Multi-Hospital

Multi-Hospital Collaborative Programs

In the Multi-Hospital System format, we bring together hospitals within the same health system that are interested in employing IHO’s Variability Methodology® services in a particular setting, such as the Operating Room or inpatient units. These programs provide extensive education and coaching for various levels of hospital management and empower health care systems to redesign their patient flow.
Participating hospitals benefit not only from our Faculty’s expertise, but also from learning from each other as they work through challenges of implementation together.

NHS Scotland – Nationwide Whole System Patient Flow Program

A global leader in patient safety, National Health Service Scotland (NHSS) worked with the Institute for Healthcare Optimization (IHO) to reduce delays, improve efficiency and further enhance the quality and safety of care.

Four pilot boards initially engaged in improvement work to implement IHO Variability Methodology®. These hospitals reported numerous subjective and measurable improvements from their work, including:

  • Created access for additional 1,072 patient admissions without adding expensive new beds or medical and nursing staff
  • Increased compliance with clinically acceptable waiting limits for unscheduled surgery from about 85% to over 95%
  • More patients admitted to appropriate wards
  • More patients moving from receiving units to inpatient wards during day time hours when they can receive earlier consultant review in a more timely manner
  • Fewer patients being asked to come to hospital the day before planned surgery
  • Identified opportunity to increase admissions further by about 2,100 per year without adding resources. Read full article here »

This Whole System Patient Flow Programme then expanded to include hospitals throughout Scotland, led in conjunction with NHSS leadership and support from the Health Performance and Delivery Directorate. Expansion of work included implementation of IHO Variability Methodology(R) in additional health boards and development of an online certification programme in IHO Variability Methodology(R).

Publications

CMS Partnership for Patients – New Jersey

Fourteen hospitals participated in a 15-month patient-flow collaborative with IHO organized by the New Jersey Hospital Association (NJHA) as part of the Center for Medicare and Medicaid Innovation hospital engagement program. Participating hospitals demonstrated significant quality improvements, reduced ED overcrowding, shortened wait times, and provided more access to patients while reducing costs. Overall program outcomes include:

  • Access increased for 11,800 – 17,300 additional patients without adding inpatient beds or operating rooms
  • Access for ~ 20,000 additional emergency department patients 21% to 85% decrease in wait times for emergency department patients to be admitted to a hospital bed
  • 3 -percent to 47 % reductions in the length of hospital stays for certain groups of patients

Sample hospital results:

CentraState Healthcare System, Freehold, NJ (Optimized Medical Inpatient Flow)
  • Telemetry beds required decreased from 54 to 42 while providing adequate clinically appropriate access
  • Inappropriate telemetry admissions decreased from 18% to 1%
  • Average ED boarding time for incoming patients decreased from 18.2 hours to about 9 hours
  • Telemetry length of stay decreased 31% from 4.4 days to just under 3 days
  • Delays in discharging patients out of telemetry decreased from 8.3 hours to 3.5 hours on average
  • Patient satisfaction increased from 56% to 73%
Monmouth Medical Center, Long Branch, NJ (Optimized Surgical Inpatient Flow)
  • Increased patient satisfaction score from the 88th to the 99th percentile of comparable hospitals
  • Decreased variability in nurse workload (number of admissions, transfers, and discharges) by over 40%
  • Significantly decreased PACU boarding
  • Increased throughput resulting in an annual margin improvement of $411K
Overlook Medical Center, Summit, NJ (Optimized Medical Inpatient Flow)
  • ED boarding time for ICU admissions decreased by 21%
  • ICU ALOS decreased by over 14% from 3.5 to 3 days
  • 40% reduction in mortality
  • Waiting time of discharge- and transfer-ready patients in the ICU decreased by 34% and 84% respectively
Ocean Medical Center, Brick, NJ (Optimized Medical Inpatient Flow)
  • Telemetry ALOS decreased by 6%
  • Average ED boarding time decreased 56%
  • $1.07 million cost reduction
Newark Beth Israel Medical Center, Newark, NJ (Optimized Medical Inpatient Flow)
  • Eliminated 26 telemetry beds, resulting in a savings of over $10 million per annum while reducing cost of care and improving quality of care
  • Decreased ALOS of telemetry patients by one full day leading to fewer hospital-acquired infections
HackensackUMC Mountainside, Montclair, NJ (Optimized OR Flow)
  • Improved elective OR block utilization resulting in increased capacity for 1,000 cases annually without additional resources
  • More than 95% of emergent/urgent patients can access the OR in a timely manner, thereby projected decreasing their ALOS by almost 40%