The flow of patients within the hospital from one ward to another is
             similar to the transfer of a baton from one runner to another in a track
             meet. Winning or loosing is in the details. This incoming runner has to
             be matched in speed and distance traveled by the runner receiving the
             baton. Their goal is to stay within the lane, and within the boundaries and
             make a full speed exchange so that the next runner can perform to the
             highest level of his ability. Failing to execute a perfectly timed
             exchange can cost the team seconds, or even the race.
             As patients are transferred from the ICU to the step down care wards,
             and then ultimately released to the care of their families, winning' for
             the hospital is defined as maintaining a continuum of care for the patient,
             as well as an efficient exchange of responsibilities. The baton'
             exchanges that happen within the hospital wards is easily manages, even if
             one of the players misses a few details on the first attempt of the
             exchange. As the patient approaches release, however, the hospital must
             make the final decisions, and finalize the release without incurring
             additional costs in order to win' the race.
             This metaphor should not be misunderstood. The hospital's goal is not
             to treat and street' the ICU patient as fast as possible without regard to
             their overall condition. But in order to eliminate inefficiency, the ICU,
             and subsequent step down wards do want to affect an efficient flow of
             patients form one ward to another in order to be prepared for the arrival
             of incoming patients, and not create financial overruns by holding onto a
             The bottleneck in the model example occurred during the release of
             patients from the step down unit to the care of their family in relation to
             becoming prepared to receive new patients from the ICU wards. When the
             patients are not released on time from the step down units, the ho...