Inpatient Nurses

Janet Gorman, RN; Director of Nursing, Boston Medical Center

Nurses and other inpatient unit staff have the complex job of balancing competing demands from patients currently on their unit, patients needing to be discharged from the unit and patients looking to be admitted to the unit. A major problem that makes this job even harder is unpredictable increases in patient census, and hence patient-to-nurse staffing ratios. One study showed that a 25% increase in census above an adequate staffing level exposes all patients on the unit to a 7% increase in mortality. Such changes in census levels lead to frequent patient misplacements and an increase in inter-unit transfers. Nurse overload with excessive patient demands leads to higher healthcare-associated infection rates (HAIs) and costs hospitals millions of additional dollars annually. IHO’s recommended approach for flow variability management addresses a root cause of these quality and safety challenges.

The Approach

Separating different types of patient flows (urgent / emergent, scheduled, etc.) into homogenous groups and then organizing resources to care for each flow minimizes delays in care delivery, particularly for the sickest patients. Smoothing the flow of electively admitted patients improves patient placement on appropriate units and minimizes patient transfers and delays in the process of care. Finally Operations Management tools such as queuing models and simulation can be used to most accurately determine the number of resources (beds, staff, equipment, etc.) required at each point of care delivery in a way that maximizes patient access, staff satisfaction, quality and safety.

The Benefits

Application of operations management and IHO recommended flow variability management can help you to: