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Capacity constraints continue to strain hospital resources and negatively impact all aspects of organizational operations. Furthermore, inconsistencies in practice patterns lead to inefficiencies in process flows and breakdowns in communications and expectations for both clinical and non-clinical personnel and patients.  

Effective resource allocation and capacity management are contingent upon patient throughput. A 225-bed women’s specialty hospital identified the need for innovative changes to successfully care for patients within the physical restraints of their facility. 

Expediting patient throughput has gained significant attention in recent years in the emergency care and outpatient clinic arenas of health care. Little research exists on patient throughput in obstetrical care areas; however, one hospital has innovatively demonstrated how many of the principles applied in the emergency and clinic areas can be applied to obstetrical areas to improve process flows, performance, communication, and overall efficiencies.  

Tapping into hidden bed capacity by nurses streamlining the movement of obstetrical patients through the health care system through proactive discharge managment and improved communication efforts has dramatically improved organizational operations at one high-volume women’s specialty hospital. 

To assist with evaluating current processes, the hospital contracted a management-engineering firm to perform an operational excellence project for inpatient obstetrical services. Process mapping, time studies, and data analyses revealed that peak obstetrical delivery and discharge times overlapped.  Furthermore, process mapping unveiled that many activities took place on the day of discharge that could occur sooner during the patient’s hospitalization to improve process flow and efficiencies.   

Establishing consistent times for completion of key performance indicator (KPI) activities based upon the type of delivery and time of delivery has improved process flows and efficiencies, as well as continuity of care by setting expectations for the patient and the nursing staff.  As a result, the perception of fragmented care has diminished with the clear coordination of care and heightened communication. By proactively completing KPI tasks sooner in the hospital stay rather than on the day of discharge, throughput has been expedited. Hence, bed capacity has been maximized,  overflow of obstetrical patients to less desirable locations has been minimized, and nursing staff overtime has been significantly reduced.  

Possessing the vision to change processes, the flexibility and resilience to adapt to and sustain innovative change, and the ability to function as change agents has been demonstrated by all disciplines of the organization. While there remains a disparity in the health care setting, many positive results and benefits derived from expediting obstetrical inpatient throughput are evident. Empowerment of the nurse as the coordinator of all aspects of the patient’s plan of care and inclusion of ancillary departments in the discharge planning process and performance improvement initiatives has resulted in decreased lengths of stay, improved bed capacity and financial performance, patient and employee satisfaction, sustained quality care, and overall efficiencies.