Student: Courtney Hore
Co-Supervisors: Suzanne Pitama, CSMHS Director Maori/Indigenous Health Institute and Kay Poulsen, Christchurch Hospital Project Manager
Sponsor: The Canterbury District Health Board [CDHB]
What was the study about?
In May 2003, the Patient Flow Project was implemented at Christchurch Hospital following the acceptance of the Patient Flow Project Report  , commissioned by the CDHB in June 2002. The project was designed to address the challenge of providing timely access to health services, despite the increasing demand for it.
This study investigated whether the increased patient throughput afforded by the Patient Flow Project had manifested itself in higher readmission rates and poor patient satisfaction. The two key aims of the study were:
- To investigate acute medical activity with consideration for the Average Length Of Stay (ALOS) per patient and readmission rates.
- To identify common perceptions amongst patients regarding the quality of care received.
What data did the study involve?
In order to obtain a preliminary analysis of what impact the Patient Flow Project had, two types of data were analysed; acute medical activity and patient satisfaction. The acute medical activity covered the period from January 2002 to November 2004 and the data was collected by Christchurch Hospital. This data was then processed by Emendo Limited  and analysed for trends. The data concerning patient satisfaction comprised 173 inpatient satisfaction survey comments from July 2003 to June 2004. This information was collected and processed by the Corporate Quality and Risk Office at Princess Margaret Hospital. The data was then further analysed to identify common perceptions of the quality of care received.
The scope of this study was restricted to General Medicine, Cardiology and Respiratory wards where the Patient Flow Project was initially introduced.
What were the findings?
Acute Medical Activity
The ALOS per patient in the General Medicine ward data set decreased from 5.80 to 4.00 days. The ALOS in the Cardiology/Respiratory ward data set increased from 3.95 to 4.05 days. The 'total readmission rate within a 60 day period' increased in the General Medicine ward data set while it remained somewhat constant in the Cardiology/Respiratory ward data set. When the total readmission rates were compared with the respective total number of discharges, it was found that there was no apparent increase in the total readmission rate for the General Medicine ward data set. The same comparison for the Cardiology/Respiratory ward data set showed a relative decrease in the total readmission rate, however, the patient throughput was much lower.
Patients did not demonstrate specific knowledge of the Patient Flow Project's policies, although many felt the reduced lengths of stay they experienced impacted negatively on the quality of care provided. A number of patients were concerned about the lack of preparation for their discharge and some patients acknowledged the high workloads staff have.
What conclusions were drawn?
The preliminary findings can not conclusively link the Patient Flow Project with the observed trends but show the project has not been detrimental to patient care when readmission rates are considered. Both the General Medicine and the Cardiology/Respiratory ward data sets demonstrated some positive outcomes in the results analysis. The relative decrease in the total readmission rate for the Cardiology/Respiratory ward data set was admirable but could be compromised by a higher patient throughput. However, a higher patient throughput, aided by a reduced ALOS, would enable more patients to be treated. With regards to patient satisfaction, it appeared that even when patients reported receiving quality care, their comments were made within the context that they knew current resources were limited. In general patients did not demonstrate any knowledge of the Patient Flow Project but did comment on some of its related policies. Many patients equated the effort to reduce the ALOS with a reduction in the quality of care provided. Patients were also aware of changes that had been made to discharge procedures and highlighted particular concerns regarding the length and organisation of the discharge process.
Among the recommendations in the final report, there have been suggestions to alleviate limitations to the preliminary findings and possible methods of enhancing patient throughput and satisfaction have been identified.
1. Patient Flow Project Team, (2002). Patient Flow Project Report. Patient Flow Project Team: June 2002, pp. 1-65
2. An Information Technology company, which designs systems to “improve operational efficiency” through the development of capacity planning tools. Emendo has been working with Christchurch Hospital in the last 18 months in support of the Patient Flow Project.