Reducing Inpatient Transport Delays: The Right Patient at the Right Time

Abstract

Introduction: Transportation of inpatients throughout hospitalization remains a critical aspect of patient care. Transport delays hinder the timely delivery of surgical procedures, radiology, and patient triage, consequently impacting the flow and receipt of treatment. This study reviews transport delays in a quaternary care hospital's inpatient orthopedic unit to the preoperative unit. The goal of the project was to reengineer processes for maximized efficiency and improve on-time starts for all surgical services. Methods: Manufacturing methods of an assembly-line–like model and contemporary process-improvement tools in Lean and Six Sigma were used to gauge, reengineer, and monitor processes to ameliorate patient flow. In addition to value streamlining the flow, evaluating communication triggers, eliminating redundant operations, and shifting roles and responsibilities, multiple data sources were used to assess flow for a redesign. Results: Changes in process operations led to a 40% decrease in delays. The grace period for 100 cases was decreased by 5 minutes, in addition to a savings of $110,000 in operating room costs in the first week and 3.5 full-time equivalents annually. Physician satisfaction with timely patient arrival increased in addition to a simplified workflow, which improved patient readiness on the inpatient surgical floor and increased safety. Discussion: Using data-driven approaches, overnight acuity level was removed as a barrier to the timely care of add-on cases. With a standardized process, prediction model, and simplified evidence-based communication strategies coupled with a “pull” manufacturing model, we implemented a structured, safe, and reliable method of efficient patient transport.