November 29, 2006 — A team of USC industrial engineers has been awarded a grant from the California HealthCare Foundation to streamline patient flow processes at California’s “safety net” hospitals, based on dramatic improvements achieved during an earlier project at Los Angeles County-USC Hospital. 

Many large hospitals experience difficulties keeping up with the number of surgeries they must schedule each week.

Using techniques derived from the industrial world, the team will evaluate and introduce new procedures for scheduling and routing patients through the acute care units of three safety net hospitals, which serve the under-insured population. California has about 100 of these facilities, which typically experience a high volume of patients, overcrowded conditions and long delays in patient treatment.  
   
The approach, known as engineering management, significantly increased the number of patients that were treated in some key clinical units of Los Angeles County-USC Hospital, such as radiology and surgery, in an earlier study,  said David Belson, senior research associate and lecturer in the USC Daniel J. Epstein Department of Industrial and Systems Engineering.

“County-USC Hospital was an ideal setting for our work,” said Belson.  “It is one of the largest hospitals on the West Coast and includes one of the largest emergency room functions in the country. 

“By applying the principles of industrial engineering to its procedures for admitting and treating patients, we’ve already seen dramatic improvements in patient access to the hospital and significant savings to the hospital,” he said.  

Identifying Significant Bottlenecks
In the first study of its kind for USC’s Viterbi School of Engineering, Belson and a team of industrial engineers partnered with Los Angeles County-USC Hospital to model the entire facility — from top to bottom — as one integrated system.  The objective was to identify the most significant bottlenecks in the patient flow process and devise a more efficient strategy for improving the flow of patients through one of the nation’s largest public hospitals.

Los Angeles County/USC Hospital is a 745-bed facility located in East Los Angeles. The county-run facility is a partner institution of the Keck School of Medicine of USC treating approximately 1 million patients annually, including at least 150,000 emergency room visits. According to hospital records, almost half of those treated are indigent or uninsured.
 

David Belson

“Patient flow represents the ability of the healthcare system to serve patients quickly and efficiently as they move through stages of care,” said Randolph Hall, USC vice provost for research advancement, who reported initial results of the study in the June 2006 issue of OR/MS Today, published by the Institute for Operations Research and the Management Sciences.

“When the system works well, patients flow like a river through the hospital; each stage of their care is completed with minimal delay,” said Hall, who is principal investigator of the study and a member of the Viterbi School faculty.  “But when the system is broken, patients accumulate like a reservoir, and you find chronic delays, like those experienced in many big city emergency departments.”

In their study, Hall, Belson, and co-principal investigator Maged Dessouky, a USC professor of industrial and systems engineering, examined hospital processes such as the synchronization of work, which involved the coordination of tests, treatments, and discharge processes; scheduling of resources, such as doctors and nurses, to match patterns of patient arrival; and patient tracking, which involved tracking the number of patients waiting by location, diagnostic grouping and acuity of their medical conditions.

Changes in Radiology and Surgery Departments
“In radiology, we found that delays in performing CT scans created long waiting times for inpatients and outpatients,” said Belson.  “We created a computer simulation model based on a month of daily observations and calculated the potential capacity of CT to determine a reasonable daily patient load. That produced 10 recommended changes, which resulted in a 50 percent increase in the number of patients who could be treated on a daily basis and significantly reduced the waiting times for those awaiting scans.”

County-USC Hospital’s surgery department, another high volume acute care area, has long been plagued by lengthy waits due to the availability of operating rooms and doctors’ schedules.  Surgery delays often increase a patient’s stay in the hospital, which results in added costs to the county.  Consequently, Belson and his team spent months observing the work flow, analyzing historical data and reviewing the surgery scheduling system.

Left to right: Maged Dessouky, Randolph Hall and David Belson on the steps of LAC-County General Hospital.

“The hospital uses a block scheduling system, which allows them to allocate operating rooms for various surgery specialties, such as cardiac and neurosurgery, on certain days and blocks of time,” Belson said.  “Interestingly, these blocks were not primarily based on demand, so we were able to devise a computer model to determine better block allocations that would reduce patient waits.”

The researchers recommended several changes, such as switching from an eight-hour surgery day to a 10-hour surgery day, to increase the number of patients who could be served without increasing the staff and number of operating rooms that were available.  Other recommendations are still being implemented, but the researchers predicted that they will see a 25 percent improvement in the number of surgeries that can be performed and a significant drop in the length of hospital stays.        

Bed Management and Outpatient Procedures
Other hospital functions studied were bed management and high volume outpatient services, such as colonoscopies.

In a busy hospital, beds can become a scarce resource, so the researchers addressed ways to increase patient access to beds, such as better ways of reporting bed availability in the wards and improving the procedures for discharging patients. They tracked patient demand for colonoscopies and ran a computer simulation to calculate the hospital’s potential capacity if scheduling problems were solved. Belson said ongoing changes in that process could significantly increase the number of patients seen each day without requiring the hospital to add another procedure room.

Maged Dessouky, left, and Randolph Hall, right.

In their new “safety net” study, the team will focus on streamlining patient flow processes in three selected safety net hospitals in California and show personnel how technology for such operations as better data gathering, electronic patient tracking, smarter queuing, communications systems and other changes will contribute to the overall success of improved operations.

Belson will present findings of the patient flow work at the 19th annual Society for Health Systems Conference, to be held Feb. 23-25, 2007, in New Orleans, LA.  A book written by Hall entitled, Patient Flow: Reducing Delay in Healthcare Delivery (Springer Science and Business Media, 2006), also addresses a variety of patient flow issues and methodologies for improving them.

The work grew out of an ongoing research program conducted by faculty and students from the Daniel J. Epstein Department of Industrial and Systems Engineering at USC in collaboration with clinical and administrative staff from Los Angeles County-USC Hospital.