Accelerating Bed Turnover in a Local Hospital: A Workflow and Coordination-Driven Approach

Diah Ariasa Kusuma Dewi; Arwita Mulyawati; Philip Sun Bunaryo

doi:10.61987/communautaire.v5i1.2286

Authors

Diah Ariasa Kusuma Dewi Lembaga Akreditasi Fasilitas Kesehatan
Arwita Mulyawati Lembaga Akreditasi Fasilitas Kesehatan
Philip Sun Bunaryo Lembaga Akreditasi Fasilitas Kesehatan

DOI:

https://doi.org/10.61987/communautaire.v5i1.2286

Keywords:

Bed Turnover Time, Workflow Redesign, Staff Coordination, Hospital Efficiency

Abstract

Bed turnover time is a critical performance indicator in inpatient services because it directly influences bed availability, patient flow, and operational efficiency. This study aimed to evaluate the effect of workflow redesign and staff coordination support on bed turnover time in an inpatient unit. A quasi-experimental one-group pretest-posttest design was used, with retrospective operational data collected from January to April 2026. January represented the pre-intervention period, while February to April represented the post-intervention period. A total of 1,492 bed turnover events were analyzed, comprising 479 pre-intervention and 1,013 post-intervention cases. The intervention included workflow restructuring, time-monitoring alerts, assignment of a final checker, improved coordination between nursing and housekeeping staff, infection prevention and control monitoring, and daily performance evaluation. The results showed a reduction in mean bed turnover time from 133.71 to 125.98 minutes and a decrease in median from 48.12 to 42.23 minutes. Statistical analysis indicated a significant difference between periods (Z = -4.01; p < 0.001). These findings suggest that structured workflow optimization and strengthened interprofessional coordination improve bed readiness and inpatient operational efficiency, supporting sustainable hospital performance improvement.

References

Aguilera, R. V., De Massis, A., Fini, R., & Vismara, S. (2024). Organizational Goals, Outcomes, and the Assessment of Performance: Reconceptualizing Success in Management Studies. Journal of Management Studies, 61(1), 1–36. https://doi.org/10.1111/joms.12994

Åhlin, P., & Wänström, C. (2023). Solutions for Improved Hospital-Wide Patient Flows a Qualitative Interview Study of Leading Healthcare Providers. BMC Health Services Research, 23(1), 17. https://doi.org/10.1186/s12913-022-09015-w

Al Harbi, S., Aljohani, B., Elmasry, L., Baldovino, F. L., Raviz, K. B., Altowairqi, L., & Alshlowi, S. (2024). Streamlining Patient Flow and Enhancing Operational Efficiency Through Case Management Implementation. BMJ Open Quality, 13(1), e002484. https://doi.org/10.1136/bmjoq-2023-002484

Anumolu, S., & Samant, M. (2026). Optimizing Hospital Bed Capacity: How Lean-AI Integration Prevents Capacity Constraints From Multiplying Demand. Intelligent Hospital, 100048. https://doi.org/10.1016/j.inhs.2026.100048

Bartlett, B. N., Vanhoudt, N. N., Wang, H., Anderson, A. A., Juliar, D. L., Bartelt, J. M., Lanz, A. D., Bhandari, P., & Anil, G. (2023). Optimizing Inpatient Bed Management in a Rural Community-Based Hospital: A Quality Improvement Initiative. BMC Health Services Research, 23, 1000. https://doi.org/10.1186/s12913-023-10008-6

Bhaladhare, R., & Rishipathak, P. (2025). Strategies of Quality Improvement in Healthcare Organizations on Sustainable Healthcare System. Discover Social Science and Health, 5(1), 74. https://doi.org/10.1007/s44155-025-00226-0

DeMaio, J., Purdy, O., Ghidini, J., Menillo, J., Viney, R., & Hogan, C. (2025). PROPEL Discharge: An Interdisciplinary Throughput Initiative. The Joint Commission Journal on Quality and Patient Safety, 51(1), 19–32. https://doi.org/10.1016/j.jcjq.2024.10.003

Endalamaw, A., Khatri, R. B., Mengistu, T. S., Erku, D., Wolka, E., Zewdie, A., & Assefa, Y. (2024). A Scoping Review of Continuous Quality Improvement in Healthcare System: Conceptualization, Models and Tools, Barriers and Facilitators, and Impact. BMC Health Services Research, 24, 487. https://doi.org/10.1186/s12913-024-10828-0

Erdmann, M. A., Paramel, I. S., Marshall, C., LeHew, K., Kee, A., Soliman, S., Vuong, M., Spillane, S., Baer, J., Do, S., Jones, T., & McGuire, D. (2024). Reduced Time to Admit Emergency Department Patients to Inpatient Beds Using Outflow Barrier Analysis and Process Improvement. Western Journal of Emergency Medicine, 25(5), 748–757. https://doi.org/10.5811/westjem.18626

Franklin, B. J., Mueller, S. K., Bates, D. W., Gandhi, T. K., Morris, C. A., & Goralnick, E. (2022). Use of Hospital Capacity Command Centers to Improve Patient Flow and Safety: A Scoping Review. Journal of Patient Safety, 18(6), e912–e921. https://doi.org/10.1097/PTS.0000000000000976

Franklin, B. J., Yenduri, R., Parekh, V. I., Fogerty, R. L., Scheulen, J. J., High, H., Handley, K., Crow, L., & Goralnick, E. (2023). Hospital Capacity Command Centers: A Benchmarking Survey on an Emerging Mechanism to Manage Patient Flow. The Joint Commission Journal on Quality and Patient Safety, 49(4), 189–198. https://doi.org/10.1016/j.jcjq.2023.01.007

Hamed, N. M. H., Deif, O. A., El-Zoka, A. H., Abdel-Atty, M. M., & Hussein, M. F. (2024). The Impact of Enhanced Cleaning on Bacterial Contamination of Hospital Environmental Surfaces: A Clinical Trial in Critical Care Unit in an Egyptian Hospital. Antimicrobial Resistance & Infection Control, 13(1), 138. https://doi.org/10.1186/s13756-024-01489-z

Hu, Y., Dong, J., Perry, O., Cyrus, R. M., Gravenor, S., & Schmidt, M. J. (2021). Use of a Novel Patient-Flow Model to Optimize Hospital Bed Capacity for Medical Patients. The Joint Commission Journal on Quality and Patient Safety, 47(6), 354–363. https://doi.org/10.1016/j.jcjq.2021.02.008

Kim, J.-N., & Oh, I.-H. (2024). Optimizing Hospital Bed Capacity and Resource Allocation Using Inflow and Outflow Indices for Effective Healthcare Management. Inquiry, 61. https://doi.org/10.1177/00469580241304244

Lee, S.-Y., Chinnam, R. B., Dalkiran, E., Krupp, S., & Nauss, M. (2021). Proactive Coordination of Inpatient Bed Management to Reduce Emergency Department Patient Boarding. International Journal of Production Economics, 231, 107842. https://doi.org/10.1016/j.ijpe.2020.107842

Manning, L., & Islam, M. S. (2023). A Systematic Review to Identify the Challenges to Achieving Effective Patient Flow in Public Hospitals. The International Journal of Health Planning and Management, 38(3), 805–828. https://doi.org/10.1002/hpm.3626

McCrimmon, C. M., Fensterwald, M. R., Czypinski, L. K., Nuwer, M. R., Abelon, S. E., & Reider-Demer, M. (2025). Enhancing Patient Flow Through Standardised Discharge Pathways for Neurology and Medicine Services. BMJ Open Quality, 14(3), e003303. https://doi.org/10.1136/bmjoq-2024-003303

Mitchell, B. G., Browne, K., Kiernan, M., Parneix, P., & Russo, P. L. (2025). Hospital Cleaning: Considerations for Designing and Maintaining a Successful Environmental Cleaning Program. CMI Communications, 2(3), 105102. https://doi.org/10.1016/j.cmicom.2025.105102

Noronha, A., Bhat, S., Gijo, E. V., Antony, J., Laureani, A., & Laux, C. (2023). Performance and Service Quality Enhancement in a Healthcare Setting Through Lean Six Sigma Strategy. International Journal of Quality & Reliability Management, 40(2), 365–390. https://doi.org/10.1108/IJQRM-07-2021-0226

Omonaiye, O., Ward-Stockham, K., Darzins, P., Kitt, C., Newnham, E., Taylor, N. F., & Considine, J. (2024). Hospital Discharge Processes: Insights From Patients, Caregivers, and Staff in an Australian Healthcare Setting. PLOS ONE, 19(9), e0308042. https://doi.org/10.1371/journal.pone.0308042

Ozkaynak, M., Unertl, K., Johnson, S., Brixey, J., & Haque, S. N. (2022). Clinical Workflow Analysis, Process Redesign, and Quality Improvement. In Clinical Informatics Study Guide: Text and Review (pp. 103–118). Springer. https://doi.org/10.1007/978-3-030-93765-2_8

Samadbeik, M., Staib, A., Boyle, J., Khanna, S., Bosley, E., Bodnar, D., Lind, J., Austin, J. A., Tanner, S., Meshkat, Y., de Courten, B., & Sullivan, C. (2024). Patient Flow in Emergency Departments: A Comprehensive Umbrella Review of Solutions and Challenges Across the Health System. BMC Health Services Research, 24, 274. https://doi.org/10.1186/s12913-024-10725-6

Sarpong, K., Kamande, S., Murray, J., Wiley, A., Bhatnagar, A., Dowlati, E., & Nair, M. N. (2022). Consecutive Surgeon and Anesthesia Team Improve Turnover Time in the Operating Room. Journal of Medical Systems, 46(3), 16. https://doi.org/10.1007/s10916-022-01802-6

Schmutz, T., Le Terrier, C., Ribordy, V., & Guechi, Y. (2023). No Waiting Lying in a Corridor: A Quality Improvement Initiative in an Emergency Department. BMJ Open Quality, 12(3), e002431. https://doi.org/10.1136/bmjoq-2023-002431

Sohrab, T. B. (2025). Predictive Analytics and KPI Dashboards for Enterprise Workflow Optimization. ASRC Procedia: Global Perspectives in Science and Scholarship, 1(01), 1848–1886. https://doi.org/10.63125/5x0d1702

Tan, C. M., Bernstein, M., Raboud, J., Mannino, B., & Tinmouth, J. (2022). Efficiency in the Endoscopy Unit: Can We “Turn Around” Room Turnover? An Observational Quality Improvement Study. Journal of the Canadian Association of Gastroenterology, 5(4), e57–e64. https://doi.org/10.1093/jcag/gwac005

Valente, R., Santori, G., Stanton, L., Abraham, A., & Thaha, M. A. (2023). Introducing a Structured Daily Multidisciplinary Board Round to Safely Enhance Surgical Ward Patient Flow in the Bed Shortage Era: A Quality Improvement Research Report. BMJ Open Quality, 12(1), e001669. https://doi.org/10.1136/bmjoq-2021-001669

Wang, S.-T., Weng, S.-J., Yeh, T.-Y., Chen, C.-H., & Tsai, Y.-T. (2025). Optimizing Emergency Department Patient Flow Through Bed Allocation Strategies: A Discrete-Event Simulation Study. Inquiry, 62. https://doi.org/10.1177/00469580251335799

Zarbo, R. J. (2022). Management Systems to Structure Continuous Quality Improvement. American Journal of Clinical Pathology, 157(2), 159–170. https://doi.org/10.1093/ajcp/aqab109

Zehir, S., & Zehir, C. (2023). Effects of Total Quality Management Practices on Financial and Operational Performance of Hospitals. Sustainability, 15(21), 15430. https://doi.org/10.3390/su152115430