital has been engaged in the issue for years under the leadership of MD and chief physician Inger Søndergaard, who has worked in emergency medicine. And an important finding is that hospital staff must change their mindset:

"Hospitals must discard the thought ’first in, first out’. We must always put the patient first, look at their individual needs and create the patient flow around that. Some patients benefit from staying for observation at the emergency department while others must immediately be passed on to other units," says chief physician Inger Søndergaard.

Patient flow paths describe the journey through the hospital

To help fulfil this vision Herlev Hospital has recently incorporated ADAPT, Adaptive Process Triage, which is a method developed in Sweden to segment patients into processes in order to assess which patients need to be attended to by a doctor and how fast this must happen: 

"The key challenge for emergency departments is to identify the ill patients faster, make diagnosis faster, find the right specialist faster and initiate the right treatment faster. But which patients need to be seen first – when doctor resources are limited – can change, and for this purpose ADAPT is very useful," says the chief physician.

She emphasises that ADAPT further helps identify patient flow paths, which are an important step towards improving patient flow. Patient flow paths are specifically described process paths based on symptoms, which patients must follow when they enter the emergency department. Within a flow path the different hospital departments must collaborate to develop, describe and manage the flow path, because the various departments can only describe and control the processes that take place within their specific department.

Fewer, but faster test results

Another important measure for improving patient flow identified by Herlev Hospital is to change the practice of doctors – especially newly qualified ones – who order an array of blood tests and X-rays before deciding on a treatment. This increases waiting time for patients, and often the numerous test results complicate the decision-making process instead of making it easier:

"To make diagnosis fast doctors need to truly trust their clinical judgment. This means that doctors must gain greater confidence in the first answer they receive from a test – instead of ordering a second or third test result. Senior doctors should be front-runners and describe patient tracks that newly qualified doctors can lean on. Additionally, introducing emergency medicine in Europe would improve matters because emergency medicine physicians are trained in making snap decisions based on few indicators," Inger Søndergaard says.

Making decisions on fewer parameters does not make blood testing superfluous. Quite to the contrary. Given they provide speedy results, blood tests will continue to play an important role at emergency departments:

"To improve patient flow emergency departments need a point-of-care testing area located right next to where things are happening, which can provide test results immediately", she points out.