Flow of Patients at Arnold Palmer Hospital

Location Strategy

Flow of Maternity Patients at Arnold Palmer Hospital (APH)

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Born w / complications

Taken to an operating room and/or intensive care unit for necessary care; o nce stabilized transferred to care unit and discharged when ready. If additional care needed child transferred to neo-natal and released at a later time.

Mother and baby discharged

Born w/o complications transferred to mother and baby care unit

Ready to deliver taken to the

nd floor until the baby is born

Not ready to deliver sent home, asked to return later.

#2 If baby is born in route or imminent goes to #6. Otherwise go to #3

#3 Patient is asked about pre- registration

#4 pregnant woman is taken to Labor & delivery Triage on the

th floor for assessment


born #1 Enter APH’s Labor & Delivery check in desk entrance

#1.Through analysis of the flow chart there really doesn’t seem to be many ways that the process could be improved. However one thing that could be done to improve the process is to ask the patient about pre-registration en route to the hospital, taking into consideration that not all pregnant women would be arriving by ambulance. Another thing that could be done to better the process is to move some of the departments in the hospital. It is evident that services concerning maternity are located on several floors, if all of the processes were offered on one unit in one location reaction time could be decreased; staffing and resources could be used in a more efficient way. These two processes / changes could make a significant impact to the entire maternity process. There is a need for a more adaptive design in order to help the hospital function more efficiently.

Research conducted in 2007 by Braaten & Bellhouse explain that with the introduction of new technology, and regulation, the processes of care becomes more complicated, creating an elaborate set of procedures connecting various hospital units and departments; using methods of Adaptive Design a nursing unit redesigned work systems to achieve sustainable improvements in productivity, staff and patient satisfaction, and quality outcomes. The first hurdle of redesign was identifying problems. Once the staff identified problems, utilizing root cause analysis, asking, “why, why, why,” was essential to unearthing the true cause of a problem. Similarly, identifying solutions that were simple and low cost was an essential step in problem solving. Adopting new procedures and sustaining the commitment to identify and signal problems was a last and critical step toward realizing improvement.

#2. If a mother is scheduled for a caesarean section the flow chart would change from step two, the patient would already be processed in the system, and instead of determining if the pregnant woman is ready to give birth she would be checked in and moved o be prepared for the procedure. Once the procedure has been completed the mother and baby would be moved to the appropriate area.

Pate & Puffe (2007), conclude that Physicians are key players in improving patient flow efficiency and effectiveness, as well as the quality of care that relates to patient flow. Physicians control critical aspects of the care delivery process, including which patients get admitted to the hospital and when, the reasons for their admission and when they get discharged. Involving physicians is important to the success of any large-scale patient flow improvement initiative. Achieving smooth, efficient patient flow requires ongoing physician executive sponsorship, leadership and participation, not only during the improvement process itself, but for the long-term, to ensure that change for the better lasts.

#3 — on the last page

#4. The hospital could insure that the assets are being properly used as well as facilitation of patient transition more efficiently. Pate & Puffe (2007), explained in their research that implementing appropriate house management roles, processes and communication protocols, Forecasting demand for service, Determining bed cleaning priorities and turnaround targets, Aligning staffing levels with peak activity, Providing real-time access to bed status and availability through integrated technology. In facilitation of timely patient transitions these activities include: Designing a case management model and roles, Facilitating timely rounding and ordering processes, Ensuring timely completion of ancillary patient care, applying standard utilization review criteria, and Securing extended authorizations, creating accountability for proactive transition planning, Improving communication and coordination between case managers, physicians and nurses, and optimizing existing discharge planning and utilization review work drivers and reporting.


Braaten, J., & Bellhouse, D. (2007). Improving patient care by making small sustainable changes: a cardiac telemetry unit’s experience. Nursing Economic$, 25(3), 162-166. Retrieved from MEDLINE with Full Text database

Pate, D., & Puffe, M. (2007). Improving Patient Flow. (cover story). Physician Executive, 33(3), 32. Retrieved from MasterFILE Premier database.

#1 Enter APH’s Labor & Delivery check in desk entrance

Process chart without registration process.

#5 Babies born

Taken to an operating room and/or intensive care unit for necessary care; once stabilized transferred to care unit and discharged when ready. If additional care needed child transferred to neo-natal and released at a later time.

#7 Mother and baby discharged


Born w/o complications transferred to mother and baby care unit


Born w / complications


Not ready to deliver sent home, asked to return later.


Ready to deliver taken to the 2

nd floor until the baby is born

#3 pregnant woman is taken to Labor & delivery Triage on the 8

th floor for assessment

#2 If baby is born in route or imminent goes


. Otherwise go to #3

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