Patient flow is concerned with the safe movement of patients through their care pathway—from community, throughout the hospital setting and through a process of egress or discharge back to the community again. It denotes the flow of patients between staff, departments and organisations along a pathway of care (Health Foundation, 2013). Configuring healthcare systems with effective patient flow is critical to the delivery of safe, effective patient care. Poor flow can lead to a poor patient experience, increased delays and therefore increased costs. Poor flow means that patients will experience delays in aspects of their care. Good flow in acute care means that patients will get to the right ward, at the right time, under the right consultant team and will have the minimum length of stay necessary. Ideally it also means that necessary tests/investigations will happen with minimal delay. Good flow also inherently means effective and timely links with alternative level of care settings—community-based services, step-down facilities, rehabilitation, long-term care, etc.
The goal of seamless patient flow across care settings is often thwarted by a lack of integration both within the hospitals and between hospitals, primary care and social care. Increasing demand and capacity issues in the acute hospital system have led to bottlenecks in hospitals for scheduled and unscheduled care (Health Service Executive (HSE), 2019). When this is combined with suboptimal coordination between hospital departments and services, efficient patient flow is prevented. The ultimate goal of improving patient flow is better outcomes and experience for patients/service users and staff (HSE, 2017; 2018). A concerted effort to maximise flow through a hospital is needed to reduce the number of patients on trolleys awaiting in-patient beds. To maximise patient flow, staff need to understand how to do this and what it means for staff and patients if this happens—better staff and patient experience and minimising patients' time spent in hospital.
For staff to understand more about patient flow, standardised teaching is imperative in spreading the key ideas of successful patient flow in any acute hospital. Two different frameworks can support the teaching of patient flow. The Teaching for Understanding (TfU) framework offers a method of goal setting and curriculum design. It allows one to structure a teaching opportunity (Wiske, 1998). Four general concepts frame the practice:
- Generative topics
- Understanding goals
- Performances of understanding
- Ongoing assessment.
This framework can be applied to teaching patient flow. On the other hand (and to complement the first framework), the Universal Design for Learning framework (https://udlguidelines.cast.org) can offer a structure for designing content to be taught in order to reach the broadest section possible of staff (Rao and Meo, 2016). This consists of three general areas:
- Multiple means of representation
- Multiple means of actions and expression
- Multiple means of engagement.
While teaching patient flow, multiple means of representation of the material regarding patient flow could be used and links forged with community services to have a more integrated educational approach. In order to provide multiple means of action and expression, sufficient numbers of trainers are required to follow this through with all members of staff, for example: introducing focused workshops on the topic, allowing follow-up sessions, contact via email, calling to wards, providing contact details for staff to follow up if further questions. Practical use of ward whiteboards that display flow needs to be built into education sessions. A variety of methods of information delivery could be represented to support different learners: handouts, leaflets, practical demonstrations, peer-to-peer learning, lectures, electronic data, etc. There needs to be a range of options to provide multiple means of engagement when recruiting staff to learn and engage with the topic. Due to the busy nature of hospital settings, time and place of education needs to be factored into planning. Having formal and informal sessions and encouraging questions would help to foster collaboration with staff.
This study was undertaken to explore how patient flow is currently taught in Irish acute hospitals, how current teaching practices link with the Universal Design for Learning and the TfU frameworks and to make recommendations for future improvements in this area to maximise patient flow learning opportunities nationally.
Background
Unnecessarily prolonged hospital stays are not good for patients, as it is well documented that prolonged hospitalisation results in substantial decline in functional status, particularly in older adults (Kortebein et al, 2008). Prolonged hospital stays result in deconditioning, lack of sleep, lack of mobilisation, increased risk of falls, increased risk of acquiring healthcare-associated infections and reduction in muscle strength, among other issues (Kortebein et al, 2008). Deconditioning affects older patients more than younger patients (Killewich, 2006; Atanelov et al, 2013; Clift, 2017). Therefore, active prevention of deconditioning improves clinical outcomes. Efficient processes are vital to achieve timely discharge, minimise delays in the patient's hospital journey and therefore achieve good patient flow. Yet, improving processes is only one part of the solution. Improved flow also needs to be achieved in conjunction with adequate hospital capacity to meet the demand for the service (NHS Improvement, 2018). The National Service Plan for 2019 stated that demand outweighed capacity, particularly for inpatient beds and patients were waiting longer than they should (HSE, 2019).
Karakusevic (2016) suggested that clear operational processes need to be evident and hospitals need to take direct action to reduce long hospital stays. Having a clear understanding of hospital processes to reduce delays will involve teaching staff about these processes and the evidence supporting their effectiveness for reducing long stays. Educating staff about the harms associated with long hospital stays is also beneficial. The practice of devolving responsibility to staff to engage in effective patient flow processes means that staff need to understand their roles in these processes.
Teaching and learning frameworks (such as the TfU framework and the Universal Design for Learning framework) have not been linked with teaching patient flow in the literature to date but both frameworks can complement how patient flow is taught to staff—particularly given the volume, diversity and transient nature of the learning group of staff/students that work in healthcare settings. Teaching needs to be a core part of sharing important healthcare-related messages (World Health Organization, 2009). The core element of spreading any healthcare message boils down to teaching the topic to the staff involved. Achieving good flow has advantages for staff and patients alike. It results in greater job satisfaction, reduced stress and improves patient outcomes (NHS Improvement, 2018). Nationally, no patient flow teaching module with core elements of what patient flow teaching should entail currently exists and there is no flow module on the national HSE learning hub. Therefore, this study aimed to explore current practices and methods being used in Ireland to teach this vital national healthcare topic and elucidate the steps required for the future teaching of this topic in Ireland.
Methods
The study design chosen was a descriptive cross-sectional qualitative study of HSE staff members involved in teaching patient flow in one hospital group in Ireland. A single semi-structured interview was undertaken with the unscheduled care leads/bed managers (predominantly nurses) in each of the five hospitals in the group to explore how patient flow is taught to all staff in their acute hospital. Following ethical approval from the clinical research ethics committee of the regional teaching hospitals, five acute hospital sites were selected and the main person involved in patient flow (unscheduled care lead/bed manager/nominated hospital representative) in each hospital was invited to participate in the study by letter. Potential participants were all HSE employees involved with maximising patient flow in their hospitals on a daily basis.
They were asked to participate in a one-off voluntary 30-minute face-to-face semi-structured in-depth interview. The hospital group CEO's permission to conduct the research in the hospital group was also obtained. Representatives from all five hospital sites agreed to be interviewed individually on their respective hospital sites. Informed written consent was received from all research participants. The five interviews were completed within 2 months of ethical approval. A semi-structured interview guide was used as standard with all five research participants (available on request). All interviews were undertaken in 2019.
The interviews were audio-taped and the data transcribed verbatim by the researcher. Field notes were recorded manually. Participants' anonymity was assured throughout the research.
Data analysis
No identifying features were attributed to any one interviewee or hospital. Interviews were transcribed verbatim by the lead researcher, which aided in data immersion. Data were then systematically analysed using a thematic analysis guide. Themes were initially analysed and then co-checked with the chief investigator for accuracy. Hycner's (1985) guidelines to qualitative data analysis were followed in a step-like fashion. Data management was carried out in accordance with HSE Data Protection Guidelines and Data Retention policy.
Results
From the data analysis five main themes were identified: current methods, unstructured nature of the teaching, frustration with frequency, dissemination of teaching/learning, and the way forward.
Current methods
All participants (who were bed managers or unscheduled care leads, predominantly staff from a nursing background) described the current methods they used when teaching patient flow. They all agreed that face-to-face teaching methods were predominantly used, complimented by a multimodal teaching approach, involving various teaching strategies. Strategies mentioned included handouts, face-to-face teaching, videos, lectures, whiteboard education, PowerPoint presentations and guest speakers.
‘I think it's all methods, there's no one [teaching] method which captures everything.’
P1 (Participant 1)
‘Yeah, I use power points and handouts, I would give them a draft copy so they can get used to it … then I email it … I would expand on it and do multiple teaching sessions, then go back, audit it, go back, that works for us.’
P4
Participants reported that ward-based teaching was their preferred method of all the teaching options used. Teaching sessions, when provided at ward level, were available to all staff—nurses, doctors, other health and social care professionals (HSCPs)—and healthcare students. One participant explained:
‘I think it is probably best on the ward, it's virtually impossible to take people off the ward for teaching, people resent being taken away from it.’
P4
All participants described how, as well as initiating informal teaching at ward level to all staff, they were involved in teaching sessions for induction of new doctors to the hospital twice a year, where they spoke about patient flow for a certain amount of time during formal induction sessions. One participant mentioned that discussing a specific case study and having a medical student shadowing the participant helped to teach the student about patient flow:
‘It's not until that girl followed me that she realised the importance of it [flow]’.
P3
Participants listed and discussed similar teaching topics on all five sites:
- Reiterating importance of having a planned discharge date (PDD) for a patient
- SAFER patient flow bundle
- How to use ward whiteboards to track patient flow
- How to access community services (eg community intervention team)
- Complex versus non-complex patients
- Weekend discharges
- Discharge planning for long-stay patients (>14 days)
- Accessing diagnostics.
In all sites the teaching was done primarily by 1-2 people, with some added support on occasions from community services reported on some sites, ie primary care staff would assist in a planned teaching session in an acute hospital.
Sending educational messages on flow via email was reported as not being an effective teaching method, yet was noted as a good way of having a record of what information was sent to staff. Participants reported that there was no guarantee that the email with patient flow information was read or even acted on.
‘Email I find less effective because people are bombarded with communication emails, but there is some merit in it because it's recorded that it's out there, you know they are receiving them, whether they read them or not is another matter.’
P1
‘With email, I would send it but I don't think it's getting through, just for records, but it's not being disseminated.’
P2
Unstructured nature of the teaching
Participants discussed their views on the frequency, planning, format and structure of the way teaching happens. All indicated that the teaching currently happens in an unstructured format, using terms such as ‘all over the place’, ‘ad hoc’, ‘on the fly’, ‘reactive’ and ‘fire-fighting’. One participant also concurred by stating that:
‘It's more in an “as necessary” way, rather than structured’
P5
Another stated that:
‘We are doing a lot of these reactively and finding out as we go along, I suppose they would be the long term goals but we are really only trying to fire fight at the moment.’
P2
One participant expressed frustration at the lack of any structure to aid teaching:
‘I'm trying anything to be honest.’
P3
Another participant suggested that:
‘What's basically coming back, in the early stages, is that they know nothing about it [flow].’
P3
The unstructured nature was also commented on in relation to various levels of engagement and different levels of importance placed on flow by different groups within a hospital.
‘We have difficulties with medical teams engaging … don't necessarily see it as their role so when one key group is excluded or have excluded themselves pretty much, it's hard to bed it in across the organisation.’
P1
‘I don't think that they [all staff in general] realise the importance of patient flow and discharging.’
P2
Frustration with frequency
Four participants expressed frustration with regards to the frequency with which the topic of patient flow needed to be taught. They felt like they were doing it on a daily basis, all day, every day reiterating the same patient flow message. They felt this was due to the volume and diversity of staff and content, limited teachers and vast variety of ways the topic needs to be taught.
‘It's relentless’
P1
‘Constant, constant, constant, going around on an hourly basis saying the same thing, you know all day long after them [acute ward-based staff in general], around after them, it is hard.’
P2
‘Reiterating.’
P3
‘Educate people and then walk the talk (laughs) … for the rest of the year (laughs).’
P4
One participant described feeling like they were perceived to be adopting an authoritarian approach while teaching about flow, by saying:
‘It's a constant headache, constantly telling them, I'm like their mother and still not getting there, like telling them about discharges, and then you are going on and on for another hour, but really the people [staff] don't have the time.’
P2
One participant mentioned that community services come into the hospital to also provide teaching sessions. But in the aftermath of the community talks the patient flow message needs to be reiterated on a daily basis after the teaching as these talks are not on a regular basis:
‘They [a community service] would reinforce their part but it's primarily me going around all the time, all the time, just reinforcing, reinforcing it. Yeah, it's me, reinforcing it all the time.’
P4
The relentless nature of the education about patient flow also came across in this comment:
‘You feel like you are just up against a wall. You are trying to get medical buy in and medical support and when that's kind of failing and you are getting every answer back under the sun, it's hard then to keep driving and driving and driving.’
P2
Dissemination of teaching/learning
All participants agreed that, from their perspective, teaching did not disseminate from one employee to another. They reported that they would like teaching material to be shared, after it was taught, but they did not see this happening at ward level. They felt this was due to a lack of structure and unclear expectations as to how this would realistically happen.
‘I suppose there would be an expectation that people on the ward would educate their colleagues, but whether that happens or not is another matter.’
P1
‘But to disseminate the information down all of the time, the ward managers just don't seem to be disseminating it down.’
P2
‘You hope that someone who comes to a study training day that should go back, but it doesn't really work, it's very fresh on the day, ‘God that's brilliant’, but then you go back to the ward and they'll say ‘God what did you say again?’
P5
‘It's been given to the CNMs [clinical nurse managers], it's not cascading down, but technically there is no formal way of teaching it.’
P3
Many participants mentioned that education was not being shared among employees. Various words with similar meanings were used by all five participants to describe this effect: ‘not filtering’, ‘not cascading’, ‘not disseminating’, ‘not trickling'and ‘it's not passed on’.
They also remarked on the fact that there was no train-the-trainer programme to disseminate the knowledge gained from one employee to another:
‘I suppose there would be an expectation that people on the ward would educate their colleagues [nurses, doctors, HSCPs], but whether that happens or not is another matter. There's no evaluation done, so I mean it's hard to benchmark people when we don't evaluate whether they have taken something from the education or not.’
P1
The use of social media as a teaching method was mentioned by one participant:
‘[Regarding social media] you've no measurement though of if you're reaching the people you want to reach, well obviously you can get the number of likes, re-tweets on Twitter, but you really don't have an idea if that's disseminating across the groups that you want it to.’
P1
The way forward
All participants stated that they felt a formal mechanism (structured standardised national programme) for teaching about patient flow in hospitals and community sites needed to be put in place. The following statements assist with explaining the strategies that the participants felt could be deployed in order to effectively teach all hospital staff about patient flow:
‘It probably should be in a formal structured way. I suppose a better way to do it would be to have structured education sessions, possibly each week, maybe if there were resources, that there should be possibly weekly training for every group.’
P1
‘You could have the scenario where you have a patient flow module that it could be signed for, that people would be certified that they received the training and competent in all flow methods, it needs to be tailored to the group you are talking to.’
P1
‘You want a standardised message delivered. I think there could be a basic message right across the organisation but I think there could be pieces tailored for individual groups.’
P3
‘I would love to have some formal simple presentation to be able to deliver to my colleagues. If someone could devise a package, then we could do marvellous teaching.’
P5
Three participants specifically discussed the importance undergraduate education could play in teaching flow. They mentioned the fact that patient flow should be taught at undergraduate level prior to healthcare staff members (nurses, doctors, HSCPs) coming to a work setting.
‘It should be taught in college from Day One, in college, it should be taught to the NCHDs [non-consultant hospital doctors] as well as the nursing students, to all disciplines. They are hearing about PDDs [planned discharge dates] for the first time here and haven't heard about it before.’
P2
‘I think if you are coming to work in a hospital you should have formal training in this before you come.’
P5
‘It should be taught in college from Day One.’
P2
‘Right across the MDT [multidisciplinary team] as a module. To physio[therapy], radiology students, student nurses, start off that level in college undergraduates, they have some baseline.’
P5
Three of the five participants mentioned that patient flow education should be mandatory. They felt that making the topic compulsory would assist in ensuring greater spread of the material to a wider audience. They felt that due to the importance of the topic it should be a necessary requirement to acquire formal flow training in order to work in a healthcare setting.
‘It should be possibly mandatory too, that's the other piece, it's not mandatory.’
P1
‘I think it needs to be mandatory. I think patient flow needs to be mandatory. It's very much part of your working day. It is a very, very significant part of the day and people don't see it.’
P2
‘We need to formalise it and almost mandatory, that's where we need to go with it, people are being taught hand hygiene, they are being taught basic life support and I know they are vitals but to be honest the bread and butter of their work is to do with flow in one way or another … so for such a big component, it's absurd that there's nothing.’
P3
However, one participant disagreed with the need for mandatory training and stated that they preferred to work on building up relationships and teach informally at ward level.
‘We try to be formally informal if you know what I mean. There's so much to be done, what with all the mandatory trainings and all the extra checklists, like you're checking your crash trolley, checking your equipment. If I came along and went onto another big sheet of what they had to be competent in, then I think we could run into trouble. There's more buy in doing it this way. The last thing we want to do is say “here's the [patient flow] checklist”.’
P5
Although many participants mentioned community colleagues coming into hospitals to teach about their services, only two participants discussed the need for integrated training in general.
‘[Patient flow training] needs to be integrated completely. It would lessen tensions or lessen the suspicions of each other. Acutes [acute hospitals/staff] need to know what the community does and community need to be trained about acutes.’
P4
‘In order for patient flow to work properly, for egress to work properly, there will have to be complete trust and buy in and work together. Primary care would need to be involved in training too.’
P4
‘It would be good to have, a module, a standardised module that people could use across the organisation. It's right across the organisation I would suggest, it's not just hospital based at all.’
P1
Changeover of doctors (typically every 6 months in an acute hospital) was mentioned by all participants as a crucial key time for teaching. One participant mentioned that although doctors receive education on flow during induction:
‘There's no verifying if people learn from it.’
P3
Another participant noted that:
‘I really think it has to be some sort of national policy. I think something has to happen.’
P5
Discussion
The Irish national healthcare implementation strategy for winter 2018/19 noted that services across all areas of the health system were stretched as demand far outweighed capacity, with hospital waiting lists under significant pressure; constraints were also evident in community-based services and there were high levels of unmet need for homecare and other social care services (HSE, 2018). Against this backdrop, patient flow is therefore a critically important topic in Irish health care. Despite this, there is currently no standardised method of teaching patient flow nationally. Knowledge of patient flow strategies is necessary due to the complexities in the Irish healthcare system. Bed occupancy in 2019 exceeded 95% (HSE, 2019), and typically 104% in Model 4 Irish hospitals—tertiary referral centres (Irish Medical Organisation, 2017)—which is well above international norms and presents significant pressure on acute services. In the UK, recommendations are for 85% bed occupancy (National Institute for Health and Care Excellence, 2018). The national service plans (HSE, 2019) forecast that this situation would continue, creating the well documented associated risks in terms of patient experience and outcome. Effective flow, especially with a situation of limited national bed capacity, is vital. Teaching this topic is therefore of relevance to all staff working in Irish healthcare settings.
Participants in this study said that patient flow should be taught at undergraduate level, before the staff ever come to work in a hospital. Interprofessional education (IPE) is one way for this to be promoted and introduced at undergraduate level. IPE is defined as a process whereby students learn with, from and about other health professions (Centre for the Advancement of Interprofessional Education, 1997). Patient flow would seem to be an ideal topic to be taught in this fashion. ‘Flow is a Team Sport’(NHS Improvement, 2018) is one of the principles advocated for underpinning good patient flow. Departments and staff groups need to collaborate and work together to achieve the aim of good flow. Brandt (2018) argued that health systems are progressing rapidly but IPE has not moved in line with same—that IPE has not reached its full potential to affect collaboration, teamwork and health and systems outcomes. She claimed that healthcare graduates are ‘clinically competent but relatively unprepared to practice in interprofessional teams'. This view was echoed by the participants in this study where they felt a greater need for pre-collaboration regarding flow strategies prior to staff coming to work in a hospital setting. Poor preparation of healthcare students for working collaboratively together and therefore understanding each other's roles and responsibilities has been identified to directly result in a range of adverse outcomes. Examples include: lower staff and patient satisfaction, increased safety issues, system inefficiencies and suboptimal engagement within community (Institute of Medicine, 2015).
Anderson et al (2006) stated that team working competencies in the workforce cannot be assumed and provided evidence of poor communication within teams—a key factor in poor flow. They strongly advocated the development of future health professionals who can work collaboratively, in effective multidisciplinary teams. This was also echoed in Widdifield et al's (2006) research with 128 Irish medical and dental students. They found that these students had little concept of the importance of working in a team and consulting with other health professionals. They recommended that medical and dental educators and curriculum committees should factor this into future curriculum development. Engagement of teams with regard to an emphasis on their specific roles/responsibilities in relation to flow was strongly advocated for in this research. Having a multidisciplinary team approach to the teaching of patient flow would enable teams to come together, to communicate and work out their roles and responsibilities in relation to flow.
Jaye et al (2009) made the point that although the primary function of a teaching hospital is healthcare provision, a secondary function is providing a learning environment, and that a consequence of this is that all clinicians are involved in daily teaching, even if they do not see their role as that of a teacher. Modelling of clinical practice and professionalism are obvious examples of ways in which their roles become educational. Participants in this study emphasised that patient flow information was not being disseminated and not being modeled to others at ward level. Perhaps the educational role of each clinician needs to be emphasised. Although some staff may not be directly employed to teach, the impact of their actions through the models of social learning within communities of practice must not be underestimated (Jaye et al, 2009). A national strategy, one that emphasised teaching methods, could highlight the importance of role modelling. Clinicians modeling good flow practices would support the daily teaching of this topic at ward or community level.
Due to the diverse nature of healthcare staff, a multimodal teaching approach was highlighted as most effective. The method that was most frequently adopted was face-to-face teaching sessions at ward level so that teaching could happen closest to the employee at a time and place that suited them. The Universal Design for Learning (UDL) framework (CAST, 2018) supports multiple means of action and expression and specifically states that multiple media and tools can be used to communicate a message to staff. Participants in this study mentioned elements of the UDL framework, but not explicitly. The UDL framework provides opportunities for comprehension (eg activating background knowledge, highlighting big ideas/patterns, maximising transfer and generalisation), which were mentioned by participants but not in a formal structured way. Mapping patient flow content against the UDL framework would allow for a standardised approach to teaching. This UDL framework would also provide a vital opportunity to take into account the voices of those being taught about patient flow (‘the learners’, ie all staff in an acute hospital who are involved in ensuring patients receive the right care, at the right time, in the right place). This research focused on the teachers per se, but a UDL framework would draw on the learners' experience to formulate a training programme.
The lack of a formal national teaching structure was reported as a significant barrier, presenting difficulties on a daily basis in a hospital. As a result of this, staff have to develop material themselves without any formalised national support or framework. There is no national package to deliver training either online or hospital wide at present. This means that currently individual hospitals are drafting up individual templates for teaching on each hospital site around the country—potentially wasting time and resources where one centralised approach could be used, with local augmentation and adaptation if required. This current system also has the potential for lack of uniformity and mixed messages. The TfU framework could be ideally applied to this topic. The TfU framework (Wiske et al, 2002) provides a structure to assist in the planning of teaching sessions. It has all the elements required to formalise teaching moments—to make the tacit flow agenda, more explicit. The topic of patient flow could easily align to the TfU framework due to the specific subsets within it. The generative topic is teaching good flow principles. This was very well laid out by the NHS Improvement (2018) guide into the SAFER patient flow bundle (understanding goals). In this research, participants reported frustration with the high frequency of teaching required and subsequent lack of dissemination of material. Yet in the absence of specific performances of understanding, it is inherently difficult to gauge each staff member's knowledge on the flow goals. Having a more formalised method of assessing knowledge would help to gather a baseline (by ward/department) with regard to what specific flow topics need more teaching/time from facilitators. The TfU framework would naturally work well with structuring teaching about flow, as it encourages the learning to be explicit, encourages the focus on students understanding and focuses on incorporating opportunities for coaching and feedback (Wiske et al, 2002).
The HSE, through its national online learning hub, offers employees an option for completion of online courses. Currently many mandatory HSE training programmes can be completed electronically on the national communication information hub known as HSE Learning and Development (HSELanD). There is also the HSE's multi-platform information hub for the public and professionals (https://www.hse.ie). Therefore, some of the structures necessary to allow teaching across a large workforce are already available. The HSE national communications priority and action plan for 2019 indicated an aim to ‘further develop consistent health service wide communications approaches, toolkits and training’ (HSE, 2019: 112). Patient flow again fits into this category. There is a platform for it and an obvious need for it.
Conclusion
The topics of daily overcrowding in Irish hospital emergency departments and trolley wait times have received much media attention nationally. This research captures a snapshot of the current teaching practices in a large hospital group in Ireland and explores approaches currently being taken to tackle this patient flow issue. Owing to the inherent need for education to help to tackle this problem, this research attempted to investigate the nature of the current educational practices and structure a framework for how education could possibly be enhanced and expanded in the future. The Universal Design for Learning framework and the TfU framework are ideally placed to support the planning of multidisciplinary teaching sessions in this area due to the diverse, transient and substantial healthcare population to be educated and the nature of the material to be taught. Application of the TfU framework to the topic of patient flow would aid in structuring common goals of teaching and realistic assessment methods to be used. It is hoped that recommendations from this research will assist in formalising a more cohesive package of patient flow education that can be easily replicated in various parts of the country. This research advocates for comprehensively including patient flow strategies (and effective teaching of same) as a vital component in both undergraduate healthcare course curricula and in the HSE national staff training programme.
KEY POINTS
- Patient flow is a common educational topic taught to staff and students in acute hospitals in Ireland
- The findings from this study highlight a need for a formalised approach to teaching this topic in the future
- The use of the Teaching for Understanding framework and Universal Design for Learning principles are strongly advocated to support the development of a nationwide module, to structure the topics to be taught and provide guidance on how to effectively and efficiently teach this topic in Ireland
- An integrated approach to teaching across acute and community sites (linking in with undergraduate healthcare course curricula) should be considered
CPD reflective questions
- What are the main topics you teach about when you cover patient flow?
- Can your teaching moments be formalised?
- If you teach undergraduate healthcare students, do you include patient flow in their training? If not, how might this be incorporated?
- What multimodal teaching methods do you use?