PHARMACY SERVICES TO OPTIMIZE PATIENT THROUGHPUT

To support the integration of pharmacy services to improve safe and efficient throughput and patient flow throughout the health system; further,

To advocate for pharmacists to serve as key decision-makers in improving medication management to optimize patient flow throughout the continuum of care.

Rationale

Efficient movement of patients throughout their course of care during a hospital stay, otherwise referred to as patient throughput, is important for care outcomes and organizational productivity. Increases in patient demand for healthcare services, high-acuity patient needs, healthcare worker staffing shortages, and constraints on organizational capacity create tensions in the flow of a patient’s hospital stay from admission through discharge (Health Policy. 2022;126:87-98).

Barriers to patient throughput in emergency departments is also a hospital-wide problem as it leads to long wait times and crowding, compromises quality of care, decreases patient and healthcare worker satisfaction, and increases costs. Root causes identified as contributors to these barriers are lack of staff, lack of standards and routines, insufficient operational planning, lack of technology functions, insufficient discharge routines, insufficient facilities and layout, insufficient communication, insufficient transfer coordination, random internal disturbances, unpredictable patient problems, lack of beds, medical quality priorities, lack of ancillary services, increased demand, and lack of separate tracks (Health Policy. 2022;126:87-98).

The Institute for Healthcare Improvement white paper, “Achieving Hospital-wide Patient Flow” identifies the following principles to achieve optimal patient throughput:

• System-wide approach to patient flow,
• Hospital-wide learning system,
• Integration of various approaches,
• Utilization of advanced data analytics, and
• Focus on reducing and shaping demand.

The white paper also suggests following three rules for clinicians and staff as a means for ensuring patients receive the right care, in the right place, at the right time:

1. Right Care, Right Place: Patients are placed on the appropriate clinical unit with the clinical team that has disease- or condition-specific expertise.
2. Right Time: There are no delays greater than two hours in patient progression from one hospital unit or clinical area to another, based on medical readiness criteria.
3. Available Capacity: Ensure each unit or clinical area has some capacity at the beginning of each day.

There are numerous reports focused on improving throughput and efficiencies with processes within the pharmacy department; however, there is limited literature about pharmacy department contribution to hospital-wide patient throughput processes. One report suggests a framework for establishing pharmacy services to support a co-located long-term acute care hospital within a health system. The suggested framework includes operationalizing processes, ensuring licensure and regulations compliance, enhancing information technology, aligning staffing models, managing pharmacy operations and distribution services, implementing clinical services, and demonstrating quality. Pharmacy service interventions included medication clarification, therapy optimization, discharge process support, antimicrobial stewardship, discontinuation of unnecessary or inappropriate medications, IV to oral medication conversion, dose adjustment, preventative care, and managing duplicate medications ordered as needed. The report identifies coordination between pharmacy team leaders and other healthcare disciplines as instrumental for seamless integration. Additional resources are necessary, including patient throughput action plans and process maps that incorporate pharmacy services, as well as identification of measures and tracking systems to demonstrate the impact of pharmacy interventions.  Pharmacy services are highly innovative and process-driven; however, they are often siloed from systemwide interventions for improving patient throughput, which this policy seeks to correct.