Institute of Medicine Report

On June 14, 2006 the Institute of Medicine (IOM) released The Future of Emergency Care in the United States Health System, a series of reports assessing the severe problems facing the nation’s emergency care system and offering recommendations to improve it. Dr. Litvak, President and CEO of the Institute for Healthcare Optimization (IHO), served as a member of the IOM Committee that prepared the report and Brad Prenney, Chief Operating Officer of IHO, was commissioned by the IOM to author a paper on Patient Flow in Hospital-Based Emergency Services.
Click here to view the press release.

One of the series’ reports, Hospital-Based Emergency Care: At the Breaking Point, outlines recommendations that affirm IHO faculty’s long-standing call that hospitals apply the principles and practices of Operations Management and Variability Methodology developed by IHO faculty to improve the quality of hospital care, reduce cost, and address the wide scale problems associated with ED overcrowding. The report states “hospitals should reduce crowding by improving hospital efficiency and patient flow and using operations management methods and information technologies.”

The report also recommends that health care personnel be trained in Operations Management; a first and necessary step to achieve a goal that enables management science tools and techniques to be properly modified and applied to health care delivery in a way that reaps the maximum benefits. This creates a demand to provide a necessary supply of specialists trained in both health care delivery and operations management methodologies who would be exposed to the practice of health care management.

Included below are several relevant excerpts from the report.

“Hospital chief executive officers should adopt enterprise-wide operations management and related strategies to improve the quality and efficiency of emergency care.”

“By applying variability methodology, queuing theory and the I/T/O model, hospitals can identify and eliminate many of the patient flow impediments caused by operational inefficiencies.”

“By smoothing the inherent peaks and valleys of patient flow, and eliminating the artificial variabilities that unnecessarily impair patient flow, hospitals can improve patient safety and quality while simultaneously reducing hospital waste and cost.”

“Tools developed from engineering and operations research have been successfully applied to a variety of businesses, from banking and airlines to manufacturing companies. These same tools have been shown to improve the flow of patients through hospitals, increasing the number of patients that can be treated while minimizing delays in their treatment and improving the quality of their care.”

“Training in operations management and related approaches should be promoted by professional associations; accrediting organizations, such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the National Committee for Quality Assurance (NCQA).”

“Hospitals should end the practices of boarding patients in the ED and ambulance diversion, except in the most extreme cases, such as a community mass casualty event. The Centers for Medicare and Medicaid Services should convene a working group that includes experts in emergency care, inpatient critical care, hospital operations management, nursing and other relevant disciplines to develop boarding and diversion standards, as well as guidelines, measures, and incentives for implementation, monitoring, and enforcement of these standards.”

Click here to view the full report.