Albert Einstein Medical Center: Patient Flow Management

Emergency room patients at the Albert Einstein Medical Center in Philadelphia faced protracted waiting periods.

Accenture helped the center set up an integrated and well-coordinated program of patient flow management, positioning itself for high performance.

Albert Einstein Medical Center (AEMC) in Philadelphia is a 500-bed acute care facility within the 1,100-bed Albert Einstein Health Network. It is a tertiary care academic hospital with a Level I regional trauma center, a Level III neonatal intensive care unit and one of the most active emergency departments in the area.

AEMC faced a significant patient flow challenge which became evident when patients had to wait for protracted periods in the emergency department; there was difficulty moving patients into appropriate beds and the average length of stay exceeded industry benchmarks.

Additionally, the hospital was assuming financial risk because the cost of care being delivered during long stays was exceeding the case-rate reimbursement. AEMC engaged Accenture as a consulting partner.

After conducting a detailed assessment of the hospital's patient flow systems and processes, Accenture worked closely with AEMC to develop and implement a set of recommendations for patient flow improvement.

The most significant change Accenture recommended was the establishment of patient flow as an organizational priority. The creation of an interdisciplinary initiative team established specific criteria to look at the end-to-end patient flow processes and develop strategies to help avoid diversion and minimize the number of patients waiting in the emergency department. Roles and processes were streamlined to help improve patient flow.

The redesigned care management department with improved processes, tools and appropriately sized caseloads now works more closely with physicians and nurses. Involving physicians as champions of the patient flow initiative was another critical success factor. And a robust measuring and monitoring toolkit is now in place to evaluate the hospital's performance in improving patient flow.

With Accenture's help, the Albert Einstein Medical Center's patient flow management has been transformed.

The new patient flow system is integrated and well coordinated, and has helped the hospital realize many benefits, including:

• Average length of stay was reduced from 6.1 days to 5.4 days.
  
  
• Denials of reimbursement for admission—or for continued inpatient stay when it was not medically appropriate—declined from 3.4 percent to 2.1 percent, as a percent of net revenue.
  
  
• Current in-house census of outlier patients with an average length of stay greater than five days decreased by 13 percent, while outlier days decreased by 39 percent.
  
  
• Increases in patient, staff and physician satisfaction.

In the emergency department, specifically, the hospital has realized the following improvements:

• Diversions have declined 89 percent with volume up 16 percent.
  
  
• Wait time for patients admitted through the emergency department has decreased 32 percent.
  
  
• An emergency department case manager has helped the hospital avoid potential admission denials in 32 percent of reviewed cases.
  
  
• The percentage of patients leaving the emergency department without being seen decreased from 5.2 percent to less than 2 percent.
  
  
• Emergency department patient satisfaction is up by 10 percent.