A key step on the path to health equity: improving patient flow

National Academies at the beginning of this year reported Although “more than 20 percent of donated organs are wasted.”An average of 17 people die every day due to lack of organs for transplant.” The main reason for this waste is the lack of surgeons when it comes to harvesting and transplanting donated organs.

If you line up for a donated organ, you’re less likely to lose your spot if you’re near the head of the queue rather than being pushed back. Such unfortunate placement is just one example of an inequitable loss of efficiency and care for patients that could be avoided.

Health care in America is inequitable in many ways, on a variety of bases: race, language, age, gender, disability, location, and insurance status—the list is long. Over the past few years, the U.S. census and the Covid-19 pandemic have focused attention on issues of equity in health care, and nearly every organization is working to identify and reduce inequity.

Since inequities are primarily caused by a lack of resources (money, staff, equipment, facilities, etc.), our first instinct is to inject more funding into the system. But America already It will cost The health care economy has an excessive share, which Compared to other rich countries, medium. And most US health spending serves no useful purpose: In a 2009 report by the National Academy of Medicine (formerly the Institute of Medicine), “Best care at low cost Healthcare waste is estimated at over $700 billion annually.

Increasing resources is sometimes necessary to reduce inequities in health care. At the same time, if we could eliminate just one source of this waste—the mismanagement of patient flow—we would face a 4 to 5 percent (150 – 180 billion dollars per year) reduction in the country’s health care costs By improving the quality of care, enhancing patient safety and addressing equity.

This asks Single management intervention – Scheduling admissions, discharges and visits in a way that streamlines patient flow and minimizes artificial peaks in demand. Such measures may be especially important in safety-net institutions, which have historically been under-resourced and hit hardest by Covid.

Streamlining patient flow has been tested and proven to work in several areas:

1. Newark Beth Israel Hospital – A major safety net hospital in New Jersey. By streamlining patient flow, in just a few months, emergency department telemetry (monitored) bed stays decreased from 15 hours to an average of 3 hours for 90 percent of patients. This has saved lives, reduced length of stay in that unit, cut costs in the department by more than $10 million annually and freed up nine nurses — an especially important step during staffing shortages during the Covid-19 pandemic. Streamlining patient flow in this situation requires consensus on the criteria for admitting and discharging patients in the telemetry department.
2. Boston Medical Center – A major safety net hospital in Massachusetts. Streamlining surgical flow with night-out scheduled surgeries on all weekdays eliminates delays in elective surgeries, significantly reducing life-threatening wait times for patients in the emergency department.
3. St. Thomas Community Health Center -SafetyNet Outpatient Clinic in New Orleans, serving vulnerable populations during Hurricane Katrina and the Covid pandemic. Systematically identifying the pools for scheduled and incoming patients has increased care and profitability by more than $20 million per year. Most importantly, many more uninsured people will have access to timely, quality care.

Facilitating patient flow by simplifying surgical schedules includes organ replacement and reduction Patient death. It can heal. Emergency room and hospital overcrowdingas well as Stress on front line workers, Improving the retention of nursesIncrease Clinician satisfaction And it will bring multi-million dollar improvements to hospital margins.

The practice was spectacular. Proven to work during the covid pandemic. Dr. Shaf Keshavjee is chief of surgery at University Health Network in Toronto (which is rated Toronto General Hospital). fourth (Newsweek’s World’s Best Hospitals 2022) and past president of the American Society of Orthopedic Surgery. He soon he said.: “The silver bullet is that we are doing more with less, more efficiently. We have created the capacity to do more. So we are working on 105, 110 percent. The hospital’s backlog has come down from “4300 to 3200” and it has cleared “about 1,000 cases,” he said. Now, in New Omicron variant On the horizon, “doing more with less” is more important than ever.

The Covid-19 pandemic has exposed and exacerbated inequities in health care. Disproportionate mortality among people of color. It stretched hospital staff to breaking point. In these troubled times, improving health care equity requires more than good intentions and even money. It requires something more serious – a commitment and practical steps to increase efficiency by overcoming habitual and traditional ways of working.

If hospitals open their eyes to the benefits of smoothing the patient flow, and CMS implements financial incentives to stop organ wastage and improve access. The benefits to patients and communities of care across the US with this intervention will be evident long after the Covid outbreak has subsided. Our commitment to equity in health care deserves no less.

Eugene Litvak, Ph.D., is president and CEO of the nonprofit Institute for Healthcare Improvement and an assistant professor at the Harvard School of Public Health. Mark D. Smith, MD, MBA, is a clinical professor of medicine at the University of California, San Francisco. Harvey v. Feinberg, MD, PhD, is president of the Gordon and Betty Moore Foundation.