Vantage Point

A year ago, Penn Presbyterian Medical Center (PPMC) launched a new program, complete with a steering committee and three working groups, to improve how we move patients through the hospital from admission until discharge for the best care. This has become paramount as we’ve seen unprecedented surges during the COVID-19 pandemic.

In short, patient “flow,” or “progression,” is how we ensure we have the ability to care for the patients that come to us for their health care needs. It is also paramount to patient safety. The steps we take to provide patients with timely care are ones that help avoid infections, medication errors, and other patient safety events. When patients receive the right care in the right place at the right time, medical errors are much less likely to occur and patients have the best outcomes.

The hospital is always focused on improving wait times and reducing patients’ hospital stays, but the pandemic intensified the challenges: We’re seeing more patients in the emergency department than ever before. In addition to our COVID-19 cases, many others have delayed care during the pandemic and are arriving sicker than in the past.

Throughout these past 12 months, our multidisciplinary Patient Flow steering committee led by Onyeka Okonkwo, MD, and Susan Chonko, RN, MSN, our medical and clinical directors of Patient Progression, respectively, and a series of workgroups have implemented strategies including:

• The addition of 30 inpatient beds, achieved by moving our skilled nursing facility from Scheie 4 to the Penn Medicine Rittenhouse site and creating another 12-bed observation unit that we’re using for inpatient care
• An extensive dashboard to track key measures on a weekly and monthly basis, including length of stay, discharge-before-noon rates, ED and post-anesthesia care unit boarding rates (when patients are kept overnight in a temporary location until an inpatient bed becomes available), delayed transfers, and emergency department admissions
• New protocols in the emergency department to give patients certain treatments, such as dialysis or stress tests, without admitting them to the hospital
• Prioritizing more timely MRIs, echocardiograms, and other interventional radiology procedures so that patients are not delayed from going home

In addition, our hospitalist service has been piloting a protocol to escalate cases where delays in a procedure, such as an MRI, is preventing the patient from being discharged. The hospital has also been developing partnerships with home health care providers, skilled nursing facilities, medical equipment companies, and other outpatient services to facilitate better transitions to home and post-acute care facilities. No one should have to stay in the hospital because they’re waiting for a bed to open up in a nursing facility or for a wheelchair to be delivered to their home.

We continue to be challenged by a number of factors, some of which are in our control and some of which are not. This is important work that we’ll continue to stay on top of, week after week and month after month. When people need care from us, we will be ready to take them in, and when they are in our care, we will help them move ahead with their recovery and get back to their lives.