title: Standardizing admission and discharge processes to improve patient flow: a cross sectional study.
abstract: BACKGROUND
  The aim of this study was to evaluate how hospital capacity was managed focusing on standardizing the admission and discharge processes.
  
  
  METHODS
  This study was set in a 900-bed university affiliated hospital of the National Health Service, near Barcelona (Spain). This is a cross-sectional study of a set of interventions which were gradually implemented between April and December 2008. Mainly, they were focused on standardizing the admission and discharge processes to improve patient flow. Primary administrative data was obtained from the 2007 and 2009 Hospital Database. Main outcome measures were median length of stay, percentage of planned discharges, number of surgery cancellations and median number of delayed emergency admissions at 8:00 am. For statistical bivariate analysis, we used a Chi-squared for linear trend for qualitative variables and a Wilcoxon signed ranks test and a Mann-Whitney test for non-normal continuous variables.
  
  
  RESULTS
  The median patients' global length of stay was 8.56 days in 2007 and 7.93 days in 2009 (p < 0.051). The percentage of patients admitted the same day as surgery increased from 64.87% in 2007 to 86.01% in 2009 (p < 0.05). The number of cancelled interventions due to lack of beds was 216 patients in 2007 and 42 patients in 2009. The median number of planned discharges went from 43.05% in 2007 to 86.01% in 2009 (p < 0.01). The median number of emergency patients waiting for an in-hospital bed at 8:00 am was 5 patients in 2007 and 3 patients in 2009 (p < 0.01).
  
  
  CONCLUSIONS
  In conclusion, standardization of admission and discharge processes are largely in our control. There is a significant opportunity to create important benefits for increasing bed capacity and hospital throughput.
authors: Clinical Services, Hospital Universitari de Bellvitge IDIBELL, L'Hospitalet de Llobregat, Barcelona 08907, Spain. bertao@bellvitgehospital.cat
authors: Berta
authors: B
authors: Ortiga
authors: Albert
authors: A
authors: Salazar
authors: Albert
authors: A
authors: Jovell
authors: Joan
authors: J
authors: Escarrabill
authors: Guillem
authors: G
authors: Marca
authors: Xavier
authors: X
authors: Corbella
mesh_terms: D003430:Cross-Sectional Studies; D016208:Databases, Factual; D006742:Hospital Bed Capacity; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D015233:Models, Statistical; D009313:National Health Programs; D010343:Patient Admission / Q000592:standards*; D010351:Patient Discharge / Q000592:standards*; D013030:Spain; D057188:Workflow