Presentation
Making Room: Human Factors Strategies for Improving Bed Flow
SessionPoster Session 2
DescriptionPatient flow is a cornerstone of hospital operations, directly influencing patient safety, care quality, staff workload, and the efficient use of resources. Within this broader system, bed assignment plays a particularly critical role. Assigning patients to the right bed requires balancing multiple factors, including but not limited to patient acuity, clinical needs, staffing levels, infection control requirements, and overall hospital capacity, all while managing shifting conditions in real time. When the process works well, patients receive timely care, bottlenecks are minimized, and the Emergency Department and Critical Care units can maintain capacity. When there are inefficiencies in the process, delays can compound and slow future assignments, strain resources and cause stress for staff and patients.
Despite its central importance, bed assignment work is often under recognized. At Mount Sinai Hospital, a Toronto acute care academic hospital, this responsibility rests largely with a single Bed Board Coordinator who manages a continuous stream of information and communication across multiple departments. The Bed Board Coordinator is responsible for assigning admitted patients to all inpatient units excluding women’s and infants’ health, a function that directly influences time to inpatient bed for patients admitted via the Emergency Department (a key performance metric). Assigning patients appropriately requires balancing clinical needs, staffing levels, infection control considerations, and resource availability, in a time-sensitive context. The role demands a deep, nuanced understanding of hospital operations, patient demographics, and real-time bed availability. Coordinators not only respond to immediate needs, but must also anticipate future scenarios, continually adjusting plans to place as many patients as possible in appropriate beds. This orchestration of complex, moving pieces creates an environment that demands high cognitive attention and exacerbates pain points when communication breaks down or resources are constrained.
This presentation examines an in-depth Human Factors (HF) analysis of bed board coordination at Mount Sinai, aimed at identifying gaps, inefficiencies, and opportunities for improvement. Collaboratively with the Senior Manager, Patient Flow and Admitting leadership, we conducted a staff survey to capture the reasons for unassigned beds at the end of overnight shifts, based upon key factors and considerations identified through in-situ observations. An information flow diagram was utilized to visually demonstrate the decision-making complexities, including decision categories and key information sources, to successfully complete a patient bed assignment. To deepen our analysis, we conducted systematic logging of all incoming and outgoing communications managed by the Bed Board Coordinator, which were later categorized and themed. Through a multi-methods approach, using in situ observation, thematic communication analysis, and staff feedback, we were able to uncover barriers, identify sources of inefficiency, and highlight opportunities for workflow redesign to support a better, more resilient hospital patient flow system.
Our observations underscored the complexity of the bed assignment role and the many factors that shape decision-making. Bed assignment decisions are highly complex, requiring Coordinators to consider patient characteristics, bed availability, unit resources, and organizational constraints, all within a context of continuously changing information. Timely and accurate communication is essential, as patient needs and hospital census shifts throughout the day, influencing optimal bed assignments at any given moment. The analysis revealed recurring challenges, including bed availability bottlenecks, resource constraints, and interdepartmental communication breakdowns that delayed assignments and created inefficiencies. Qualitative findings, supplemented by interviews with Bed Board Coordinators, highlighted key themes and pain points, and pointed to opportunities for improvement in areas such as duplicate work, workflow inefficiencies, and communication gaps. Complementing these insights, the end-of-shift survey identified the primary and secondary factors driving bottlenecks in bed assignments, particularly instances where patients remained unassigned despite available medicine beds, helping to validate which issues had the greatest operational impact.
This presentation will share the outcomes of this multi-methods analysis, illustrating how human factors methods can identify root causes that affect patient flow. We will also present actionable recommendations for risk mitigation and workflow redesign, with implications for improving coordination, reducing delays, and enhancing system resilience. This work provides practical strategies for leveraging human factors to address a highly complex and relevant operational challenge in healthcare and for designing interventions that address both human and organizational constraints.
Despite its central importance, bed assignment work is often under recognized. At Mount Sinai Hospital, a Toronto acute care academic hospital, this responsibility rests largely with a single Bed Board Coordinator who manages a continuous stream of information and communication across multiple departments. The Bed Board Coordinator is responsible for assigning admitted patients to all inpatient units excluding women’s and infants’ health, a function that directly influences time to inpatient bed for patients admitted via the Emergency Department (a key performance metric). Assigning patients appropriately requires balancing clinical needs, staffing levels, infection control considerations, and resource availability, in a time-sensitive context. The role demands a deep, nuanced understanding of hospital operations, patient demographics, and real-time bed availability. Coordinators not only respond to immediate needs, but must also anticipate future scenarios, continually adjusting plans to place as many patients as possible in appropriate beds. This orchestration of complex, moving pieces creates an environment that demands high cognitive attention and exacerbates pain points when communication breaks down or resources are constrained.
This presentation examines an in-depth Human Factors (HF) analysis of bed board coordination at Mount Sinai, aimed at identifying gaps, inefficiencies, and opportunities for improvement. Collaboratively with the Senior Manager, Patient Flow and Admitting leadership, we conducted a staff survey to capture the reasons for unassigned beds at the end of overnight shifts, based upon key factors and considerations identified through in-situ observations. An information flow diagram was utilized to visually demonstrate the decision-making complexities, including decision categories and key information sources, to successfully complete a patient bed assignment. To deepen our analysis, we conducted systematic logging of all incoming and outgoing communications managed by the Bed Board Coordinator, which were later categorized and themed. Through a multi-methods approach, using in situ observation, thematic communication analysis, and staff feedback, we were able to uncover barriers, identify sources of inefficiency, and highlight opportunities for workflow redesign to support a better, more resilient hospital patient flow system.
Our observations underscored the complexity of the bed assignment role and the many factors that shape decision-making. Bed assignment decisions are highly complex, requiring Coordinators to consider patient characteristics, bed availability, unit resources, and organizational constraints, all within a context of continuously changing information. Timely and accurate communication is essential, as patient needs and hospital census shifts throughout the day, influencing optimal bed assignments at any given moment. The analysis revealed recurring challenges, including bed availability bottlenecks, resource constraints, and interdepartmental communication breakdowns that delayed assignments and created inefficiencies. Qualitative findings, supplemented by interviews with Bed Board Coordinators, highlighted key themes and pain points, and pointed to opportunities for improvement in areas such as duplicate work, workflow inefficiencies, and communication gaps. Complementing these insights, the end-of-shift survey identified the primary and secondary factors driving bottlenecks in bed assignments, particularly instances where patients remained unassigned despite available medicine beds, helping to validate which issues had the greatest operational impact.
This presentation will share the outcomes of this multi-methods analysis, illustrating how human factors methods can identify root causes that affect patient flow. We will also present actionable recommendations for risk mitigation and workflow redesign, with implications for improving coordination, reducing delays, and enhancing system resilience. This work provides practical strategies for leveraging human factors to address a highly complex and relevant operational challenge in healthcare and for designing interventions that address both human and organizational constraints.
Event Type
Poster Presentation
TimeTuesday, March 244:45pm - 6:15pm EDT
LocationRhinelander Gallery
Hospital Environments