Table 3.

Third PDCA cycle interventions aimed at reducing median time to elective admission

Aim	Strategy	Action	Responsibility	Time frame
To reduce the median time to elective admission	Instituting a centralised bed management authority	Establishing BM as a division of the CM department.		August 2021
		Moving admission office authority to the CM department to enable processing of all hospital admissions and transfers.		August 2021
		Initiating daily bed meetings to oversee bed placement of admitted and transferred patients and update or report hospital bed status.	Case managers, bed managers and discharge coordinators	August 2021–ongoing
	Using data-driven learning systems for bed capacity planning	Using advanced data analytics coupled with expert physician knowledge to understand variation in bed capacity patterns.	BM division and admission office	August 2021–ongoing
		Predicting seasonal and volume variations to forecast changes in demand patterns.	BM division and admission office	August 2021–ongoing
	Enforcing BM huddles and managing demand and capacity processes in real-time	Daily morning BM huddle
		Each unit representative is given 1 min to communicate the current census, anticipated discharges, admissions and transfers within the hospital (and other major issues).	BM division	August 2021–ongoing
		Meeting times are limited to 10–15 min.
		Using huddles to make decisions regarding cancellation of elective surgeries or procedures based on the demand of ED or other services. Managing issues surrounding gaps in communication and decision-making of the admission process.
	Monitoring hospital bed status	Tracing emergency and elective admissions all year round for early recognition of high census and capacity surges and expediting surge protocols. Updating hospital bed status to guarantee vacant beds for elective surgery admission.	BM division and admission office	August 2021–ongoing
	Implementing IHI Be a bed ahead: ‘The Pull versus Push’ system	Proactive management of admissions or transfers to facilitate the patient movement to next point of care.	BM division, nursing, administration and admission office	August 2021–ongoing
		Anticipating demand and having a bed ready in an inpatient unit into which a patient can be moved as soon as occurs.
	Increasing patient awareness of admission requirements	Providing information booklets for patients. Providing hospital-wide educational posters complemented with barcodes for direct access on mobile phones. Offering routine education by admission office personnel to patients prior to admission (including preadmission requirements, patient rights and responsibilities, and hospital information). Identifying cases scheduled for elective surgery to inform patients or family members of arriving early at the hospital for timely admission and proper preparation. Notifying patients via phone messages to ensure admission before 10:00.	BM division, admission office and OPD	August 2021–ongoing
	Education of non-medical staff to improve the elective admission process	Hiring an admission office manager with a nursing specialty and knowledge of the patient flow process to offer education to non-medical staff. Providing in-service education for admission office staff on medical terminology and routine workflow. Providing internet services to admission office staff to facilitate looking up unknown terminologies or diagnoses.	BM division and admission office	August 2021– ongoing
		Providing orientation by the BM division on the hospital patient flow process.
	Setting the maximum number of elective admissions per day and/or specialty	Screening of all additional cases per day from outpatient departments.	Medical administration, BM division, admission office, OR department	August 2021– ongoing
		Informing all heads of departments (through distributed memos) of the suggested total number of patients for elective surgeries per day or week to prevent overbooking resulting in cancellation of surgery.

BM, bed management; CM, case management; ED, emergency department; IHI, Institute for Healthcare Improvement; OPD, outpatient department; OR, operating room; PDCA, Plan-Do-Check-Act.