Your Patients Aren't the Ones Failing Their Tests

By Brooke Breunig

Oftentimes, people earn the title of "patient" unexpectedly, for unknown and unwanted reasons. Perhaps they enter through your Emergency Room and are not even in a condition to verbalize what is bothering them. Your hospital admits these patients to determine a diagnosis. X-rays are ordered. CT scans are ordered. MRIs are ordered. As a part of the care team, you wait for the results of these tests to diagnose your patient and develop a plan of care.

Days can pass between these multiple tests. Treatment is delayed because of the constant bottleneck in your diagnostic and procedural areas. The care team on the unit is frustrated because they lack a treatment plan without test results. There are most likely a number of valid reasons why your inpatient procedures are delayed; staffing issues, resource limitations, outpatient prioritization, etc.

Regardless of those reasons, your patients may be the ones having the tests, but your hospital is the one failing.

The concept of coordinated care isn't a new one. Hospitals around the country have established robust departments to improve coordinated care. What most are missing though is the idea that care should be coordinated outside of the patient's unit. Taking a multidisciplinary approach to caring for patients is a great one, however, it is easy to forget the silos that exist and need disrupting outside of the walls of a hospital unit. That is why your hospital is failing.

So how do you not fail? Here are three quick wins that can help your hospital:

Challenge the Norm

It may in fact be true that every patient who presents with head trauma should have an MRI exam to establish an appropriate plan of care. However, all too often we are too focused on what needs to be done for a patient to follow protocol and not what needs to be done for the patient to progress their care. The use of automated order sets takes the thought out of care needs and, in some cases, results in unnecessary testing. Our patients are waiting on test results that have no impact on how we treat them. We stall progression in vain.

Challenge that norm. If a test result will not impact the care you provide your patient during their current hospital stay, move the test to the outpatient setting after discharge, or don't make that patient get the test at all. This will not only free up your service areas to perform procedures on the appropriate patients, but it will also reduce the cost of care for your hospital.

Eliminate White Space

White space? What is that? In a hospital setting, white space is all of the time a patient is idle, just waiting for care. They are not actively being treated, tested, consulted, or cared for. They are most likely watching reruns of Jeopardy and wondering when they can go home.

Some white spaces are unavoidable. I am not suggesting you don't allow your patients to sleep at night, I promise. I am suggesting that you take a deep dive into how prevalent avoidable white space is in your hospital. If a procedure required to progress the patient's care is being ordered on Tuesday and three days later the patient is still waiting for the procedure to be scheduled, your hospital has potentially created days of avoidable white space. This doesn't only cost the hospital, it also costs the patient. The risk of a patient falling increases. The risk of a patient acquiring a pressure ulcer increases. The risk of the patient catching an HAI increases. The patient's satisfaction most definitely decreases. White space really benefits no one and your hospital should develop a process for escalating avoidable white space.

Break Down the Islands of Excellence

I am confident that there are many different parts of your organization who function excellently and could ace the exam of their particular area of expertise. They live on their island and on that island, they are excellent. However, when asked to collaborate and coordinate the care of the patients, they most likely aren't as excellent. Imagine Chuck Noland and how outstanding he was at surviving with Wilson on an uninhabited island in Cast Away. When he was rescued from that island and brought back to function with non-volleyballs, he struggled to be outstanding. Your service areas are probably similar.

It is time to break down the islands of excellence and refocus all areas of your hospital on your one common goal: the patient.  Examine how often complex patient procedures in your service areas are coordinated and allow your patients to seamlessly transition from procedure to procedure. By doing this, you are not only breaking down the islands of excellence, but you are also eliminating white space and increasing patient satisfaction (no patient wants to go up and back to their room multiple times for procedures, trust me).

While these three quick wins may seem as simple as the equation 2+2=4, you would be surprised how many hospitals are coming up with the incorrect answer. Service coordination for the inpatient population should be a priority for your hospital in order to improve patient throughput and decrease length of stay. If you follow the quick study guide above to address the Service Coordination opportunities in your hospital, you’ll be well on your way to straight A's for both your hospital and your patients.