Ryckman Frederick C, Yelton Paula A, Anneken Amy M, Kiessling Pamela E, Schoettker Pamela J, Kotagal Uma R
Cincinnati Children's Hospital Medical Center, Cincinnati, USA.
Jt Comm J Qual Patient Saf. 2009 Nov;35(11):535-43. doi: 10.1016/s1553-7250(09)35073-4.
Poor flow of patients into and out of the ICU can result in gridlock and bottlenecks that disrupt care and have a detrimental effect on patient safety and satisfaction, hospital efficiency, staff stress and morale, and revenue. Beginning in 2006, Cincinnati Children's Hospital Medical Center implemented a series of interventions to "smooth" patient flow through the system.
Key activities included patient flow models based on surgical providers' predicted need for intensive care and predicted length of stay; scheduling the case and an ICU bed at the same time; capping and simulation models to identify the appropriate number of elective surgical cases to maximize occupancy without cancelling elective cases; and a morning huddle by the chief of staff, manager of patient services, and representatives from the operating room, pediatric ICUS, and anesthesia to confirm that day's plan and anticipate the next day's needs.
New elective surgical admissions to the pediatric ICU were restricted to a maximum of five cases per day. Diversion of patients to the cardiac ICU, keeping patients in the postanesthesia care unit longer than expected, and delaying or canceling cases are now rare events. Since implementation of the operations management interventions, there have been no cases when beds in the pediatric ICU were not available when needed for urgent medical or surgical use.
A system for smoothing flow, based on an advanced predictive model for need, occupancy, and length of stay, coupled with an active daily strategy for demand/capacity matching of resources and needs, allowed much better early planning, predictions, and capacity management, thereby ensuring that all patients are in suitable ICU environments.
重症监护病房（ICU）患者流入和流出不畅会导致拥堵和瓶颈，扰乱医疗护理，对患者安全与满意度、医院效率、员工压力与士气以及收入产生不利影响。从2006年开始，辛辛那提儿童医院医疗中心实施了一系列干预措施，以使患者在整个系统中的流动“顺畅”。
关键活动包括基于外科医生对重症监护的预测需求和预测住院时间的患者流动模型；同时安排病例和ICU床位；采用上限和模拟模型来确定合适数量的择期手术病例，以在不取消择期病例的情况下最大化床位占用率；以及由院长、患者服务经理、手术室、儿科ICU和麻醉科代表进行晨间碰头会，以确认当天计划并预测次日需求。
儿科ICU新的择期手术入院病例限制为每天最多5例。将患者转移至心脏ICU、让患者在麻醉后护理单元停留时间超过预期以及延迟或取消病例现在已很少见。自实施运营管理干预措施以来，从未出现过儿科ICU床位在紧急医疗或手术需要时不可用的情况。
基于需求、占用率和住院时间的先进预测模型以及积极的每日资源需求与容量匹配策略的顺畅流动系统，实现了更好的早期规划、预测和容量管理，从而确保所有患者都处于合适的ICU环境中。
