Patient Flow Management Research Articles

Understanding the impacts of health information systems on patient flow management: A systematic review across several decades of research.

Patient flow describes the progression of patients along a pathway of care such as the journey from hospital inpatient admission to discharge. Poor patient flow has detrimental effects on health outcomes, patient satisfaction and hospital revenue. There has been an increasing adoption of health information systems (HISs) in various healthcare settings to address patient flow issues, yet there remains limited evidence of their overall impacts. To systematically review evidence on the impacts of HISs on patient flow management including what HISs have been used, their application scope, features, and what aspects of patient flow are affected by the HIS adoption. A systematic search for English-language, peer-review literature indexed in MEDLINE and EMBASE, CINAHL, INSPEC, and ACM Digital Library from the earliest date available to February 2022 was conducted. Two authors independently scanned the search results for eligible publications, and reporting followed the PRISMA guidelines. Eligibility criteria included studies that reported impacts of HIS on patient flow outcomes. Information on the study design, type of HIS, key features and impacts was extracted and analysed using an analytical framework which was based on domain-expert opinions and literature review. Overall, 5996 titles were identified, with 44 eligible studies, across 17 types of HIS. 22 studies (50%) focused on patient flow in the department level such as emergency department while 18 studies (41%) focused on hospital-wide level and four studies (9%) investigated network-wide HIS. Process outcomes with time-related measures such as 'length of stay' and 'waiting time' were investigated in most of the studies. In addition, HISs were found to address flow problems by identifying blockages, streamlining care processes and improving care coordination. HIS affected various aspects of patient flow at different levels of care; however, how and why they delivered the impacts require further research.

Utilization of an Internal Medicine Triaging Resident in the Emergency Department Reduces Preventable Admissions and Improves Trainee Experiences.

Increasing patient care requirements and suboptimal communication between emergency department (ED) and Internal Medicine (IM) services may lead to inefficient hospital utilization, lapses in transitions of care, and reduced trainee satisfaction in the inpatient setting. Furthermore, a lack of triaging roles for IM trainees has been a common limitation in graduate medical education. We aimed to demonstrate that the addition of an IM triaging resident (TR) in the ED may represent an innovative solution to these problems. A single-center pilot study was performed. An IM trainee served as the TR at a tertiary Veterans Affairs hospital for 2 weeks. The TR evaluated medical patients in a parallel manner with ED physicians and assisted in the initial management, disposition, and transitions of care under the supervision of an IM attending physician. Hospital utilization and patient safety were tracked using electronic records, and trainee satisfaction was measured using daily surveys administered to IM resident teams. Of the 62 cases evaluated by the TR for medical admission, 26 (42%) represented preventable admissions; 12 (46%) of those patients were discharged from the ED, representing a 19% overall reduction. There were statistically significant improvements in trainee experiences relating to patient flow (P < 0.01) and initial patient management (P < 0.02), and our intervention did not have a negative impact on ED performance metrics or patient safety. Expansion of this model in select integrated health systems may improve graduate medical education and healthcare system performance. Future iterations of this study can aim to improve transitions of care between ambulatory and inpatient providers and limit the overuse of antimicrobial agents, radiography, and consultative services.

Dynamic Interday and Intraday Scheduling

Adaptive Patient Flow Management Appointment scheduling has significant clinical, operational, and economical impact on healthcare systems. An informed scheduling strategy that can effectively match patient demand and service capacity dynamically is vital for the business of medical providers, quality of care, and patient satisfaction. By regulating patient flow via an appointment system, healthcare providers can mitigate arrival process variability and improve operational performance. The simultaneous consideration of appointment day (interday scheduling) and time of day (intraday scheduling) in dynamic scheduling decisions is an important theoretical and practical problem that has remained open because of its stochastic nature, complex structure, and large dimensionality. Zacharias et al. (2022) fill this critical gap in the literature. They introduce a novel dynamic programming framework, designed with the intention of bridging two independently established streams of literature, and to leverage their latest advances in tackling the joint problem. They advance the theory of the field to provide a rigorous and practically implantable solution.

Use of Artificial Intelligence to Manage Patient Flow in Emergency Department during the COVID-19 Pandemic: A Prospective, Single-Center Study

Background: During the coronavirus disease 2019 (COVID-19) pandemic, calculation of the number of emergency department (ED) beds required for patients with vs. without suspected COVID-19 represented a real public health problem. In France, Amiens Picardy University Hospital (APUH) developed an Artificial Intelligence (AI) project called “Prediction of the Patient Pathway in the Emergency Department” (3P-U) to predict patient outcomes. Materials: Using the 3P-U model, we performed a prospective, single-center study of patients attending APUH’s ED in 2020 and 2021. The objective was to determine the minimum and maximum numbers of beds required in real-time, according to the 3P-U model. Results A total of 105,457 patients were included. The area under the receiver operating characteristic curve (AUROC) for the 3P-U was 0.82 for all of the patients and 0.90 for the unambiguous cases. Specifically, 38,353 (36.4%) patients were flagged as “likely to be discharged”, 18,815 (17.8%) were flagged as “likely to be admitted”, and 48,297 (45.8%) patients could not be flagged. Based on the predicted minimum number of beds (for unambiguous cases only) and the maximum number of beds (all patients), the hospital management coordinated the conversion of wards into dedicated COVID-19 units. Discussion and conclusions: The 3P-U model’s AUROC is in the middle of range reported in the literature for similar classifiers. By considering the range of required bed numbers, the waste of resources (e.g., time and beds) could be reduced. The study concludes that the application of AI could help considerably improve the management of hospital resources during global pandemics, such as COVID-19.

Evolution and Applications of Artificial Intelligence to Cataract Surgery.

TopicDespite significant recent advances in artificial intelligence (AI) technology within several ophthalmic subspecialties, AI seems to be underutilized in the diagnosis and management of cataracts. In this article, we review AI technology that may soon become central to the cataract surgical pathway, from diagnosis to completion of surgery.Clinical RelevanceThis review describes recent advances in AI in the preoperative, intraoperative, and postoperative phase of cataract surgery, demonstrating its impact on the pathway and the surgical team.MethodsA systematic search of PubMed was conducted to identify relevant publications on the topic of AI for cataract surgery. Articles of high quality and relevance to the topic were selected.ResultsBefore surgery, diagnosis and grading of cataracts through AI-based image analysis has been demonstrated in several research settings. Optimal intraocular lens (IOL) power to achieve the desired postoperative refraction can be calculated with a higher degree of accuracy using AI-based modeling compared with traditional IOL formulae. During surgery, innovative AI-based video analysis tools are in development, promoting a paradigm shift for documentation, storage, and cataloging libraries of surgical videos with applications for teaching and training, complication review, and surgical research. Situation-aware computer-assisted devices can be connected to surgical microscopes for automated video capture and cloud storage upload. Artificial intelligence-based software can provide workflow analysis, tool detection, and video segmentation for skill evaluation by the surgeon and the trainee. Mixed reality features, such as real-time intraoperative warnings, may have a role in improving surgical decision-making with the key aim of reducing complications by recognizing surgical risks in advance and alerting the operator to them. For the management of patient flow through the pathway, AI-based mathematical models generating patient referral patterns are in development, as are simulations to optimize operating room use. In the postoperative phase, AI has been shown to predict the posterior capsule status with reasonable accuracy, and can therefore improve the triage pathway in the treatment of posterior capsular opacification.DiscussionArtificial intelligence for cataract surgery will be as relevant as in other subspecialties of ophthalmology and will eventually constitute a future cornerstone for an enhanced cataract surgery pathway.

Paradoxical consequences of CBHI scheme in rural Ethiopia: Enrollees’ perceived preferential treatment to paying clients and concomitant problems

Though financial protection and improvement in health seeking behavior of rural societies is the intended role of health insurance schemes, empirical evidence indicated that the scheme faced multitude of implementation challenges. This paper examined insurance enrollees’ perceived preferential treatment for paying clients and other concomitant problems in Eastern Gojjam district of north western Ethiopia. Researchers conducted in-depth interviews with 53 enrollees, six FGDs (with a total of 48 discussants) and 7 key informants with professionals from public healthcare facilities and other health insurance administrators. The data encoding, transcription, and thematic analysis process was all conducted manually. Findings indicated that, despite the economic relief households gained, the thrust on the service delivery process seems to be far behind. Comparing them with paying patients combined with the presumed “free medical treatment” that they associated with the insurance, the perceived preferential treatment for paying patients by practitioners seems common. Due to this, most participants hold a belief that visiting private health facilities during critical illness appears preferable to get quality health service. The perceived preferential treatment is alleged to be happening during consultation with physicians, medicine prescription, referral service, patient flow management, and others. Shortage of drugs induced frequent stock out and thereby prolonged reimbursement process, high patient flow induced over load in public health facilities, unnecessary price increment by private pharmacies on insurance beneficiaries and confusion on annual renewal payment without using service are all concomitant problems. Necessary awareness creation interventions and also improvements of public health facilities are recommended.

Increased use of birth interventions during the COVID-19 pandemic?: An exploratory qualitative study.

Context: Since the onset of the COVID-19 pandemic policies have been implemented to limit disease transmission and manage patient flow in clinical settings, including perinatal healthcare settings. Emergent literature indicates increased medicalization of childbirth during the pandemic, however experiences of pregnancy and birth remain unexplored. Understanding the impact of pandemic policies on healthcare practices is important for planning better care in future. Objective: To examine how people in Canada who gave birth during the COVID-19 pandemic were affected by pandemic-related policies, especially policies aimed at limiting interpersonal contact to reduce SARS-CoV-2 transmission. Study Design: exploratory qualitative descriptive study. Dataset: Semi-structured telephone interviews. Population studied: 67 participants were recruited. Study inclusion was extended to anyone aged 18 years or more who was located in Canada and was pregnant or had given birth during the COVID-19 pandemic. Intervention/Instrument (for interventional studies): N/A. Outcome Measures: N/A. Results: Findings suggest that the pandemic has resulted in an overall scaling back of perinatal care alongside the heavy use of interventions (e.g., induction of labour, cesarean section) in response to pandemic stresses and uncertainties on the part of both healthcare providers and pregnant people themselves. Some participants pushed for non-medically necessary interventions as a means of averting the possibility that their partner would be banned from attending the birth (e.g. if the partner contracted COVID-19). Some participants reported being offered interventions as a means of controlling patient flow and in response to clinicians' fears of healthcare system collapse in the event of escalating infection rates. Conclusions: For some people in Canada, giving birth during the COVID-19 pandemic entails medicalization and implementation of non-medically necessary interventions. If healthcare systems are increasing intervention use at the same time that the "safety net" intended to catch the complications from those interventions is reduced, then birthing people are being exposed to extra risk precisely when it is most important to minimize it. Continuity of care throughout pregnancy and postpartum, labour support persons, and non-medical forms of care are all essential components of safe maternal healthcare, however pandemic perinatal care demonstrates that they are not viewed as such.

The impact of reduced operating room capacity on the time delay of urgent surgical care for neurosurgical patients during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic raised major challenges to the management of patient flows and medical staff resource allocation. To prevent the collapse of medical facilities, elective diagnostic and surgical procedures were drastically reduced, canceled or rescheduled. MethodsWe recorded all in-hospital treated patients and outpatient clinics visits of our neurosurgical department from March 2017 to February 2021. Changes of OR capacity, in-hospital neurosurgical treatments and outpatient clinics visits during the pandemic episode was compared on a monthly bases to the previous years. ResultsA total of 3′214 data points from in-house treated patients and 11′400 outpatient clinics visits were collected. The ratio of elective (73.5% ± 1.5) to emergency surgeries (26.5% ± 1.5) remained unchanged from 2017 to 2021. Significantly less neurosurgical interventions were performed in April 2020 (−42%), significantly more in July 2020 (+36%). Number of outpatient clinics visits remained in the expected monthly range (mean n = 211 ± 67). Total OR capacity was reduced to 30% in April 2020 and 55% in January 2021. No significant delay of urgent surgical treatments was detected during restricted (<85%) OR capacity. On average, the delay of rescheduled consultations was 58 days (range 3 – 183 days), three (6.5%) were referred as emergencies. ConclusionsDynamic monitoring and adjustment of resources is essential to maintain surgical care. The sharp restrictions of surgical activities resulted in significant fluctuations and 5% decrease of treated neurosurgical patients during the COVID-19 pandemic. However, urgent neurosurgical care was assured without significant time delay during periods of reduced OR capacity.

Does Insurance Status Influence Outpatient Flow? Cross-Sectional Comparison of Insured and Uninsured Patients in a Tertiary Hospital in Nigeria.

Background: While patient satisfaction is a core index for the assessment of health quality, waiting time and payment mode in hospitals could influence outpatients’ flow and as well as their level of satisfaction. Objective: This study compared the waiting time of insured and uninsured patients seeking general outpatient care in a tertiary hospital. Methods: A total of 166 insured and 166 uninsured ambulatory adult patients seeking outpatient services were recruited by systematic random sampling and followed through their consultation at the outpatient clinic. Descriptive and inferential statistics were conducted using the Statistical Package for Social Science (version 20.0) at a 5% alpha level and power of 80%. Results: There were more males (54.8%) among the insured and more females (53.0%) among the uninsured, but the difference was not statistically significant (P = .153). There were significant differences in mean total idle time during outpatient visits (md = 65.7 min; 95% CI: 69.1, 162.8; P < .001) and total time spent (md=106.6 min; 95% CI: 204.8, 211.8; P < .001) in favor of insured patients. The time spent during the consultation was not significantly different (md = 0.8 min; 95% CI: 0.2, 1.7; P = .107). The insured patients were significantly more satisfied with the time spent waiting for nurses’ and doctors’ attention (P < .001). Conclusion: Significant variations exist in the time spent and level of satisfaction with time spent by insured and uninsured ambulatory patients. Findings call for improving efficiency in patient flow management especially for uninsured patients attending outpatient clinics in public hospitals.

A STUDY TO ASSESS PATIENT SATISFACTION IN EMERGENCY DEPARTMENT OF A TERTIARY CARE HOSPITAL IN KARACHI

The Emergency Department (ED) is a crucial medical treatment unit of hospital specializing in emergency medicine. EDs are responsible for providing immediate healthcare facilities to patients arriving without prior appointment. Thus, evaluating patient satisfaction is of immense importance for efficient service delivery. Very few studies are found in Pakistan, related to patients’ satisfaction and utilization of ED services both from demand and supply perspective of ED-Services Supply Chains (SSCs). Data was collected to assess 200 patient’s satisfaction towards quality of healthcare services of ED of Sindh Government Qatar Hospital, Orangi town-a tertiary care hospital in Karachi. Structured questionnaire was developed to interview patients and their attendants. Results of SPSS analysis revealed that 55% of patients were transferred to ED within 5 minutes, which shows efficient patient queues and flow management. 64.5% patient’s average LOS was between 40-60 minutes. 71% get the availability of basic facilities in ED. Majority of patients i.e. 96.5% and 90.5%, showed satisfaction with the time spent and treatment given by the doctor. Majority of the patients (96%) are satisfied with the services and performance of ED of a tertiary care hospital and 76% patients showed willingness to recommend ED of Government Qatar Hospital, Karachi to others.

An analysis of the concept of patient flow management.

To analyze the concept of patient flow management. Patient flow has a significant impact on the provision of patient care. The term "patient flow" is widely used, but the related concept of "patient flow management" has been poorly defined. The ability to differentiate and clarify the term patient flow management has implications on strategies to improve patient flow. Rodgers evolutionary method of concept analysis. Literature published between 2000 and 2021 in the PubMed, CINAHL, and Business Source databases. Inductive analysis of the literature was performed to identify the usage and features of the concept. Patient flow management is defined as the application of holistic perspectives, dynamic data, and complex considerations of multiple priorities to enable timely, efficient, and high-quality patient care. Patient flow management requires the identification of a patient, care processes, a flow manager, and frontline staff. It has profound consequences on patient, staff, and hospital system outcomes. Literature should more carefully delineate between "patient flow" and "patient flow management." Effective patient flow management increases the speed and quality of patient care, improves employee satisfaction, and reduces healthcare costs. Strategies to improve patient flow management should focus on understanding the role and interventions of flow management nurses.

Unprecedented times in the emergency department: are “board rounds” and leadership the missing links to improve patient flow?

PurposeNational Health Service (NHS) Emergency Department (ED) attendances are at the second highest level ever recorded, (RCEM, 2021a) and as they soar, performance plummets, putting patient safety at risk (RCEM, 2021b). Managing patient flow in the ED is critical to reduce patient safety incidents and crowding, however, this needs effective leadership (Jensen and Crane, 2014). This paper aims to introduce an innovative form of managing patient flow in ED, which is a two hourly “Board Rounds”, providing a managed process to pull patients through the system meeting pre-determined time critical standards and preventing patient harm. Board Rounds combined with effective leadership can play a contributory role preventing crowding in the ED.Design/methodology/approachAn evaluation of two hourly ED Board Rounds was undertaken using the hospitals’ ED Board Round Standard Operating Procedure to develop a series of short questions. As leadership is the responsibility of all clinicians (Darzi, 2008; Moscrop, 2012), a separate survey was undertaken for clinicians of all grades and managers to self-assess their own leadership styles using the Path-Goal Leadership Theory (House and Mitchell, 1974; Indvik, 1985; Northhouse, 2013). Findings were reported to the team to explore ideas for improvement not only to develop more effective leadership in the ED but also to raise awareness of how to optimise leadership in Board Rounds.FindingsIn total, 27 (n = 27) clinicians and managers reported support for a 2 hourly Board Round, for a period of 15 min, in both minor and major injuries departments in ED. A multi-disciplinary Board meeting, led by the lead nurse with support from the Emergency Physician in Charge, was preferred, locating it at the nurse’s station. A validated Path-Goal Leadership survey instrument was returned (n = 24). The findings reveal that leaders and managers are using a high level of the directive leadership style, where there is more potential to use the supportive, participative and achievement approaches to leadership.Research limitations/implicationsThis was a small sample, returned from a Hospital ED located in a semi-rural location, department requiring “improvement” from the Health Regulator. This research would benefit from being undertaken in a medium/large NHS ED department to identify if the findings report on a wider leadership culture in the NHS ED. The implications for this study are that improvement interventions such as a “Board Round” can be usefully evaluated alongside a review of leadership styles and approaches to understand the wider implications for continuous improvement and change in the ED.Originality/valueNHS EDs are facing unprecedented challenges and require innovative evidence-based solutions combined with leadership at this time. The evidence base for improving patient flow is limited, however, this study provides some initial findings on the positive perception and experience of staff to Board Rounds. Board Rounds combined with leadership has the potential to contribute to the wider strategy to prevent crowding in ED. This paper is the first of its kind to evaluate perceptions of Board Rounds in the ED and to engage clinicians and managers in a self-assessment of their own leadership styles to reflect on optimum leadership styles for use in ED.

Following Interprofessional Education: Health Education Students’ Experience in a Primary Interprofessional Care Setting

BackgroundThere is an accelerating need for interprofessional education (IPE) in the Public Health field, as healthcare providers become diverse and multi-disciplinary. Public Health students with health education concentration at Qatar University are required to join training sessions in IPE before the start of their field experience, where students are placed in a variety of community-based and clinical settings including, but not limited to, primary healthcare.PurposeThe goal of this qualitative research study is to understand health education students’ experience in interprofessional care during their field experience in a primary healthcare setting and to highlight the successes and challenges.Patients and MethodsParticipants were third-year health education students (N = 22) enrolled in the Public Health program at Qatar University who obtained their experiential learning in three different primary health care centers. Students’ weekly reports reflecting on primary interprofessional care were included in the analysis for the purpose of this study. Following constant comparative techniques, thematic analysis was conducted on health education students’ reports.ResultsInterprofessional care was witnessed and practiced by students in teamwork and collaboration for the benefit of the patient, communication among health care professionals and referral process and patient flow. Health education students understood their role in interprofessional care in the fields of behavior change, and patient education and empowerment. However, professionals and patients were not recognizing health educators’ role and were not familiar with their contributions to interprofessional care in primary healthcare. Students suggested delivering interprofessional education for health care providers to enhance collaborative teamwork and promote knowledge about the evolving health education field among healthcare providers in Qatar. In addition, they recommended orienting their training supervisors about the goal of IPE-based practice in a primary healthcare setting.ConclusionInterprofessional care was observed and practiced by health education students through collaborative teamwork, communication among health care professionals and management of patient flow. However, they faced challenges during their practice-based IPE. The findings can be tailored towards planning for interprofessional education workshops to boost collaboration progress among health care providers including health educators and supporting professionals interested to implement practice-based IPE in their placement curriculums.

Information technology in hospitalization management in a federal medical organization

The article presents the experience of organizing the management process of planned hospitalization at the Federal Center for Traumatology, Orthopedics and Arthroplasty (Cheboksary). Automation of the process of hospital admission planning, including monitoring of hospital admissions failures and the length of patient stay in the Hospital admission, organization of information support for the staff of the Center's admission department based on the developed MIS "Medialog" module, related to patient registration and registration of documents specific to the federal medical center in the Hospital admission, allowed for ongoing monitoring of hospitalization, reducing the proportion of patients waiting in the emergency department for more than 3 hours, improving the quality of patient flow planning and management.

Enhancing palliative care occupancy and efficiency: a quality improvement project that uses a healthcare pathway for service integration and policy development

This article described our experience in implementing a quality improvement project to overcome the bed overcapacity problem at a comprehensive cancer centre in a tertiary care centre. We formed a...

ANALYSIS OF THE AVAILABILITY AND EFFICIENCY OF MEDICAL CARE PROVIDED TO PATIENTS IN THE PROFILE "MEDICAL REHABILITATION" IN ASTRAKHAN REGION

The relevance of the study due to the need to pay more attention to the effective planning of health care volumes under the compulsory health insurance and the creation of an accessible system of medical rehabilitation for adults in the region. The purpose of the study is to analyze the availability and effectiveness of medical care provided to adults in the "medical rehabilitation" profile within the framework of compulsory medical insurance in the Astrakhan region. Materials and methods - on the basis of data from the Federal State Statistics Service, the territorial fund of compulsory medical insurance in the Astrakhan region, annual reporting statistical forms No. 30, 14, 14-DS, the calculation and analysis of indicators of the optimal volume of medical care for the profile of medical rehabilitation was carried out, taking into account the profile of the disease (the number of hospitalizations per one inhabitant per year, funding per unit of the volume of medical care) of adult patients aged 18 years and older. Results and discussion - the article presents the results of assessing the planned and actual indicators of the volume of medical care for medical rehabilitation for adults, taking into account the profile of diseases in the conditions of round-the-clock and day hospitals of medical organizations participating in the territorial program of state guarantees of free provision of medical care to citizens in the region in 2019. It was revealed that at the expense of the compulsory medical insurance fund, the largest proportion of treated patients in rehabilitation beds is noted among those who receive medical services for neuro- and cardiac rehabilitation. However, rehabilitation care for critically ill patients with scores on the rehabilitation routing scale of 5 and 6 points, with a high rehabilitation potential, as well as for other categories of patients with somatic diseases, remains inaccessible. Conclusion. The obtained research data can be used for further organizational and methodological work to increase the availability and efficiency of medical rehabilitation care for adults, the development of available routing schemes, selection procedures, digitalization of the management of patient flows sent to medical rehabilitation within the framework of compulsory medical insurance at the regional level.

One year with the COVID-19 pandemic − Lessons learnt? Intersectoral collaboration measures established during the crisis could benefit capacity and patient flow management in daily clinical practice

PurposeThe COVID-19 pandemic has changed the way hospitals work. Strategies that were detached from the boundaries of departments and responsibilities in the COVID-19 pandemic have proven themselves under extreme conditions and show a beneficial influence on patient flow and resource management as well as on the communication culture. The continuation of closer interdisciplinary and cross-sectoral co-operation in a “new clinical routine” could have a positive impact on personnel concepts, communication strategies, and the management of acute care capacities and patient pathways.Design/methodology/approachThe aim of the paper is to critically discuss the knowledge gained in the context of the COVID-19 pandemic from the various approaches in patient flow and capacity management as well as interdisciplinary co-operation. More recent research has evaluated patient pathway management, personnel planning and communication measures with regard to their effect and practicability for continuation in everyday clinical practice.FindingsPatient flows and acute care capacities can be more efficiently managed by continuing a culture change towards closer interdisciplinary and intersectoral co-operation and technologies that support this with telemedicine functionalities and regional healthcare data interoperability. Together with a bi-directional, more frequent and open communication and feedback culture, it could form a “new clinical routine”.Originality/valueThis paper discusses a holistic approach on the way away from silo thinking towards cross-departmental collaboration.

Implementing a Novel Nursing Site Manager Role in the Pediatric Emergency Department for Patient and Staff Safety During the COVID-19 Pandemic

Implementing a Novel Nursing Site Manager Role in the Pediatric Emergency Department for Patient and Staff Safety During the COVID-19 Pandemic

Evaluating factors associated with the cancellation and delay of elective surgical procedures: a systematic review.

Elective surgery cancellation is considered a fundamental problem in health care services-it causes considerable disruption to patient flow, further eroding often already stretched operating capacity, and consequentially reduces both hospital performance and patient satisfaction. This research presents a systematic review (SR) of the reasons for surgery cancellation among different hospitals and countries. By highlighting these causes, we identify how to reduce cancellations, thereby improving the use of surgical capacity and resources and creating a more predicable patient flow. An SR was performed on elective surgery cancellation in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analysis and by assessing the methodological quality of SR with Measurement Tool to Assess Systematic Reviews guidelines. There are different reasons for surgery cancellation that vary between hospitals. This SR demonstrates that hospital-related causes (e.g. unavailable operation room time, inappropriate scheduling policy and lack of beds) are the primary reason for surgery cancellation, followed by work-up related causes (e.g. medically unfit and changes in the treatment plan) and patient-related causes (e.g. absence of a patient and patient refusal). This review demonstrates that the main causes for surgery cancellation can be controlled by hospital managers, who can aim to improve areas such as patient flow and capacity management. Ultimately, this will improve the quality of healthcare delivered by hospitals.

One Year with the COVID-19 Pandemic - Lessons Learnt? Intersectoral Collaboration Measures Established during the Crisis Could Benefit Capacity and Patient Flow Management in Daily Clinical Practice

The COVID-19 pandemic has changed the way hospitals work. Some of the urgently established measures have proven to be so useful that they should be adopted in standard care. Recent research has assessed patient management, human resource planning and communication measures in terms of their impact and practicality for continuation in daily clinical practice. Strategies that were detached from the boundaries of departments and responsibilities in the COVID-19 pandemic and that have proven themselves under extreme conditions show a beneficial influence on patient flow and resource management as well as on the communication culture. The continuation of closer interdisciplinary and cross-sectoral cooperation in a “new clinical routine” could have a positive impact on personnel concepts, communication strategies, acute care capacities and the management of patient pathways.