Analysis of Patient flow through general medical wards at a Tertiary Academic Hospital

Abstract

Abstract Background The challenge of enhancing service delivery to meet the needs of a growing and aging population, whilst minimizing expense, is a global concern. There is an urgent need to understand and quantify systemic gaps in the efficient delivery of healthcare services. Movement of patients through a health establishment is a complex activity reliant upon multi-actor co-ordination across departments. Stagnation has negative impacts on both staff and patients by increasing risks of adverse outcomes, staff frustration and job dissatisfaction. An inefficient discharge process can be a significant barrier to timely patient movement. Discharge planning has been adopted in many high-income countries to ensure standardization and process efficiency. However, the heterogeneity of healthcare facilities and their challenges needs to be understood to implement targeted and effective discharge planning. Methods We conducted a retrospective cohort study at a central hospital in the Western Cape, South Africa to assess the journey of medical patients from admission to discharge. We reviewed the folders of eligible patients using a data-extraction tool to ascertain reasons for admission and barriers to timely discharge. Results Among 86 patient folders reviewed, cumulatively accounting for 596 in-patient days, a difference in the median length of in-patient stay between medical firms (p = 0.042) was noted. The shortest length of stay corresponded to firms with the greatest proportion of daily senior oversight (defined as documented patient reviews by a registrar, medical officer and/or consultant independently or in addition to reviews done for the day by interns and students). Firm 5 had a median length of stay of 5 days with 64% senior oversight and Firm 2 with the lowest senior oversight at 26% had amongst the longest lengths of stay at 8 days. While 52% of patients vacated their beds between 14:00 and 17:00, 66% of patients were admitted after 20:00. Reasons for prolonged admission were variable, and attributable to a range of different disciplines across the multidisciplinary team. Conclusion Delays in discharge were multi-factorial, highlighting the need for a standardized discharge process. Increasing senior oversight could assist in enhancing efficient patient movement.