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Children's facility comes into its own with cutting-edge access center
'It's like having a command center,' manager says
Ever since Monroe Carell Jr. Children's Hospital at Vanderbilt in Nashville, TN, opened more than three years ago, it has been "slowly but surely" establishing its own specialized access services mirroring those at the Vanderbilt University adult facility, says Tina Williams, CPC, manager of admitting and emergency registration.
The Children's Hospital opened its own business center right away, and has since moved over its own bed management staff and admitting management, Williams adds. The last service to be moved over is the transfer center, she notes, and the process is culminating with the creation of a distinct access center for the pediatric facility.
"We've created a little bit of a new model, different from the adult hospital," says Williams. At the adult hospital, she explains, "everything is separate." Bed management, the transfer center, the ADT (admission/discharge/transfer) staff, and the administrative coordinator are all in different areas, Williams says, and environmental services dispatch is in the same area as bed management.
At the Children's Hospital's access center, however, all of the functions mentioned above are headquartered in the same big room, she adds. "It's like having a command center in an emergency, but this is 24-7."
As a result, Williams says, "we are able to watch the flow of patients and communicate different issues and opportunities right in the same room, which is different from most hospitals across the country."
From that area, she continues, all the patient throughput stakeholders will be able to view the entire process — from the time a patient is discharged to when a dispatch that the room is dirty is sent to when cleaning starts to when the room is clean.
"We have two flat-screen monitors on the wall — one with the electronic bed board and one with the electronic white board from the emergency department," Williams says.
"We can see what patients are in the queue, what the bed availability is in the house, how many patients are waiting in the ED, and their acuity," she notes. "So we're not only all electronically connected, but now for the communication that requires a phone call, we'll all be in the same room."
The problem the hospital has experienced in the past is that each area involved in the throughput process tends to use its own system, Williams says. "Bed management has always used the bed board, the ED has always used the white board, and we have electronic dispatching for transport and environmental services."
While each staff could access the other's systems, whether and how often they would do so is another matter, she says. "The bed board and the white board do communicate back and forth to a certain degree, but this will enable all of the experts to sit in the same room and report through the same reporting structure."
All of the players involved already reported to her, Williams says, except for environmental services dispatch, for which she now has responsibility. The only access center employees for which she won't have oversight now are the administrative coordinators, which still report to nursing.
There will be a direct link with Vanderbilt University Medical Center (VUMC) Lifeflight, Williams explains, so that, when requested in the case of patients being picked up by VUMC Lifeflight, the access center can connect to Lifeflight dispatch for simultaneous activation of the transport team.
Those transports, however, will not be dispatched out of the center, she says.
Another big step for Children's Hospital, Williams notes, is the activation — on the same day the access center goes live — of the facility's own 24-7 trauma service, which means the capability to care for all children, regardless of the extent of their injuries or illnesses. (See related article in box below.)
Pediatric trauma service speeds up access to care
'Better communication' cited
"The common complaint of community hospitals," says Beth Broering, RN, MSN, CEN, trauma program manager at Monroe Carell Jr. Children's Hospital at Vanderbilt, "is that [their staff] get passed from one person to the next to the next."
Such occurrences should become virtually non-existent at Children's Hospital, she adds, with the activation on July 1 of the facility's own 24-7 trauma service.
"When a person calls and says, 'I need to help this child get out of my emergency department because he's very sick and I can't take care of him,'" Broering says, the last thing that caller needs is to be passed around on the telephone.
"They need a very rapid response," she says, "and [the new service] will significantly decrease our response time to these community providers. We will be much more efficient in our ability to respond to their needs."
In the past, Broering notes, the ED and trauma team at the Vanderbilt University adult hospital "would receive and care for and manage" children of all ages who had very critical injuries — including those who were unstable because their blood pressure or vital signs were abnormal — as well as any child who had "penetrating" injuries.
"Children's Hospital has been slowly increasing [its ability] to be able to care for the most critically injured," she says. "Over the past year, we have significantly ramped up our resources so that we will have the capability to care for all children, regardless of what happened to them, what injuries they have, and how sick they are."
The children's facility now has in-house pediatric trauma surgeons and an operating room with anesthesia coverage available 24 hours a day, Broering notes.
"We feel this will be very beneficial from a communication and access standpoint," she says. "This means that providers in the community don't have to wonder who to call: For anyone 15 years of age and younger, they call Children's Hospital."
Opening in conjunction with the trauma service is a new access center at the pediatric hospital that Broering says will further enhance the facility's relationship with community providers.
Any time a child goes to another hospital first and is then referred to Children's, she notes, providers will use the access center "and will be able to have better communication, improved follow-up, and more continuity. We are really excited about that."
(Editor's note: Beth Broering can be reached at email@example.com.)
New space created
To make space for the new access center, two offices — including her own — were vacated, and a wall was knocked down, Williams says. The area was gutted, and seven workstations, with computer ports and other equipment, were installed, she adds.
All calls coming into the access center will be recorded for quality assurance, Williams says.
The workstations are designated as follows, she says:
The access center will provide services such as notifying primary care physicians in real-time when a patient is admitted or discharged, Williams notes.
"This process will be done manually as we work on an automated process scheduled to roll out within the first 90 days of 'go live'"
The new center also will provide an ED "expect sheet" to let registration and clinical staff know about incoming patients, she says. "Say a physician is called in the middle of the night because Suzie has a 105-degree temperature and he tells the parents to take her to the hospital and that he'll call and let staff know she's coming.
"The old way," Williams explains, "the physician would call the transfer center and get connected to a resident in the ED who would fill out the expect sheet by hand."
As of July 1, access center employees still gave the PCP the option of talking to an ED resident, but they also completed the form and sent it to both the front desk and the ED treatment area, she says.
"The biggest downfall [in the past] was that when the physician connected with the ED resident in the back, he would complete the form, but nobody upfront would see it," Williams says. Registration staff didn't know about the physician's call or the expected patient.
Call ahead scheduling
Now the greeter or registrar will be able to confirm with the arriving patients and family members that their physician has called ahead, she adds. "The paperwork will also go to the triage nurse, who is the first clinical person the patient will see."
Staff can greet the patient with, "Oh, yes, we're expecting you." It makes the patient feel like, "Oh, my physician did what he said he would do."
In the past, it wouldn't be apparent to patient and family that the physician had called until they got to the treatment area, Williams notes. "We're hoping that this will be a big community physician pleaser."
Soon the new process will be further enhanced and the information will be sent electronically, she notes. "We have created an electronic expect sheet that will pop up on the white board to indicate the pending arrival of a patient.
"In the top right corner of the electronic white board, there will be the abbreviation 'exp' and a number indicating the number of expected patients," Williams explains. On the left side, she adds, there will be a list of names that staff can click on to display the actual sheet for the individual patients who are expected
One of the intentions with the new center, Williams says, "is that we will always provide our physicians with a live person who can assist them with access to our hospital."
Call volume is so high that under the old process, she adds, "if we can't answer in the transfer center, it rolls over to bed management, and if there is no answer there, it goes to an answering service. Children's will no longer have that rollover to the answering service."
Community physician liaison
In preparation for the opening of the new access center, Williams says, "a community physician liaison met with a large organization of physician practices that serve the hospital to explain exactly what is happening."
The idea, she adds, was "to actually give the visualization that the switch will flip and we will have specialized services within Children's Hospital. We are educating and reiterating to our physicians in-house and in the community that this is actually a place now, as well as a phone number, and what services will be available."
For the sake of continuity, the telephone number that in the past would roll over to bed management will be used for the access center, Williams says, but it will now be "for all of access. It will [reach] whatever you want.
"One of our physicians with a direct admit will get bed management, and if it's a facility-to-facility transfer from a small town, [that caller] will get the person needed to do that," she explains. Someone wanting to send a patient to the ED for evaluation will get the right person, Williams adds. "The only thing we won't handle will be transfers from the scene of an accident or emergency."
Staff at the adult transfer center have been — and will continue to be — "extremely helpful" in ensuring that customers' needs are met, she notes.
The biggest challenge will be getting the telephone number for the new pediatric access center ( 936-4444) out to callers accustomed to calling the number of the adult transfer center and then being transferred, Williams says. "We hope that because this will be such easy access and they won't reach a recording or be rolled over to an answering service, that they will want to use the access center number."
Either way, no customer will be told that they need to call another number, she emphasizes. "If you call the wrong number, we will still take care of your call."
(Editor's note: Tina Williams can be reached at firstname.lastname@example.org.)