Examining Throughput in Academic Medical Center Inpatient Obstetric Units, A Comparative Quality Improvement Project
College
School of Nursing
Graduate Level
Doctoral
Graduate Program/Concentration
Doctor of Nursing Practice - Nurse Executive
Presentation Type
Poster Presentation
Abstract
ABSTRACT
Problem: An Academic Medical Center in the southeast is delivery records and growing. With increased patient volumes, there is no additional space to place patients and rooms quickly fill. Efficient patient throughput is vital to minimize waiting, enhance satisfaction, and uphold safety. Recently, there have been delays in transfers from Labor and Delivery (L&D) to the Mother and Infant Unit (MIU), as well as discharge delays from MIU. The actual throughput data and staff perceptions of throughput were unknown.
Purpose: The purpose of this quality improvement (QI) project was to collect and analyze the throughput data for inpatient OB units and determine staff perceptions.
EBP Question: Will analysis of the variables of time/day/shift, patient volume, and staff perception provide direction for improving patient throughput including discharges and transfers between inpatient obstetric units?
Methods: This QI project was non-experimental causal comparative, with descriptive questions. The variables were compared to determine the relationship with patient throughput. The project occurred on L&D and MIU. The individuals for the project are employees from L&D or MIU that voluntarily completed the anonymous survey excluding nurse leadership or floated staff, with a total of 66 participants. The throughput metric data from the EHR was declassified and included aggregate data from a convenience sample of patients admitted and transferred to MIU, excluding patients who did not transfer or were not postpartum, with a total of 198 records meeting criteria. The data metrics included times delivery, ready to transfer, arrival to MIU, and discharge order to discharge, room clean turn over time, patient transport times and daily census. The data were collected over a 30-day period and then analyzed.
Outcomes: Data was analyzed and compared to determine the relationships between the variables and to determine the barriers. An outcome of the project was strategic future improvement recommendations to enhance throughput or patient flow. Subsequent QI projects implementing the recommendations should be completed.
Significance: This project is important as it made recommendations for future quality improvement projects as well as a throughput framework in the EHR for the OB units. The future QI projects should increase efficiency of throughput to minimize risks, improve satisfaction, and accommodate the high patient volumes. Other organizations that have separate postpartum care units can also use the recommended findings to implement changes to enhance throughput, or the survey to determine the bedside expert’s perception, following the high reliability organization principles of sensitivity to operations and deference to expertise.
Keywords
OB, Labor and Delivery, Mother and Infant, Nursing, Nurse Leader, Throughput, Patient Flow, Executive, HRO
Examining Throughput in Academic Medical Center Inpatient Obstetric Units, A Comparative Quality Improvement Project
ABSTRACT
Problem: An Academic Medical Center in the southeast is delivery records and growing. With increased patient volumes, there is no additional space to place patients and rooms quickly fill. Efficient patient throughput is vital to minimize waiting, enhance satisfaction, and uphold safety. Recently, there have been delays in transfers from Labor and Delivery (L&D) to the Mother and Infant Unit (MIU), as well as discharge delays from MIU. The actual throughput data and staff perceptions of throughput were unknown.
Purpose: The purpose of this quality improvement (QI) project was to collect and analyze the throughput data for inpatient OB units and determine staff perceptions.
EBP Question: Will analysis of the variables of time/day/shift, patient volume, and staff perception provide direction for improving patient throughput including discharges and transfers between inpatient obstetric units?
Methods: This QI project was non-experimental causal comparative, with descriptive questions. The variables were compared to determine the relationship with patient throughput. The project occurred on L&D and MIU. The individuals for the project are employees from L&D or MIU that voluntarily completed the anonymous survey excluding nurse leadership or floated staff, with a total of 66 participants. The throughput metric data from the EHR was declassified and included aggregate data from a convenience sample of patients admitted and transferred to MIU, excluding patients who did not transfer or were not postpartum, with a total of 198 records meeting criteria. The data metrics included times delivery, ready to transfer, arrival to MIU, and discharge order to discharge, room clean turn over time, patient transport times and daily census. The data were collected over a 30-day period and then analyzed.
Outcomes: Data was analyzed and compared to determine the relationships between the variables and to determine the barriers. An outcome of the project was strategic future improvement recommendations to enhance throughput or patient flow. Subsequent QI projects implementing the recommendations should be completed.
Significance: This project is important as it made recommendations for future quality improvement projects as well as a throughput framework in the EHR for the OB units. The future QI projects should increase efficiency of throughput to minimize risks, improve satisfaction, and accommodate the high patient volumes. Other organizations that have separate postpartum care units can also use the recommended findings to implement changes to enhance throughput, or the survey to determine the bedside expert’s perception, following the high reliability organization principles of sensitivity to operations and deference to expertise.