Academic journal article Australian Health Review

Electronic Patient Journey Boards a Vital Piece of the Puzzle in Patient Flow

Academic journal article Australian Health Review

Electronic Patient Journey Boards a Vital Piece of the Puzzle in Patient Flow

Article excerpt


Like other developed countries Australian hospitals are demon- strating that technological enablers,1-4 such as the electronic patient journey board (EPJB), are being used successfully to improve patient flow and patient continuity of care improve- ments.5,6 The ability to respond to this increased demand hinges on establishing sustainable systems to facilitate the flow of patients through our hospitals and then safely and effectively back into the community; however, it is difficult to achieve this whentheentirepatient'shospital journeyislargely invisibleto the staff involved in their care.7

What makes streamlining a patient's journey through the hospital so challenging is the sheer number of people involved in the delivery of care and the need for awareness around what tasks have been completed and which ones still remain.7-9 Until recently, paper-based systems, whiteboards and scheduled meet- ings were the only way for staff to communicate this information to one another.10 In practice, this means that information vital to patient care is infrequently communicated between team mem- bers, is recorded in different places and in different ways, and is heavily reliant on care providers seeking out, in a demanding work environment, the information they need to effectively perform in their role.

The introduction of EPJBs into Queensland hospitals and South Australia in 2009-10 in combination with criteria-led discharge process improvements has transformed patient care and delivered tangible improvements in admission practices, bed management, discharge planning and care coordination.11 Queenslandand South Australian Health systems have succeeded in 'making the hospital patient journey visible' through an innovative combination of information management and prom- inent display of key information related to patient care on large liquid crystal display (LCD) screens in hospital wards. Although technology has been a key enabler of the change, it is by no means the crux.12 The real catalyst for change has been the creation and continual communication via the EPJB of a plan for care based on individual patient needs, overt planning for discharge (through development and display of an 'estimated date of discharge') and continual performance monitoring (using a traffic light system to track progress against the estimated date of discharge and local or state-based average lengths of stay for patients who have previously been admitted with similar diagnoses). The end result has been the creation of a patient-centred, collaborative service improvement model with the ability to drive patient- and system-level changes to enhance patient flow.

The capability to systematically and logically link selected patient datasets into a cohesive EPJB holds tremendous potential for improving care quality, patient safety and clinical outcomes.13 Ultimately, it is about clinicians using information technology as an accelerator of best practice workflow, although it should be remembered that this is not a substitute for first redesigning processes and systems of delivery.14

What was the problem?

In healthcare, the term 'patient flow' is used to describe the progressive movement of patients, information or equipment between departments, staff groups or organisations as part of a patient's care pathway. Efficient management of patient flow has become an urgent issue for most hospitals, both nationally and internationally,asdemandforhealthcareservices increasesinline with population growth, aging and the increasing prevalence of chronic conditions.15 Improving patient flow ensures that patients receive the right care, in the right place, at the right time, with flow-oneffectsinterms ofthequality and safety of carebeing delivered.

Common problems found in Queensland hospitals before implementation of EPJBs, as described by clinicians in their everyday practice,3 included the following.

* The traditional manual white boards did not have all the information needed to display a complete picture of the patient's care and progress. …

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