Planning for predictable emergency admissions to improve patient access and flow

ABSTRACT Objective To implement and evaluate a new inpatient flow process designed to reduce overnight transfers, decrease Emergency Department length of stay, and improve overall hospital throughput. Methods A two-phase quality improvement initiative was conducted using the DMAIC (Define, Measure, Analyze, Improve, Control) framework. In Phase 1, "flow beds" were introduced to minimize overnight patient transfers and enhance staff and patient experiences. Phase 2 implemented an early morning transfer process from the trauma and neurosurgery intensive care unit to the trauma and neurosurgery inpatient ward, aligning intensive care unit capacity with anticipated daily demand. The effectiveness of the interventions was assessed using a before-and-after study design. Results Flow beds were successfully created in over 85% of eligible cases, reducing overnight transfers to alternate units by more than 50%. Emergency Department length of stay and decision-to-admit times improved by 25% and 43%, respectively, at the 90th percentile (p < 0.05). Total inpatient length of stay decreased by 11% (approximately 1 day). In Phase 2, early trauma and neurosurgery intensive care unit discharges occurred in 50% of cases, eliminating surgical cancellations due to intensive care unit bed shortages during the study period. Conclusion Proactive inpatient flow strategies focused on demand-capacity alignment significantly improved Emergency Department and inpatient metrics, while reducing intensive care unit-related surgical delays.