Optimizing inpatient bed management in a rural community-based hospital: a quality improvement initiative.

BACKGROUND: Appropriate use of available inpatient beds is an ongoing challenge for US hospitals. Historical capacity goals of 80% to 85% may no longer serve the intended purpose of maximizing the resources of space, staff, and equipment. Numerous variables affect the input, throughput, and output of a hospital. Some of these variables include patient demand, regulatory requirements, coordination of patient flow between various systems, coordination of processes such as bed management and patient transfers, and the diversity of departments (both inpatient and outpatient) in an organization. METHODS: Mayo Clinic Health System in the Southwest Minnesota region of the US, a community-based hospital system primarily serving patients in rural southwestern Minnesota and part of Iowa, consists of 2 postacute care and 3 critical access hospitals. Our inpatient bed usage rates had exceeded 85%, and patient transfers from the region to other hospitals in the state (including Mayo Clinic in Rochester, Minnesota) had increased. To address these quality gaps, we used a blend of Agile project management methodology, rapid Plan-Do-Study-Act cycles, and a proactive approach to patient placement in the medical-surgical units as a quality improvement initiative. RESULTS: During 2 trial periods of the initiative, the main hub hospital (Mayo Clinic Health System hospital in Mankato) and other hospitals in the region increased inpatient bed usage while reducing total out-of-region transfers. CONCLUSION: Our novel approach to proactively managing bed capacity in the hospital allowed the region's only tertiary medical center to increase capacity for more complex and acute cases by optimizing the use of historically underused partner hospital beds.

Implementation of a pediatric bed prioritization process in a rural Minnesota community-based hospital.

Inpatient capacity constraints have been a pervasive challenge for hospitals throughout the COVID-19 pandemic. The Mayo Clinic Health System - Southwest Minnesota region primarily serves patients in rural southwestern Minnesota and part of Iowa and consists of 1 postacute care hospital, 1 tertiary care medical center, and 3 critical access hospitals. The main hub, Mayo Clinic Health System in Mankato, Minnesota, has a pediatric unit with dedicated pediatric hospitalists. To address the growing demand for adult inpatient beds at the height of the pandemic, the pediatric unit was opened to allow adult patients to be admitted when necessary. For several months, adult inpatient capacity exceeded 90%, which decreased the number of available pediatric (vs adult) beds throughout Minnesota, particularly in rural communities. Data for the health system showed that children were most affected because transfers to the next available hospitals for pediatric cases were 55 miles away or more. To address this gap, the hospital team successfully trialed a pediatric bed prioritization guideline that reduced pediatric transfers by 40%. This was accomplished by prioritizing the last remaining inpatient bed on the pediatric unit for pediatric patients only. This process not only reduced pediatric transfers but also increased unique patient admissions because of an average lower length of stay for pediatric patients compared with adult patients.