The safe patient flow initiative: a collaborative quality improvement journey at Yale-New Haven Hospital.

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.

Hospital readmissions under the spotlight.

Healthcare leaders see the future of their dynamic industry through the eyes of patients, families, providers, clinicians, employers, health insurers, and policymakers. As healthcare organizations face growing economic challenges and the nation engages in comprehensive healthcare reform, reducing preventable readmissions is considered part of the solution to achieving new system-wide efficiencies. Healthcare leaders can adopt a fresh approach to reducing preventable readmissions that includes three basic components: (1) identify patients at risk for readmission based on sociodemographic factors, care-related factors, and measures of severity of illness; (2) anticipate reform that aligns reimbursements and payment incentives for readmission reductions; and (3) structure coordinated, patient-centered discharge planning.