Critical Path Network: Flow-gorithms: New tools for process improvement

At the heart of the decision to use computer simulation modeling at Overlook was the need to answer one basic question: Will the flow-gorithms work?

What, you may well ask, is a flow-gorithm? It is the marriage of a flowchart and an algorithm, created by Overlook to depict the new processes for the emergency department (ED) and pulmonary unit direct admissions. (See example, below.)

"The idea was to integrate the more traditional medical algorithm for what antibiotics should be selected with the more nursing-oriented structure of how to triage the patients, and the ED physician’s challenge of how to pick up on what he sees in nursing," explains James Espinosa, MD, FACEP, FAAFP, chairman of Overlook’s emergency department. "Many EDs see this as an ED problem and believe direct admissions to the floor are someone else’s concern. We looked at all pneumonia patients — direct to floor and ED-admitted. We made tools for both."

A team of Overlook professionals worked on the basic structure of the flow-gorithms, including representatives from the ED and from pediatrics, and received notable support from Robert Sussman, MD, the director of pulmonology.

"We looked at best practices, got the team together, and responded to their particular elements," Espinosa continues.

He’s enthusiastic about flow-gorithms as a new data collection tool. "It’s an exciting possibility to use in other studies. We will look at new designs with this and with new pathways."