Improving patient flow at Haraldsplass Diaconal Hospital

At many hospitals, transferring patients from the emergency department to the wards can be a slow and resource-intensive process, often leading to bottlenecks in patient flow. Haraldsplass Diaconal Hospital, located in Bergen, Norway, recognised this challenge and embraced digital solutions to streamline patient transfers. Through a pilot project, they developed a digital bed management solution that enabled better communication and resource allocation, leading to more efficient operations and improved patient care.

About Haraldsplass diaconal hospital

The hospital operates as a private, non-profit institution with a staff of approximately 1250 individuals. Specialised healthcare services are provided in internal medicine, surgery, orthopaedics, and radiology, complemented by associated outpatient services. Housing approximately 170 beds, the majority of patient admissions occur through the emergency department. On an average day, the emergency department attends to around 40 patients, with approximately 90% requiring immediate medical attention.

The challenge of patient transfers

Haraldsplass diaconal hospital (HDS) was an early adopter of digital tools, implementing digital interaction boards from DNV Imatis across all wards in 2018 to enhance patient and staff management. However, the transfer process between the emergency department and the wards remained cumbersome. Without a dedicated tool for patient transfers, communication relied heavily on verbal exchanges, leading to delays and errors.

A significant hurdle arose from the emergency department’s reliance on the shift leader to manage patient flow single-handedly. This individual bore the burden of contacting the wards to ascertain the appropriate contacts, and then redundantly verbalising information already documented on the DNV Imatis digital board. This process consumed valuable time for both the shift leader and the receiving ward’s coordinator. Moreover, critical information, often scribbled on yellow notes, risked being misplaced, leading to inefficiencies and confusion. Verbal communication, therefore, became prone to errors, exacerbating the challenges faced.

Recognising the need for improvement, the hospital embarked on a project to streamline internal communication and optimise patient transfers.

Efficient and precise communication

In a bid to enhance internal communication during patient transfers, the hospital formed a project group comprising staff from both the wards and the emergency department. Following a comprehensive analysis of workflow, a novel solution dubbed “Reported to” was devised and trialled initially between the emergency department and the surgical ward.

Under this new approach, patient reports were directly relayed from the emergency department’s board to the respective ward. This empowered the shift leader with a comprehensive ward overview, facilitating direct patient assignments based on the overall situation. Rather than relying on verbal relay through multiple channels, communication was streamlined via standardised messages. Notifications of patient reports were transmitted directly to the mobile devices of responsible nurses, enabling prompt assignment of beds and resources.

Subsequently, the responsible party could swiftly signal readiness to receive the patient with the press of a button, ensuring seamless communication between departments. Importantly, information remained accessible at all times through the same digital board, mitigating the risk of data loss.

“Reflecting on the process, we observed a departure from the belief that verbal discussions were indispensable for effective communication”, remarked Michael Fjeldstad, former system manager at HDS. “The adoption of the digital solution played an essential role in maintaining information consistency across departments, thus diminishing the necessity for prolonged discussions and clarifications. Furthermore, prompt notification of the patient’s designated room to porters significantly reduced wait times and bolstered overall efficiency in patient transfer processes.”

Through the utilisation of the boards’ functionalities in patient transfers, all parties involved had access to the necessary information. When the emergency department reported a patient to the surgical ward, they were provided with the same patient information, reducing the need for discussions and clarifications. Furthermore, porters were promptly informed of the patient’s designated room for transportation, preventing patients from waiting in the hallway for the responsible nurse.

Transitioning from pilot to successful implementation

Throughout the pilot phase, two critical prerequisites emerged for optimising logistics from the emergency department to the wards. Firstly, it was imperative that the shift leader in the emergency department had a comprehensive overview of occupancy. This was achieved by aggregating real-time data on occupancy from all wards, providing the shift leader with vital insights into resource allocation. Secondly, patients were categorised based on their level of care, enabling a more balanced distribution of workload across departments. This level of planning necessitated active participation from the wards, ensuring that patient statuses were regularly updated on their respective ward boards.

Anne Sværen Langnes, who served as the assistant department manager at the emergency department during the pilot phase, highlighted the ease of training due to the solution’s intuitive nature. Immediate feedback from shift leaders indicated a perceived increase in efficiency and time management.

Despite initial plans for an eight-week pilot, the project group found themselves encouraged by management to implement the solution hospital-wide. “People had become accustomed to it; it proved to be an effective method of operation. Removing something they found beneficial wasn’t well-received—they wanted more.” – Anne Sværen Langnes, Assistant Department Manager, Emergency Department.

Immediate Benefits

HDS currently utilises the DNV Imatis board to streamline patient reporting both within and between wards, often originating from the emergency department. The foremost advantage experienced by employees is the enhanced precision in internal communication. This improvement has led to a host of positive outcomes, including time savings, improved distribution of care demand, heightened patient safety, and a more robust foundation for resource planning.

Time Savings: Access to real-time information regarding available beds and occupancy enables the shift leader to allocate patients to wards without the need for extensive phone calls or time-consuming coordination. Consequently, communication is expedited, alleviating the daily workload for both the shift leader and the ward’s responsible resource. The continuous reporting feature facilitates more efficient transfers and capacity management, resulting in significant time savings for all parties involved.

“We received immediate feedback from the shift leader that this provided a benefit in the form of them feeling they got more time.” – Anne Sværen Langnes, Assistant Department Manager, Emergency Department.

Distribution of care demand: Presently, the shift leader in the emergency department benefits from a comprehensive overview of the entire hospital, streamlining the planning and distribution of care demand. This transparent display of care demand fosters a more equitable allocation of resources, eliminating any ambiguity regarding which patients require the most attention. Previously, the emphasis on care levels was less pronounced, largely falling under the responsibility of the shift leader. However, with the current system, all staff members can monitor the distribution of tasks, enabling preparation and equitable workload distribution across departments.

Patient safety: Direct access to the appropriate resource is now a reality, eliminating the need for employees to navigate through multiple channels, thereby reducing the risk of erroneous verbal messages. This enhanced communication method contributes to increased patient safety. Additionally, the digital retrieval of patient information on the boards supersedes the previous reliance on handwritten notes, ensuring the privacy of patient information through role-controlled access.

Resource Planning: Communication of care demand facilitates more accurate staffing levels, encompassing occupancy planning and also the assessment of caregiver requirements on each ward. While challenges persist on days with high occupancy, such as discharging patients quickly, the project’s provision of vital real-time data aids in ongoing improvement efforts and resource planning.

Looking ahead

The implementation of the “Reported to” function has successfully addressed numerous challenges concerning patient flow from the emergency department. Despite occasional high occupancy levels, the hospital now possesses enhanced capabilities to identify and manage bottlenecks, expediting the flow of patients through and out of the facility. This marks a significant stride towards more efficient resource allocation and patient flow management.

Through collaborative innovation projects with suppliers such as DNV Imatis, Haraldsplass Diaconal Hospital has been able to co-create solutions tailored to meet both current and future needs.