A Study On Hospitalization Process Optimization In X Hospital Based On ABPMP Model

BackgroundIn order to respond to national policy on the reform of public hospitals and the reform of medical insurance payment,hospitals need to improve refine management,optimize process of medical service and reduce medical expenses and length of stay(LOS)in a reasonable way.Secondly,there are many delays in the process of hospitalization in Chinese hospitals,such as delays in being admitted in hospital and handling procedures for admission,long waiting time for examination and long waiting time before surgery,which lead to low efficiency of service.Additionally,hospital X is confronted with obvious differences in LOS of patients with single disease and increasing inpatients expenses.Therefore,under the reform of the payment method of basic medical insurance in China,for the sake of proactively adapting to the different inpatient payment plan in Shandong province,hospital X plans to reduce unnecessary medical expenses and LOS by optimizing the process of hospitalization.ObjectivesUsing ABPMP model of business process management as framework of this,under the control of the effect of the basic features on LOS,this study combined quantitative analysis and qualitative analysis methods to analyze process of hospitalization to find the specific problems of the specific links of hospitalization which may extend LOS meaninglessly.Then,this study put forward suggestions for the process optimization,which helps to shorten the hospitalization days of patients.MethodThis study selected 268 adult inpatients with lighter femoral neck fracture and simple complication(Garden type Ⅰ and Ⅱ,no more than two complication)who stayed in the X hospital from June,2015 to June,2018This study is conducted according to the specific steps of ABPMP model of Business Process Management.The first step is the planning,which includes the selection of team members(three hospital administrators and graduate students as core team members),the determination of project objectives and plan of implementation.The second step is analysis,including making the flow chart of hospitalization service,looking for the specific links in the process of hospitalization that may cause the meaningless extension of LOS and the specific problems existing in those links.(1)Making a flow-chart of process of hospitalization.Firstly,observation method was applied to understand the projects of diagnosis and treatment and the links of these projects that patients would experience during hospitalization.And then according sequence of those links,we made a draft of the flow-chart of process of hospitalization.After that,the chief resident physician and head nurse of orthopedics department worked on this draft and gave advice about whether the steps that should be included in the hospitalization service process were covered,which projects were the representative items of each link,the starting and ending points of each representative project,and the hospital’s regulations on the time of each representative project.(2)We applied univariate analysis and multiple linear regression analysis to analyze the influence of patients’basic characteristics on the length of stay,and then patients were grouped according to the previous key characteristics,so as to control the influence of patients’basic characteristics on the length of stay.Secondly,in order to obtain the specific links in the hospitalization service process that may cause the LOS to be extended meaninglessly,for each group of patients,we used the combined method of single factor analysis and multiple linear regression analysis to analyze the effects of the total time of each link of on the LOS.Based on this result,we conducted a team discussion.The team is composed of three administrative staffs in the hospital.Based on their practical experience of management,the team members discussed about problems may exist in hospitalization process that may lead to the meaningless extension of LOS.The discussion contents were classified according to which the specific links did they belong and the number of times that the problem was repeatedly mentioned was marked.Among those listed specific links,according to the times of repeated problems and the possibility of optimization of these problems,we select some links as outcomes of discussion.After that,the results discussed by the team were mutually confirmed with the results of the previous quantitative analysis,and the same results were selected as the specific link in the hospitalization process that led to the meaningless extension of hospitalization days.(3)An administrative administrator and a graduate formed a team to interview the staff who were engaged in both business and management works in the departments related to specific links.The content of the interview includes:firstly,interviewees describe the specific working process of the link;secondly,according to the work experience and the order of specific work process,the interviewees pointed out the main problems that might lead to meaningless waiting and made corresponding explanations;thirdly,what suggestions do the interviewees have for these questions.Finally,based on the above interview contents,we proposed suggestions for process optimization.OutcomesFirst,after controlling the effect of age on the length of stay by grouping,the method of single factor analysis and multiple current regression was applied to analyze the influence of the total time of each link in the hospitalization process on the length of stay.The analysis results showed that for patients aged<70 years,the time of waiting operation>48 hours and has postoperative imaging examination were factors.For patients age>70 years old,the time of preoperative imaging examination≤6 hours and the time of consultation>24 were factors.Therefore,the waiting of preparation for operation,imaging examination and consultation may lead to the meaningless extension of LOS.Second,the results of discussion were consultation and imaging examination.Confirming the results of the previous quantitative analysis and discussion mutually,we identified imaging examination and consultation as specific links in the hospitalization process that led to the meaningless extension of LOS.Third,the results of the qualitative interview show that there are three specific problems in the two links:(1)Imaging examination still used paper application,when name of project in application is not accurate,because the radiologist fail to communicate with ward doctor directly and modify the application form,or because patients run between the two departments to get a new application,the waiting time for the examination would be extended meaninglessly.(2)The CT examination in the sample hospitals usually cannot be carried out according to the appointment time,and the radiology department does not distinguish the imaging examination of inpatients from that of patients with outpatient clinic or emergency department,therefore,in the peak period of outpatient service,the time of waiting of non-critical inpatients for examination would prolonged meaninglessly.(3)Although the time of consultation in the consultation link exceeds the requirements of the hospital,the specific reasons on why that situation happened cannot be found because the consultation prescription system.Conclusions and SuggestionsFirstly,the information system of radiology department does not support electronic application form and online communication between radiologists and ward doctors,which result in that patients’waiting time for imaging examination is extended meaninglessly.The hospital should educate residents about the reasons for inaccuracies and the correct form to reduce such cases firstly.And then,the hospital should shorten the time of patients waiting for imaging examination by improving the function of radiology information system.Secondly,the current arrangement of imaging examination appointment in radiology department is disordered and patients who have CT examination cannot be conducted examination according to the appointment time which lead to the meaningless extension of patients’waiting time for imaging examination.First of all,the hospital should well-plan the appointments of different imaging examinations according to the previous work experience.Then it can reduce the time of inpatients waiting for examination and examination results by making an appointment for imaging examination in the off-peak period.Thirdly,for the consultation,the imperfect consultation supporting information system makes the consultation process unable to be measured and monitored,which is not conducive to reduce the meaningless waiting time of patients in the consultation link.So,the hospital should have more advanced consultation information system such as recording time of arrival and has electronic application,so that the hospital’s medical department can understand specific problems that exist in the consultation process by analyzing the data collected and make corresponding improvement.