Reduced wait times and shorter hospital stays for patients. Reduced operating costs and increased revenues for hospitals. Those are among the results of a 15-month collaborative effort by New Jersey hospitals and the Boston-based Institute for Healthcare Optimization.
Data from 14 participating hospitals that engaged in patient flow and work flow reforms in their operating rooms and emergency departments yielded projected summary results of:
- 11,800 to 17,300 additional patients that could be treated without adding inpatient beds or operating rooms
- Roughly 20,000 additional patients that could be accommodated in hospital emergency departments
- 21 percent to 85 percent decrease in wait times for emergency department patients to be admitted to a hospital bed
- Reductions in the length of hospital stays ranging from 3 percent to 47 percent for certain groups of patients.
The collaborative is part of the New Jersey Hospital Association's Partnership for Patients contract with the U.S. Centers for Medicare and Medicaid Services as a "hospital engagement network." The work is funded through the Affordable Care Act.
"The results are consistent with the goals of the Affordable Care Act – to reduce healthcare costs through improved efficiency," said NJHA President and CEO Betsy Ryan. "But each of those efficiency standards also yield important results in improved quality and safety for patients."
Added Aline Holmes, RN, director of the NJHA Institute for Quality and Patient Safety, "Patients in these hospitals can expect shorter waits for emergency admissions, faster transfer to an inpatient bed or specialty unit and smoother recoveries that see them discharged sooner."
The work was led by Eugene Litvak, PhD, IHO's president and CEO and a specialist in operations management in healthcare delivery organizations and cost-effective medical decision-making. A native of Kiev, Ukraine, he also serves as an adjunct professor in operations management in the Department of Health Policy & Management at the Harvard School of Public Health and was co-founder of the Program for the Management of Variability in Health Care Delivery at the Boston University Health Policy Institute.
Dr. Litvak is an expert in healthcare bottlenecks – spotting them, identifying their causes and designing solutions to smooth them out. His research has discovered certain peaks and valleys in the daily operations of hospitals, especially in the operating room and emergency department. Left unaddressed, those peaks and valleys can lead to longer waits for care for patients, increased costs from staff overtime and missed opportunities for added revenue by providing more procedures.
Fourteen New Jersey hospitals completed a 15-month collaboration with the IHO to analyze their operations and reveal glitches in the optimal flow of patients. The work was broken down into three specific areas, with each hospital choosing one as a focus: reengineering the operating room, redesigning surgical inpatient flow and right-sizing medical inpatient units.
Hospitals analyzed the inefficiencies in their operations, which included uneven usage of operating rooms, which led to long waits, overtime costs and cancellation of procedures at peak times and wages paid to idle staff during low usage. Others identified bottlenecks in admitting patients to inpatient beds which forced many patients to wait long periods in the emergency department or in post-surgery units. Solutions included a reallocation of OR space and staffing, including the creation of designated blocks for emergency and urgent surgeries; and new standardized discharge processes to increase bed availability.
Based on current data, individual hospitals adopting these strategies project some impressive long-term results:
- One hospital expects to schedule 1,000 additional surgical cases, resulting in a potential $1.27 million to $5 million increase in annual revenue.
- Another projects annual cost savings of $1.7 million for redesigning its OR scheduling and operations.
- One hospital expects to reduce its wait time for emergency surgery to just 18 minutes, based on its OR redesign.
- Another reported an increase in patient satisfaction scores from 56 percent to 73 percent.
Dr. Litvak says the success of the New Jersey hospitals in reengineering processes and producing measurable results can provide a model for the rest of the nation in improving the value of our healthcare delivery system.
"The Partnership for Patients collaborative between NJHA and IHO provided a unique opportunity to improve quality of care, patient safety and hospitals' margins by streamlining patient flow," said Dr. Litvak. "Participating hospitals fully utilized this opportunity. By applying IHO Variability Methodology they made themselves much more efficient and much safer places for patients, thereby improving their own survivability in the current cost constraint healthcare environment."
New Jersey hospitals that completed the NJHA-IHO collaborative and shared data results are: CentraState Medical Center, Cooper University Hospital, HackensackUMC Mountainside, Inspira Health Network Woodbury, Jersey Shore University Medical Center, Monmouth Medical Center, Morristown Medical Center, Newark Beth Israel Medical Center, Ocean Medical Center, Overlook Medical Center, Robert Wood Johnson University Hospital, St. Joseph's Regional Medical Center, University Hospital and The Valley Hospital.