title: The safe patient flow initiative: a collaborative quality improvement journey at Yale-New Haven Hospital.
abstract: BACKGROUND
  Yale-New Haven Hospital (YNHH) began a successful journey to achieve safe patient flow in fiscal year (FY) 2008 (October 1, 2007-September 30, 2008). The 966-bed (now 1,541-bed) academic medical center faced several challenges, including overcrowding in the Adult Emergency Department (ED); delays in the postanesthesia care unit, which affected the flow of patients through the operating rooms; pinched capacity during the central part of the day; and a lack of interdependent institutionwide coordination of patients.
  
  
  METHODS
  The Safe Patient Flow Steering Committee oversaw improvement efforts, most of which were implemented in FY 2009 (October 2008-September 2009), through a cascade of operational meetings. Process changes were made in various departments, such as the Adult ED, Physicians/Providers, and the Bed Management Department. Organizationwide method changes involved standardizing the discharge process, using status boards for visual control, and improving accuracy and timeliness of data entry.
  
  
  RESULTS
  Between FY 2008 and FY 2011, YNHH experienced an 84% improvement in discharges by 11:00 A.M. The average length of stay decreased from 5.23 to 5.05 days, thereby accommodating an additional 45 inpatients on a daily basis, contributing to YNHH's positive operating margin amid increasing volume and overall decreasing inpatient length of stay.
  
  
  CONCLUSIONS
  YNHH improved clinical, operational, and financial outcomes by embracing five key components of demand capacity management: real-time communication, inter/intradepartmental and interdisciplinary collaboration, staff empowerment, standardization of best practices, and institutional memory.
authors.affiliation: Yale-New Haven Hospital, New Haven, Connecticut, USA.
authors.forename: Jillian
authors.initials: J
authors.lastname: Jweinat
authors.forename: Peter
authors.initials: P
authors.lastname: Damore
authors.forename: Victor
authors.initials: V
authors.lastname: Morris
authors.forename: Richard
authors.initials: R
authors.lastname: D'Aquila
authors.forename: Sandra
authors.initials: S
authors.lastname: Bacon
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Balcezak
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D003237:Connecticut; D017598:Efficiency, Organizational; D006746:Hospital Bed Capacity, 500 and over; D006748:Hospital Departments / Q000458:organization & administration; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D061214:Patient Safety; D017064:Process Assessment, Health Care / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration*; D011787:Quality of Health Care; D057188:Workflow