Improving hospital patient flow: a systematic review

Abstract

Purpose Improving hospital patient flow has become a policy priority, to effectively balance the increasing demands of an unknown and variable volume of patients with limited available hospital resources. A systematic literature review was conducted in order to identify actions, actors involved and enablers in improving hospital patient flow. The paper aims to discuss this issue. Design/methodology/approach Searches were conducted in Scopus, Web of Science, MEDLINE and The Cochrane Library for quantitative and qualitative empirical primary studies with patients (adults) receiving inpatient acute hospital care. The study protocol was based on PRISMA-P guidance. A critical appraisal of included studies was performed by using the Quality Improvement Minimum Quality Criteria Set. Findings In total, 38 key papers were identified. A wide range of actions are reported, but most studies focus on one or a few departments instead of a whole hospital. Process efficiency is most often used as a performance indicator, clinical outcomes are poorly analyzed, and patients’ expectations and experience are rarely considered. Top-management commitment and front-line staff involvement are considered key factors for the success of implementations. Patient involvement in the process improvement is rarely mentioned. Originality/value Achieving improvements in hospital patient flow requires the design and implementation of complex, multifaceted and coordinated interventions. This study may be of value to healthcare managers, helping them to act effectively in their context, and to researchers of future studies including the different variables and the patient’s perspective.