Critical Path Network: Technology increases patient throughput
Critical Path Network
Technology increases patient throughput
System provides information in real-time
Oakwood Hospital and Medical Center reduced the number of patients waiting more than four hours in the emergency department by 35% and cut salaries by $60,000 after installing an electronic bed management system that provides information on bed availability and patient status and location in real-time.
"We had been using a manual system for bed management and knew we were not using resources efficiently. Patient throughput was a real issue. We were looking for real-time information to improve the patient experience and patient safety," says Monica Donofrio, RN, BS, CPHQ, senior director for care management and access.
The salary savings were generated by eliminating staff whose main responsibility was to round on the floor to find empty beds and communicate with the bed control center. In addition, because the system is paperless, the bed control center was able to decrease the paper it prints each day by 250 sheets, she adds.
The hospital's electronic "whiteboard" interfaces with other systems in the hospital, giving staff all over the hospital information in real-time.
"This system enables us to admit patients more efficiently and to move them along the continuum in an efficient and effective manner," Donofrio says.
The hospital uses an off-the-shelf capacity and throughput management software package with some customization.
Large electronic displays throughout the hospital have color-coded and time-stamped icons that allow the staff to see the status of every room and what is going on with the patient at a glance without having to log in to any system.
For instance, rooms for patients in observation status are shown in blue; those with patients with a scheduled discharge are green striped; empty rooms are white; rooms being cleaned are brown striped.
Icons on each room provide additional information, such as identifying patients with a core measure diagnosis or those who need consultations for case management or social work. Other icons indicate if a patient needs transportation, when diagnostic results are available, when medications are ready, and if there is a patient safety alert, such as a potential for a fall.
Timers for all assigned patients and beds alert staff to the time the discharge orders were issued, when patients were placed in observation status, when patients will be leaving the hospital by ambulance, and other information.
When the result of an X-ray, MRI, blood test, or other test or procedure is posted in the hospital's electronic information system, an icon pops up on the patient's room and stays for 30 minutes, notifying staff that the results are in the system. If the results are normal, the icon is blue. If they are abnormal, the icon is red. If they are a critical value, the icon is striped.
"If case managers or bedside nurses are waiting for results before developing a plan of care or discharge plan, they can see when they're available, rather than having to go in and out of the system to check," she says.
The system helps cue case managers to work on the case so that patient doesn't exceed his or her expected length of stay.
For instance, if a patient is in observation status, the screen shows that room in blue with a timer that indicates how long the patient has been in that status.
"When the case manager arrives in the morning and sees someone who has been in observation since the evening before, he or she knows to expedite the plan of care and ensure that the patient is either admitted or is ready for discharge," Donofrio says.
After the patients are admitted, staff can use a mouse to hover over the room and determine the patient's insurance coverage, length of stay, and other information.
"This allows the case managers to see which patients need utilization review so they can begin to process that work," Donofrio says.
All patients who are admitted to the hospital, flow through the bed control center. About 55% of patients are admitted through the ED.
When patients are waiting for a bed, the bed placement staff are able to look at the electronic whiteboard and go through the hospital unit-by-unit or in special screen views to see all potential discharges, all pending discharges, and all empty rooms.
When an inpatient is assigned a bed on a different unit, it feeds into the system.
"With an in-house transfer, we can see how long we're waiting for a patient to move from one room to another. The system is a tool that helps the nursing leaders manage an efficient throughput on their units," she says.
Discharge within three hours of order
The system helps the hospital meet its goal of discharging a patient within three hours of the physician signing a discharge order.
Each day, case managers and unit nursing leaders manually input into the system any patients with an 85% or greater chance of discharge.
"Based on the patient's DRG or clinical condition and knowing the physician's discharge plan, the case manager uses the electronic system to notify everyone on the floor that the patient is likely to leave," Donofrio says.
When the unit case management placement coordinators process an ambulance transfer, a time pops us, alerting the entire unit-based interdisciplinary team to make the final discharge arrangements.
"This enables everybody on the patient care team to organize their work around the timing so the patient is well prepared to leave when the ambulance arrives," Donofrio adds.
The housekeeping system interfaces with the main system, which notifies the housekeeping department when a patient is discharged. The system includes information on specific types of cleaning needed, such as if the room is an isolation unit.
The housekeepers enter codes through the telephone when they start to clean the room and when they have completed the cleaning process. All phases of the bed cleaning process are displayed on the electronic whiteboards and allow bed control to assign patients before the cleaning process is completed.
"Patients are much happier knowing which bed they will be admitted to and knowing it will be only a short while until the room is ready," Donofrio says.
There are electronic whiteboards at each nursing station, on each hallway, and in the physician lounge, allowing the doctors to see at a glance where bottlenecks are occurring so they can move their patients out faster if appropriate.
Some contain information just for the floor on which they are installed. Others, such as those in the bed control department, nursing office, or physician lounge, have an enterprise view that includes all nursing units and all waiting areas.
Radio-frequency devices implanted in the patient chart help the staff track when patients are in and out of the room. The electronic boards show where every patient is at any point during the day.
For instance, if a physician comes to the hospital to see a patient, he or she can go into the physician lounge and see that the patient is in the X-ray department.
"When physicians identify that a patient is not in their room, they can go to that treatment or diagnostic area to evaluate the patient and make their notes on their assessment findings in the chart. It makes their time very efficient," she says.
The hospital has a geographic-based care management model. Most of the patient care units are DRG-based.
On the inpatient side, one case manager and one social worker are assigned to a 32-bed unit.
The case managers handle utilization review, home care referrals, and resources used within the organization. The social workers focus on patients with psychosocial needs and discharge planning, particularly for complex patients who need long-term acute care.
Before implementing the new system in June 2007, the hospital held 10-minute inservice educational systems to show staff how the system works.
"It's a very simple system but we needed to show what the colors, stripes, and timers mean," she says.Oakwood Hospital and Medical Center reduced the number of patients waiting more than four hours in the emergency department by 35% and cut salaries by $60,000 after installing an electronic bed management system that provides information on bed availability and patient status and location in real-time.
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