New patient placement algorithm aims to improve patient flow

Most patients probably don’t give much thought to how they’re assigned to a hospital bed at Michigan Medicine — but behind-the-scenes, a complex process is at work.

“Admitting a patient to a bed is not like checking into a hotel, where there either is a room available or there isn’t,” said Vikas Parekh, M.D., associate chief clinical officer (medical) for University Hospital and the Frankel Cardiovascular Center. “There are many factors that affect not only the patient, but the faculty and staff responsible for that patient’s wellbeing.”

Taking those factors — and frequent high occupancy — into account, UH/CVC redesigned the patient placement algorithm (the decision-making tool and processes used to assign patients to beds). The new algorithm went live on Wednesday.

Parekh served as co-lead of the multidisciplinary project team, along with David Somand, M.D., MPLAN medical director for adult emergency services, and Francene Lundy, UH/CVC associate chief nursing officer (surgical).

“Because this impacts how so many of us do our jobs, it was imperative that all voices were represented,” Parekh said.

The new algorithm is based on the concept of pooling: It will group nursing units into pools that care for similar patient populations. Patients will be placed freely within the pools as beds become available, with some limited and specific placements taken into account for patients with unique clinical needs.

The goal of the new algorithm is to reduce the need for bed managers to preserve empty beds in anticipation of a specialized patient’s arrival. In the end, this will decrease wait times for accessing a bed as it avoids the scenario of patients waiting for a bed to open on a single-destination unit.

“By creating pools of like patients and beds accessible to related services, we create more flexibility and placement choices,” said Somand. “At the same time, we increase efficiency and are able to more consistently fill previously under-utilized areas.”

The algorithm works in tandem with other recent initiatives — including the new central remote telemetry unit, which allows patient to be monitored from anywhere in the hospital — to help improve patient flow and patient care.

A massive effort

The implementation of the new algorithm required a monumental educational effort. Nursing in particular was affected, as staff on impacted units had to prepare to care for new or different patient populations.

“While nursing doesn’t determine which patients go to which beds, they are responsible for those patients once they arrive on the unit,” said Lundy. “Our nursing staff was extremely proactive during the education and implementation process, coming forward with questions and ideas and taking advantage of the leadership opportunities provided by this effort. I cannot thank them enough for their flexibility and dedication to providing the safest care.”

Various support mechanisms were also put in place for the go-live period, including implementing a command center and providing population-specific experts on each unit to ensure that staff members were properly trained to care for any new populations that will be seen.

“Superior patient care is at the center of everything we do,” said Somand. “Our staff is fully supported during the initial transition phase, allowing them to remain focused on patients.”

Lundy, Parekh, and Somand all expressed confidence that faculty, staff, and patients will benefit from the new algorithm.

“Capacity constraints are challenging for everyone,” Parekh said. “By improving this and other processes, we hope to ease some of those frustrations and create a better experience for our entire UH/CVC community.”

More information about the UH/CVC patient placement algorithm, including impacted units, background and rationale, steering committee members and frequently-asked questions, can be found on the UH/CVC internal website.