Bed blocking at MST : Reducing variation and waste in the transition process from the hospital to aftercare institutions

Haas, W. (2011) Bed blocking at MST : Reducing variation and waste in the transition process from the hospital to aftercare institutions.

Abstract:The importance of an efficient patient flow is increasing nowadays, while discharging patients is getting more and more complex. Since the pressure on occupied hospital beds increased drastically at MST, they would like to structurally reduce the total amount of so called blocked beds. The purpose of this research is to come up with useful recommendations on how to reduce the total throughput time for patients from the enrolment (for an aftercare institution) till the physical discharge (out of the hospital). The 3 research questions (RQs) are: · (RQ1) What is the current throughput time for patients in the transition process from enrolment (for an aftercare institution) till the physical discharge (out of the hospital)? · (RQ2) What kind of variation and waste can be identified in the different steps of the transition process from the MST to aftercare institutions? · (RQ3) What are the typical characteristics of patients on the waiting list and is there any relation to the amount of blocked beds? Main findings after investigation of above mentioned RQs: · (RQ1) This RQ learns that the current throughput time of the transition process takes approximately one week (including all inefficiencies), while theoretically the actual physical work could be done in less than one hour. Furthermore is noticed that the total transition process could basically be distinguished into five steps: 1. Enrolment, 2. Transferpoint, 3. Queue list, 4. Contact, 5. Discharge. · (RQ2) Per step the main types of variation and waste are: - Step 1: The method of enrolment to an aftercare institution together with the method of collecting the admissions forms delays the process with more than one day. - Step 2: The incompleteness of admission forms (in 34,5% of the cases) together with the indication request contributes to a few days of delay. - Step 3: The moment a patient is placed at the queue list, communication disorders and admission limitations leads to one hour till a few days of delay. - Step 4: Visiting the patients by aftercare increases the throughput time with a few days. - Step 5: Unexpected changes during the enrolment step and the registration of patient data leads to delay of many days. These typical findings are explained into more detail in table 5 (page 26) and figure 5 (page 27). Each reduction of variation or waste can be a relatively small change, but together they may result in an overall process improvement and consequence an increased throughput time. · (RQ3) After investigation of the patient database of MST was figured out that the typical characteristics for patients on the waiting list are: - In 46% of the cases the admission form was handed in too late. - 33% of the registered patients have as the main diagnose CVA with an average of 6,2 days of bed blocking instead of the overall average of 4,67 days. - 26% of the blocked beds were a consequence of complex cases. In chapter 14 the main recommendations for structural improvements are described, see table 9 (page 38). In principle it is a list of many small improvements. Looking over this improvement list, the main advice to the MST would be to digitalize the whole paper flow. Preferable with a kind of trackand trace system to be able to follow the status of the mediation.
Item Type:Essay (Master)
Medisch Spectrum Twente, the Netherlands
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:85 business administration, organizational science
Programme:Business Administration MSc (60644)
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