Hospital Patient Flow Research Articles

A Discrete-Event Simulation Model of Hospital Patient Flow Following Major Earthquakes

Following a major disaster, hospitals must promptly rearrange their organization and treatment procedures to deal with the sudden arrival of a high number of injured people to minimize morbidity and mortality. These procedural changes are included in emergency plans that hospitals are required to define. Nonetheless, procedures followed in emergency situations may not always be consistent with those planned during “peace time”, and their effectiveness is tested only in case of a disaster. For these reasons, defining a model that simulates the patient flow through the hospital would prove crucial to preventively test the response capacity in case of a disaster. In this paper, the analysis of different emergency plans, interviews with healthcare professionals and an extensive literature review are used to derive two Discrete-Event Simulation models of a hospital digital twin, representing operations in routine and post-earthquake conditions. The two models are defined by balancing the need to represent a complex system with sufficient accuracy, the limitations posed by data availability and the multiplicity of outcomes of a patient treatment. The models are general in their definition, and their potentiality is shown through the application to a reference case study representative of a small hospital in Central Italy.

Sequencing Daily Patient Workload for an Ancillary Service Provider

Ancillary service providers (ASPs) on an inpatient unit (IU), such as social workers, care managers, and physical and occupational therapists, play crucial roles in the inpatient discharge process. However, on a typical day, these ASPs must balance the needs of newly arriving, recurring, and outgoing patients (discharges). While prioritizing the discharges is shown to improve the hospital patient flow and bed utilization, the needs of the other patients cannot be neglected. We examine whether patient sequencing strategies for these ASPs can be found that maintain patient care and optimize patient flow. We approach this ASP workload sequencing problem by proposing a stochastic optimization model and developing a simulated annealing algorithm to derive sequencing strategies that are easy to implement and promising to all scenarios. Our experimental results suggest that patients with pressing constraints should be prioritized over discharges, with discharges then prioritized over other patients. As the complexity of the workload increases (a large number of patients and/or a high percentage of discharges), the focus should shift more towards discharges. We further evaluate the performance of our derived strategies against simpler realistic ASP sequencing strategies and classical machine scheduling rules. Our strategies consistently perform well on deviation from the optimal upstream boarding time and always ensure that patient constraints are met; other simpler strategies can outperform ours only at the cost of increases in cutoff and due-date violations. This paper reveals the importance of a systemic view (inpatient and upstream) on the part of the ASP when prioritizing patients in an IU.

Prophylactic permanent pacemaker strategy in patients with right bundle branch block undergoing transcatheter aortic valve replacement.

To report on the experience with a selective prophylactic permanent pacemaker (PPx-PPM) implantation strategy in patients with pre-existing right bundle branch block (RBBB) undergoing transcatheter aortic valve replacement (TAVR). Pre-existing RBBB is an independent predictor for PPM after TAVR and has been linked to increased mortality. Hospital patient flow and longer-term clinical endpoints were compared for TAVR patients with pre-existing RBBB treated in a period with and without selective PPx-PPM strategy (2013-2020). A total of 260 patients were included: 170 in the early period without PPx-PPM strategy and 90 patients in the late period with selective PPx-PPM strategy. A PPx-PPM was implanted in 44% of patients in the late period. Overall, 69% versus 80% of all patients in the early versus late period ended up with a PPM (p=.06). Streamlined transfemoral TAVR was routinely used from 2017-in this series of patients, both TAVR procedural time and hospital length of stay (LoS) were significantly shorter in the late versus early period (mean procedural time: 70 vs. 83 min and LoS ≥5 days: 15% vs. 40%; p < .05). No difference in all-cause/cardiovascular mortality was observed between both strategies, whereas cardiac rehospitalization was significantly higher for patients treated in the early versus late period (hazard ratio 2.33 [1.04-5.26]; p=.042)-this mainly due to (sub)acute PPM-implantation early after discharge. Selective prophylactic PPM implantation in TAVR candidates with pre-existing RBBB results in shorter TAVR procedural time and hospital LoS and prevents early cardiac rehospitalization related to complete heart block.

Teaching acute hospital staff and students about patient flow.

Good patient flow in an acute hospital is concerned with ensuring patients experience minimal delays throughout the hospital journey, from the emergency department to the wards, outpatients and to a suitable discharge destination. Good flow requires effective processes, staff buy-in and staff education. This study aimed to explore ways in which this topic is currently taught in an Irish acute hospital group. Participants were recruited to engage in semi-structured interviews about their experience of teaching patient flow. Following qualitative data analysis using a structured analysis guide, five main themes were identified: current methods, unstructured nature of teaching, frustration with frequency, dissemination of teaching/learning and opportunities for improvement. Recommendations from this study could be used to support a formalised approach to teaching this topic in the future. The use of the Teaching for Understanding framework and Universal Design for Learning principles are strongly advocated to support the development of a nationwide module, to structure the topics to be taught and provide guidance on how to effectively and efficiently teach this topic in Ireland.

The expansion of the HCA role: introducing the ‘doctors' assistant’

British Journal of Healthcare AssistantsVol. 15, No. 6 ProfessionalThe expansion of the HCA role: introducing the ‘doctors' assistant’Sarah Jane PalmerSarah Jane PalmerRegistered Nurse and Freelance WriterSearch for more papers by this authorSarah Jane PalmerPublished Online:11 Jul 2021https://doi.org/10.12968/bjha.2021.15.6.279AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References McNally S. Doctors’ assistants—a new NHS hybrid admin/clinical role. 2017. file:///Users/peter.bradley/Downloads/Doctors%20Assistants%20RCS%20SCARLETT%20McNALLY%20for%2024317.pdf (accessed 24 May 2021) Google ScholarMcNally S, Huber J. Developing a ‘doctors’ assistant’ role to ease pressure on doctors and improve patient flow in acute NHS hospitals. BMJ Leader. 2021;5:62–64 Google Scholar FiguresReferencesRelatedDetails 2 July 2021Volume 15Issue 6ISSN (print): 1753-1586ISSN (online): 2052-4420 Metrics History Published online 11 July 2021 Published in print 2 July 2021 Information© MA Healthcare LimitedPDF download

SKUBI MEDICINOS PAGALBA: TARPHOSPITALINIAI PERVEŽIMAI

In this article an emergency medical assistance and the inter hospital transfer problems are analysed in context of the restructurization of health care institutions and services, also of regionalization and centralization policy in Lithuania. Though the increased accessibility of health care services and improvement of the quality, also reduction of social exclusion and unevenness of provision of health care services are declared as the main objectives (purpose) of restructurization, however increased number of inter hospital transfers and crowding of the Emergency Departments indicate the possible negative tendencies. One of the substantial (fundamental) requirement of the inter hospital transfers is the continuous emergency care during transportation. The article provides a unified concept of second transportation between hospitals. The survey results contain the points of specialists and executives of emergency medical assistance on the current management situation of inter hospital patient flow and the ways how the management of patient flow can be improved. The study was made using questionnaire survey, the questions were divided into separate groups by the objectives of this study. Reasoned conclusions and the scheme of the emergency medical care patients flow are developed with reference to the results of this study.

The impact of COVID-19 testing on length of hospital stay and patient flow in hospitals

ABSTRACT The CDC regularly updates guidance on COVID-19 testing for inpatients and hospital discharges to nursing homes and long-term care facilities. However, most long-term care facilities require a negative COVID-19 test result before accepting patients discharged from the hospital which directly contravenes the CDC guidelines. Due to delays in COVID-19 testing and obtaining test results, patients end up staying additional 2–3 days in the hospital before they can be discharged to nursing care facilities. Furthermore, hospitals have reported facing resistance from health insurance plans to paying for patients’ additional days in the hospital while awaiting COVID-19 test results. Hospitals across the country continue to experience an increase in hospitalizations for COVID-19 infection. Complying with the CDC guidance on testing and disposition of patients may prevent delays in transferring patients to long-term lower acuity level nursing facilities, reduce the length of hospital stay, improve patient flow and ultimately free up hospital beds for incoming COVID-19 patients.

Reducing the Length of Stay by Enhancing the Patient Discharge Process: Using Quality Improvement Tools to Optimize Hospital Efficiency.

Delays in the discharging process can affect hospital efficiency. Improving patient flow in acute care hospitals is an essential issue that hospital management and research aim to achieve. Admission volume and LOS for hospitalized patients in the medical specialties department was examined at a tertiary care center in Riyadh, Saudi Arabia, to explore practical approaches to reduce the LOS. We aimed to identify and manage reasons for the delay in discharging patients from the medical specialties department at a tertiary care center in Saudi Arabia. Admission and discharge data for hospitalized patients were collected from 2016-2018. In 2017, a FOCUS (find, organize, clarify, understand, select)-PDSA (plan, do, study, act) quality improvement method was used to improve the discharge processes, with specific measurable targets per year. The number of readmissions and mortality rates decreased significantly after the intervention was implemented, suggesting an improvement in the quality of treatment and the process of admission and discharge. Despite gradual increases in admissions from 2016 to 2018, the mean LOS decreased significantly between 2016 and 2018, from 9.16 to 7.47 days (p < 0.001). The number of readmissions and mortality rates decreased after the intervention was implemented in 2017, suggesting an improvement in the process of admission and discharge. The LOS can be reduced by implementing a quality improvement intervention, driven by a multidisciplinary committee involving healthcare personnel, to facilitate the optimal discharge mechanism through available hospital resources and services.

Measurement of high-sensitivity troponin-I in suspected coronary-related chest pain in Emergency Departments.

The study aimed to evaluate a new algorithm based on analyses of high-sensitivity troponin I for rapid diagnostic clarification in cases of suspected cardiac chest pain. Two time periods - before (01.10.2016-31.12.2016) and after (01.03.2017-28.02.2018) the introduction of a diagnostic algorithm - were studied by reviewing the medical records of patients who arrived at the emergency department with chest pain. The diagnostic algorithm included a high-sensitivity troponin I test on admission (0hours) and one hour later (the 0h/1h algorithm). The primary endpoint was the proportion of patients that were discharged directly from the emergency department. Secondary endpoints were acute cardiac arrest and death within 30 days and within one year. A larger proportion of patients with chest pain were discharged directly from the emergency department when the 0h/1h algorithm was used (10/91 (11%) before versus 118/306 (39%) after, p <0.001). Deaths and the incidence of acute myocardial infarction one year after the introduction of the 0h/1h algorithm were low (≤3%) and not statistically different from the period before the introduction (p≥0.20). The implementation of a diagnostic algorithm based on measurements of high-sensitivity troponin I resulted in fewer patients being hospitalised, and we did not register more deaths or deaths from myocardial infarction. The algorithm was suitable for identifying patients with chest pain who could safely be discharged without the need for hospitalisation, which we believe may optimise patient flow in hospitals.

Effectiveness Optimization of an Automatic Medicine Dispenser Based on the Entry-Item-Quantity ABC Analysis Method and Track Utilization Rate Algorithm

Modern hospital pharmacies are undergoing broad-scale shifts toward informatization and automation. With the widespread use of automated medicine dispensing systems in major Chinese hospitals, their application value has been increasingly confirmed. However, relative to other countries, automation of China’s pharmacies was relatively delayed, and the use of imported automated equipment in domestic hospital pharmacies dealing with an enormous prescription burden poses substantial challenges in maintaining high automation efficiency when the hospital patient flow is at its peak. Objective to optimize the medicine storage system of automatic medicine dispensers and to improve the automation efficiency of pharmacies using the entry-item-quantity (EIQ)-ABC analysis method and a track utilization rate algorithm. Methods A total of 76,069 prescriptions from the CONSIS automated medicine dispensing system of medicine dispensing system of our hospital’s outpatient pharmacy were selected in June 2020, and the EIQ-ABC analysis method was used to perform associative classification of the dispensing volume and frequency of each medicine. The varieties of medicines in the automatic dispenser were adjusted according to the classification results, and then, the storage space of medicines was optimized using a track utilization rate algorithm. The performance of this method was evaluated by comparing the automatic rate of the dispensing volume, and the real-time window dispensing rate and prescription ratio before and after optimization. Results After the implementation of the EIQ-ABC analysis method and track utilization rate algorithm, the average automation rate of dispensing volume, real-time window average dispensing rate, and real-time window average prescription ratio increased by 2.46%, 4.4%, and 4.87%, respectively, which were significantly higher than those before implementation (P < 0.05). Conclusion Using the EIQ-ABC analysis method and the track utilization algorithm to optimize the varieties and storage space of medicines in an automatic medicine dispenser can fully utilize storage space, reduce instances of lack of medicine in the dispenser, and improve the fully automatic dispensing rate.

Way forward from the experiences of disaster preparedness and response at Patan Hospital during 2013-2020: Nepal

The history of the disaster management plan at Patan Hospital goes back to 1995 A.D (2051 B.S). The plan was first written by Dr. Cleve Chevassut. This was a hospital-based disaster management plan and consisted of a hospital incident command system (HICS), triaging, patient flow, job description, and management protocol. This plan was regularly updated and tested with disaster drills. In the year 2013, the 10th revision of the disaster management plan was done. This plan was tested with a disaster drill and the template of this plan was circulated to different hospitals of Nepal. This document consists of a part of experiences and evidence of hospital-based disaster activity that took place inside Patan hospital and activities to establish hospital-based disaster management plan in different hospitals of the country from 2013 to 2020. This document does not cover the overall preparedness response of all hospitals and that of the country.

COVID-19 and Palliative Care Services: Comparative Patterns of Inpatient, Outpatient, and Consultation Services in a Tertiary Care Center in Riyadh.

IntroductionThe coronavirus disease 2019 (COVID-19) outbreak caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) marked the third introduction of a highly pathogenic and large-scale epidemic coronavirus into the human population in the 21st century. The World Health Organization declared the COVID-19 outbreak as a pandemic on March 11, 2020. Lockdowns were imposed in multiple countries affecting patient flow in hospitals.MethodsThis is a retrospective study conducted at King Fahad Medical City (KFMC), a tertiary care hospital in Riyadh, Saudi Arabia, which examined the differences in palliative care services during the initial four months of the COVID-19 pandemic compared to the respective four months in 2019 (March, April, May, June).ResultsA total of 319 patients were seen at the palliative care department from March to June 2020 during the COVID-19 pandemic (119 inpatient, 200 outpatient), compared to 346 patients seen during the corresponding months in 2019 (97 inpatient, 249 outpatient). Our main findings included more patients being discharged home, lesser transfers, shorter hospital length of stay, lesser imminent death protocols, and a higher palliative performance score (PPS) during the COVID-19 pandemic. Although there were more cancelations by the hospital for the outpatient department, a virtual clinic was started, and 84 patients were effectively seen. Around 87% of patients were fully satisfied (5/5) with the services provided by the virtual clinic. There were no positive COVID-19 cases in our healthcare workers in the palliative care department due to the high standard precautions applied at KFMC. Family meetings as well as administrative and academic meetings have been efficiently held virtually and may possibly become the standard of practice.ConclusionPalliative care services were successfully maintained during the COVID-19 pandemic at KFMC.

Challenges and potential improvements in hospital patient flow: the contribution of frontline, top and middle management professionals

PurposeThis study aims to describe and understand the contributions of frontline, middle and top management healthcare professionals in detecting areas of potential improvement in hospital patient flow and proposing solutions.Design/methodology/approachThis is a qualitative interview study. Semistructured interviews were conducted with 22 professionals in the orthopedic department of a 250-bed academic teaching hospital. Data were analyzed through a thematic framework analytical approach by using an a priori framework. The Consolidated Criteria for Reporting Qualitative (COREQ) checklist for qualitative studies was followed.FindingsWhen dealing with a hospital-wide process, the involvement of all professionals, including nonhealth professionals, can reveal priority areas for improvement and for services integration. The improvements identified by the professionals largely focus on covering major gaps detected in the technical and administrative quality.Research limitations/implicationsThis study focused on the professional viewpoint and the connections between services and further studies should explore the role of patient involvement. The study design could limit the generalizability of findings.Practical implicationsImproving high-quality, efficient hospital patient flow cannot be accomplished without learning the perspective of the healthcare professionals on the process of service delivery.Originality/valueFew qualitative studies explore professionals' perspectives on patient needs in hospital flow management. This study provides insights into what produces value for the patient within a complex process by analyzing the contribution of professionals from their particular role in the organization.

Forecasting emergency department overcrowding: A deep learning framework.

As the demand for medical cares has considerably expanded, the issue of managing patient flow in hospitals and especially in emergency departments (EDs) is certainly a key issue to be carefully mitigated. This can lead to overcrowding and the degradation of the quality of the provided medical services. Thus, the accurate modeling and forecasting of ED visits are critical for efficiently managing the overcrowding problems and enable appropriate optimization of the available resources. This paper proposed an effective method to forecast daily and hourly visits at an ED using Variational AutoEncoder (VAE) algorithm. Indeed, the VAE model as a deep learning-based model has gained special attention in features extraction and modeling due to its distribution-free assumptions and superior nonlinear approximation. Two types of forecasting were conducted: one- and multi-step-ahead forecasting. To the best of our knowledge, this is the first time that the VAE is investigated to improve forecasting of patient arrivals time-series data. Data sets from the pediatric emergency department at Lille regional hospital center, France, are employed to evaluate the forecasting performance of the introduced method. The VAE model was evaluated and compared with seven methods namely Recurrent Neural Network (RNN), Long short-term memory (LSTM), Bidirectional LSTM (BiLSTM), Convolutional LSTM Network (ConvLSTM), restricted Boltzmann machine (RBM), Gated recurrent units (GRUs), and convolutional neural network (CNN). The results clearly show the promising performance of these deep learning models in forecasting ED visits and emphasize the better performance of the VAE in comparison to the other models.

Waiting times in emergency departments: exploring the factors associated with longer patient waits for emergency care in England using routinely collected daily data

BackgroundLong lengths of stay (also called waiting times) in emergency departments (EDs) are associated with higher patient mortality and worse outcomes.ObjectiveTo add to the literature using high-frequency data from a...

COVID-19 Models for Hospital Surge Capacity Planning: A Systematic Review.

Health system preparedness for coronavirus disease (COVID-19) includes projecting the number and timing of cases requiring various types of treatment. Several tools were developed to assist in this planning process. This review highlights models that project both caseload and hospital capacity requirements over time. We systematically reviewed the medical and engineering literature according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We completed searches using PubMed, EMBASE, ISI Web of Science, Google Scholar, and the Google search engine. The search strategy identified 690 articles. For a detailed review, we selected 6 models that met our predefined criteria. Half of the models did not include age-stratified parameters, and only 1 included the option to represent a second wave. Hospital patient flow was simplified in all models; however, some considered more complex patient pathways. One model included fatality ratios with length of stay (LOS) adjustments for survivors versus those who die, and accommodated different LOS for critical care patients with or without a ventilator. The results of our study provide information to physicians, hospital administrators, emergency response personnel, and governmental agencies on available models for preparing scenario-based plans for responding to the COVID-19 or similar type of outbreak.

Perspectives and practices of health workers around diagnosis of paediatric tuberculosis in hospitals in a resource-poor setting \u2013 modern diagnostics meet age-old challenges

BackgroundDetection of tuberculosis (TB) in children in Kenya is sub-optimal. Xpert MTB/RIF® assay (Xpert®) has the potential to improve speed of TB diagnosis due to its sensitivity and fast turnaround for results. Significant effort and resources have been put into making the machines widely available in Kenya, but use remains low, especially in children. We set out to explore the reasons for the under-detection of TB and underuse of Xpert® in children, identifying challenges that may be relevant to other newer diagnostics in similar settings.MethodsThis was an exploratory qualitative study with an embedded case study approach. Data collection involved semi-structured interviews; small-group discussions; key informant interviews; observations of TB trainings, sensitisation meetings, policy meetings, hospital practices; desk review of guidelines, job aides and policy documents. The Capability, Opportunity and Motivation (COM-B) framework was used to interpret emerging themes.ResultsAt individual level, knowledge, skill, competence and experience, as well as beliefs and fears impacted on capability (physical & psychological) as well as motivation (reflective) to diagnose TB in children and use diagnostic tests. Hospital level influencers included hospital norms, processes, patient flows and resources which affected how individual health workers attempted to diagnose TB in children by impacting on their capability (physical & psychological), motivation (reflective & automatic) and opportunity (physical & social). At the wider system level, community practices and beliefs, and implementation of TB programme directives impacted some of the decisions that health workers made through capability (psychological), motivation (reflective & automatic) and opportunity (physical).ConclusionWe used comprehensive approaches to identify influencers of TB case detection and use of TB diagnostic tests in children in Kenya. These results are being used to design a contextually-appropriate intervention to improve TB diagnosis, which may be relevant to similar low-resource, high TB burden countries and can be feasibly implemented by the National TB programme.

Predictors of ED attendance in older patients with chronic disease: a data linkage study.

Objective Older people represent a large proportion of emergency department (ED) presentations, with multiple comorbidities a strong predictor of frequent attendance. This study examined associations between the general practice management received by older patients with chronic disease and ED attendance. Methods This retrospective study examined linked data from general practice and ED for patients aged ≥65 years who presented to a general practitioner (GP) between 2010 and 2014. Data from the computerised medical records of patients attending 50 general practice clinics in the inner east Melbourne region ere linked with ED attendance data from the same region. Patients with chronic disease were identified and characteristics of ED versus non-ED attendees were compared. Poisson regression was used to explore factors associated with ED usage. Results During the study period, 67474 patients aged ≥65 years visited a GP, with 63.3% identified as having at least one chronic condition and 21.4% of these having at least one ED presentation. Over 70% of the ED presentations in this group resulted in hospital admissions. The most common diagnoses for ED presentation were cardiovascular disorders, pain and injuries. ED attendance was associated with being aged ≥85 years (incidence rate ratio (IRR) 2.09; 95% confidence interval (CI) 1.96-2.11), higher socioeconomic status (IRR 1.49; 95% CI 1.45-1.53), having a GP management plan (IRR 1.47; 95% CI 1.43-1.52), multimorbidity (IRR 1.53; 95% CI 1.46-1.60), more frequent GP visits (IRR 1.10; 95% CI 1.05-1.15) and having a higher numbers of prescriptions (IRR 1.51; 95% CI 1.44-1.57). Conclusion This study suggests that ED presentation is associated with greater frailty and multimorbidity in patients. Further research is necessary to determine why higher rates of chronic disease management through GP management plans and more frequent visits did not mediate higher rates of presentation and the reasons behind the socioeconomic differences in ED presentation for patients in this age group. What is known about the topic? Increases in the volume and rate of ED presentations by older people will markedly affect emergency and acute hospital care and patient flow as the proportion of older Australians increases. What does this paper add? We used a novel and highly transferable data linkage between data collected from the clinical records of general practice patients and their associated data from ED and hospital settings and examined the relationship between GP management received by older patients with chronic disease and ED attendance. What are the implications for practitioners? Increasing utilisation of GP services may not have an effect on reducing ED attendance, particularly for older patients who may experience poorer overall health.

Temporal pacing of outcomes for improving patient flow: Design science research in a National Health Service hospital

AbstractImproving patient flow in hospitals is a contemporary challenge in the UK National Health Service (NHS). When patients remain in a hospital bed for longer than clinically necessary, hospital performance is dramatically impacted, quality of care is reduced, and elective surgeries are cancelled at great cost to both hospital and patient. This research explains how one UK hospital employed design science research to improve patient flow after other process improvement techniques had failed. The work focused on improving patient flow through the creation of a set of interconnected, temporally paced routines that successfully engaged doctors and nurses in new, outcome‐specific ways of working. These routines were both independent and interdependent, were relationally coordinated through time, and systematically and unambiguously engaged all levels of staff at specific temporal junctures. We discover that the successful adoption of these routines was cumulative rather than iterative and was aligned with ongoing efforts supporting the social aspects of change. Through this work, our case hospital saw performance improvements that moved them from being below average to the best in the country, combining improvements in patient care with savings of over £3 million in the first 12 months. The contribution of this research is twofold; first, we explain how the development of outcome‐specific routines can facilitate process improvement, and second, we illustrate how design science research can successfully bridge theory and practice to promote swift and even flow in healthcare.

Improving hospital patient flow: a systematic review

PurposeImproving hospital patient flow has become a policy priority, to effectively balance the increasing demands of an unknown and variable volume of patients with limited available hospital resources. A systematic literature review was conducted in order to identify actions, actors involved and enablers in improving hospital patient flow. The paper aims to discuss this issue.Design/methodology/approachSearches were conducted in Scopus, Web of Science, MEDLINE and The Cochrane Library for quantitative and qualitative empirical primary studies with patients (adults) receiving inpatient acute hospital care. The study protocol was based on PRISMA-P guidance. A critical appraisal of included studies was performed by using the Quality Improvement Minimum Quality Criteria Set.FindingsIn total, 38 key papers were identified. A wide range of actions are reported, but most studies focus on one or a few departments instead of a whole hospital. Process efficiency is most often used as a performance indicator, clinical outcomes are poorly analyzed, and patients’ expectations and experience are rarely considered. Top-management commitment and front-line staff involvement are considered key factors for the success of implementations. Patient involvement in the process improvement is rarely mentioned.Originality/valueAchieving improvements in hospital patient flow requires the design and implementation of complex, multifaceted and coordinated interventions. This study may be of value to healthcare managers, helping them to act effectively in their context, and to researchers of future studies including the different variables and the patient’s perspective.