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Bed Huddles Unite Staff to Improve Patient Flow

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Jeff Smith, MD, executive vice president of Hospital Operations and chief operating officer, meets with representatives from departments across the medical center to talk about patient flow during a daily bed-huddle discussion.

A new initiative is bringing staff from across Cedars-Sinai medical center together daily, in support of organization-wide efforts to proactively manage capacity and patient flow.

Daily bed huddles are being held at 9 a.m. in North Tower Conference Room B. The 15- to 20-minute huddles, which began in December, allow operational leaders to discuss census, capacity and the projected flow of patients in and out of inpatient beds. The discussions help guide decisions around optimization and mobilization of resources and help move inpatients safely and effectively through the care process.

"Our census remains high, and on one hand this demand speaks to the outstanding quality of care we provide," said Jeff Smith, MD, executive vice president of Hospital Operations and chief operating officer. "But if operating at capacity forces us to divert ambulances or extend wait times, we're not fulfilling our mission to serve the community. Patient flow is a challenge belonging to all of us, and each bed huddle provides us with an opportunity to strengthen our situational awareness and decisionmaking as a team."

During each huddle, representatives from departments across the medical center work together to tackle discharge-planning obstacles—such as pending tests, lab results and discharge orders—in order to move patients to their next point of care and free up beds. The departments represented include Medicine, Perioperative Services, Nursing, Pharmacy, Case Management, Central Transportation Services, Environmental Services, Laboratory, Imaging, Acute Therapy, Pharmacy, Procedure Center and Noninvasive Cardiology, among others.

To support the initiative, physicians are asked to ensure discharge orders are written by 9 a.m. so patients who can be discharged safely are processed by 11 a.m. Incoming patients from the Emergency Department (ED) and post-anesthesia care units tend to increase around this time. Increased discharges before 11 a.m. also have been linked to a reduction in ambulance diversions and the number of patients leaving the ED without being seen, said Heidi High, associate director of Patient Placement.

"The idea is to get the operational leaders in the same place," said High. "You bring up your barrier, you've got the people in the room, you connect them, and by the time we leave, we have a plan on how to resolve that barrier."

After the huddles, staff monitor progress throughout the day, and if the medical center meets certain capacity triggers, an additional huddle is held at 2 p.m. to address issues.

Bed huddles are just one part of the organization's ongoing efforts to increase patient flow.

The huddles work in conjunction with daily unit-based Progression of Care Rounds (POCR), where staff discuss their patients' care and discharge planning. Both initiatives aim to improve flow, patient experience, patient safety and financial stewardship by promoting a proactive approach to capacity management and decisionmaking.

Additionally, a Departure Lounge, open from 9 a.m. to 9 p.m. in Cafeteria Conference Room A, offers a comfortable area with refreshments and entertainment to eligible patients who are unable to go home within two hours of discharge. This provides them with a place to rest as they wait, and allows the medical center to create capacity for patients waiting in the Emergency Department for a bed.