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Children's Hospital Boston Finds That Hospital Capacity Can Be Increased By Smoothing Scheduled Patient Flow
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June 2, 2003
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Contact:
Susan Craig
CHB/617-355-6420
susan.craig@tch.harvard.edu
Laure Kesner/Peter Arnold Associates
BU-SMG/781-239-1030
lkesner@parnold.com
Jonathan Small
IHI/617-754-4874
jsmall@ihi.org
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In the first publication on the application of variability methodology to estimate the direct impact of patient flow variability on access to medical care, doctors at Children's Hospital Boston and professors at Boston University School of Management have identified an encouraging way effective management can improve patient care. They found that variability in scheduled surgical intensive care unit (ICU) caseload represents a potentially reducible source of stress on ICUs in hospitals and throughout the healthcare delivery system.
The study's authors maintain that when variability in intensive care patient scheduling is uncontrolled, it can limit access to care and impair overall responsiveness to emergencies. As a result, the problem of access to intensive care services is prevalent throughout the nation.
The article, published in the June 2003 issue of Anesthesiology and titled ''Variability in Surgical Caseload and Access to Intensive Care Services,'' is authored by Michael L. McManus, M.D., M.P.H., Michael C. Long, M.D., Abbot Cooper, James Mandell, M.D., Donald M. Berwick, M.D. M.P.P., Marcello Pagano, Ph.D., and Eugene Litvak, Ph.D.
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After more than a decade of downsizing, many hospitals throughout the country have begun to experience stress related to diminished capacity. This is particularly evident in emergency departments where overcrowding and ambulance diversion are now widely recognized as public health problems threatening national emergency preparedness.
''The study's primary finding is that scheduled patient flow, although theoretically controllable, is counter intuitively more variable than the random demand of emergencies,'' said Eugene Litvak, Ph.D., Director of the Program on Variability and Professor of Healthcare and Operations Management at Boston University School of Management. ''The practical implication is that hospital capacity could be increased and systematic stresses reduced simply by smoothing scheduled patient flow.''
In this one-year study, information was collected prospectively on all aspects for admission to the Medical/Surgical Intensive Care Unit of Children's Hospital Boston, an 18-bed, multi-disciplinary unit. Data included the nature of each request and each patient's final disposition. The daily variability of requests was then analyzed and related to the unit's ability to accommodate new admissions.
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''Due to the increasing trend of overcrowding at hospitals nationwide, we have become interested in the variability of demand for hospital services and the impact of this variability on access to care,'' said Dr. Michael McManus, Senior Associate in Medicine, Anesthesia, and Critical Care at Children's Hospital Boston and Associate Professor of Anesthesia at Harvard Medical School. ''In busy hospitals, competing patient flows frequently collide to produce intermittent demand surges that exceed the supply of available beds. When these demand peaks occur, hospitals are often forced into measures, such as ambulance diversion, that diminish access to critical services. By understanding and smoothing peaks whenever possible, patient flow can be improved and access to care preserved.''
Researchers analyzed two types of variability in demand for hospital services, natural and artificial. ''Natural'' refers to variability in type of disease, its severity, and the arrival patterns of patients. This variability cannot be eliminated, but it can be managed through operations management methodologies. ''Artificial'' is characteristically non-random or more unpredictable since it is driven by unknown individual priorities and related to controllable factors in the design and management of healthcare systems. An example of this type of variability is scheduled surgical demand to the ICU.
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According to Litvak, ''Artificial variability is best managed by elimination wherever possible.''
Donald Berwick, President and CEO of the Institute for Healthcare Improvement, summarized the study's findings by saying, ''Reduction of artificial variability represents a promising area where astute managers may improve patient care without intruding on the specifics of clinical decision-making.''
Co-authors of the study include James Mandell, M.D., President and CEO at Children's Hospital Boston and Professor of Surgery at Harvard Medical School; Michael C. Long, M.D., Senior Anesthetist at the Massachusetts General Hospital, Assistant Professor at Harvard Medical School and Adjunct Associate Professor of Operations Management at Boston University; Abbot Cooper, Senior Research Analyst at Program on Variability and the Health Policy Institute at Boston University; and Marcello Pagano, Ph.D., Professor of Biostatistics at the Harvard School of Public Health.
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Children's Hospital Boston is the nation's premier pediatric medical center. Children's has been ranked #1 among the country's pediatric hospitals in U.S. News and World Report for 13 years in a row. Founded in 1869 as a 20-bed hospital for children, today it is a 300-bed comprehensive center for pediatric and adolescent health care grounded in the values of excellence in patient care and sensitivity to the complex needs and diversity of children and families. Children's Hospital Boston is the primary pediatric teaching affiliate of Harvard Medical School, home to the world's leading pediatric research enterprise, and the largest provider of health care to the children of Massachusetts. For information about the hospital visit. For more information about the hospital visit: www.childrenshospital.org.
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