Hospital throughput is the movement of patients from admission to discharge, ensuring they receive timely, appropriate care at every stage of their hospital stay. An efficient throughput process affects clinical outcomes and many other aspects of care, such as care experience and cost of care, as documented in numerous studies.
“When a patient transfer is delayed within the hospital, it creates a ripple effect. For example, a backlog in the Emergency Department (ED) leads to longer wait times for community members seeking emergency care. Delayed discharges result in fewer available beds for incoming patients. Holding patients in the Operating Room (OR) because the Post-Anesthesia Care Unit (PACU) bed is not ready can also affect the patient’s recovery from anesthesia,” explains Carri Carson, BSN, RN, Assistant Director, Sacramento Emergency Department. “Hospital throughput is a complex process requiring close collaboration across multiple departments.”
The hospital has prioritized initiatives to optimize the throughput process. Sacramento’s throughput core team is at the forefront of leading this work. The team is composed of interdisciplinary leaders who work together to identify barriers, implement strategies, and monitor outcomes. The throughput team’s leadership has positioned the hospital as a benchmark for throughput efficiency. Dorothy Vergel MSN, RN, CCRN, Nurse Manager, Post Anesthesia Care Unit shared an example of improvement led by clinical nurses, “when we started our PACU to Floor process improvement, clinical nurses from PACU and the inpatient units collaborated that led to a streamline in the hand-off and escalation process to reduce delays in patient transfers. It did not only reduce delays but also increased staff satisfaction.”
In 2024, key metrics have consistently outperformed regional and local benchmarks, including ED-to-Floor, OR-to-PACU, and PACU-to-Floor times. “Our success highlights the strong culture of interdisciplinary collaboration in our hospital,” says Kristin Davis, MSN, RN, House Supervisor. “My role in coordinating bed placement relies on the efficient work of every team member—clinical nurses, physicians, pharmacy staff, lab personnel, bed control staff, house supervisors, Patient Care Coordinators, nurse leaders, transport, and housekeeping. Everyone contributes to the process, and our results reflect that teamwork.”
Key Throughput Achievements in 2024:
- ED to Floor: The percentage of patients admitted in less than 60 minutes rose from 9% in 2023 to 32% in 2024. The average time patients spent waiting to be moved to a hospital room was 178 minutes in 2023. In 2024, this average wait time decreased to 110 minutes, representing a 38% reduction.
- OR to PACU: Achieved less than 15 minutes from “time zero,” with only three total holds in 2024, (total of 25 minutes).
- PACU to Floor: Reduced the time from inpatient order release to bed placement by 45% compared to 2023, moving closer to the goal of 60 minutes.
Nurses have been instrumental in optimizing workflows and ensuring efficient systems. Tim Hutchinson, MSN, RN, Hospital Operations Director, underscores this impact: “The leadership and advocacy of clinical nurses at the bedside is helping drive these processes efficiently while keeping our patients safe.” By leveraging their expertise and collaboration, nurses continue to lead meaningful change that enhances patient care and strengthens operational excellence.