The Johns Hopkins Hospital in Baltimore is improving quality and patient safety with a state-of-the-art, advanced control center that coordinates care throughout the facility, bringing together many department representatives who can work efficiently with real-time data.
The Judy Reitz Capacity Command Center opened in February 2016 after Johns Hopkins leaders collaborated with GE Healthcare Partners (GE) to design and implement the center. Operating much as the central monitoring and command control one might find in a military complex or a nuclear power plant, the command center combines the latest in systems engineering, predictive analytics, and innovative problem-solving to address safety, volume, and the movement of patients in and out of the hospital.
About 24 staff members from different departments work together in a single room filled with computer displays that show real-time and predictive information. They are empowered to act to prevent or resolve bottlenecks, reduce patient wait time, coordinate services, and reduce risk. A main wall of computer monitors provides situational awareness and can detect potential problems, automatically triggering the command center team to take immediate action.
The system receives about 500 messages per minute on a typical afternoon, from 14 different Johns Hopkins IT systems generating real-time data, says James Scheulen, PA, chief administrative officer in the Johns Hopkins Department of Emergency Medicine and president of Johns Hopkins Emergency Medical Services.
“We came to the realization that the hospital was running constantly at a very high occupancy rate, and because of that our patients were facing more delays and we were not able to manage as many patients as we wanted to,” he says. “We had a problem with the number of patients who were waiting for an extended period in the emergency department before being admitted, and we had problems with our operative system getting people into patient beds, so we ended up cancelling procedures.”
The hospital also was not able to efficiently accept all the patient transfers from other hospitals, Prior to the command center, Johns Hopkins had a widely distributed system of control, rather than having key players together and others empowered to make decisions quickly.
“We had groups of people working together every day, coordinating services and optimizing what we provide patients, but they were distributed throughout the institution,” he says. “They had archaic communication modes, and even the process of doing their basic, fundamental work took too long because they didn’t share systems and information, and they’re physically in different locations. The simple process of getting someone in the hospital was taking hours instead of minutes.”
Needed to Improve Efficiency
Expanding capacity was not a viable solution to those problems, so Johns Hopkins looked at ways to improve efficiency.
“Everything about operating this place is about how process works. If you’re trying to improve an operation with high utilization, you can either control the number of patients accessing your facility, improve the number of beds you have, and you can control the time they take in process,” Scheulen says. “We can’t address the first two more than we’re doing already, so we have to do is to manage our processes very efficiently so we don’t waste time.”
The Hopkins team began with a series of process improvement projects intended to identify the processes that most needed improvement and would have the biggest effect on overall hospital efficiency. A first project was looking at perinatal delays and how to reduce OR holds.
Like at most hospitals, physical space is in high demand at Johns Hopkins, so finding a place to put the command center was a priority. Fortunately, one of the people working on the project with Scheulen oversaw a space that had recently been vacated, and she made it possible to put the command center there. It happens to be in the exact center of the facility.
“We could have made it work in another location, but having it dead center in the middle of all hospital operations sends the right signal to people that this is an important function, and that its purpose is to bring all these different departments into the same room,” he says.
Development and construction of the command center took 17 months, after more than a year of discussion, Scheulen says. Activating the command center did not require hiring any new staff; people from many departments were transferred to the command center to more effectively do the jobs they already were doing, Scheulen says. With the command center up and running, Hopkins is beginning more cross-training for the command center staff.
A key benefit of the Capacity Command Center is that it gives front-line managers real-time information about their work, so they don’t have to rely on old data, Scheulen says.
The command center replaces the traditional ways of doing many things in the hospital, such as using phones and email to assign beds, coordinate work between departments, and respond to problems, Scheulen says.
For instance, the technology in the Capacity Command Center keeps staff members informed 24/7 about when there is an influx of patients coming into the hospital, which hospital units need additional staff members, the status of how many patients are being treated, the need for and availability of beds across the hospital, the highest-priority admissions and discharges, and other information essential for ensuring high-quality patient care.
Scheulen says there have many measurable benefits from the command center: Johns Hopkins has seen 60% improvement in the ability to accept the transfer of patients with complex medical conditions from other hospitals around the region and country, and ambulance pickup times have improved significantly. A Johns Hopkins critical care team is now dispatched 63 minutes sooner to pick up patients from outside hospitals. In the ED, a patient is assigned a bed 30% faster after a decision is made to admit him or her, and ED patients are also transferred 26% faster after they are assigned a bed.
Better coordination also helped reduce transfer delays from the operating room after a procedure by 70%. In addition, the number of patients discharged before noon rose by 21%.
The software in the command center draws on data from the different software systems in use throughout the facility, applying logic and thresholds established for the command center, and displays it for the staff to see in real time. Staff response to a flashing display signaling trouble in a unit is governed by established protocols, which may include dispatching additional resources and staff, halting further admissions, or organizing a huddle with key people to find a solution.
“A lot of times you might think that the people involved should know what’s happening and how to respond, but in many cases we get a trouble warning or signal that something is building up, and we realize it before the staff on the unit does,” Scheulen says. “That’s from the real-time data and analytics, and it allows us to act on the problem and mitigate the issue immediately, and often before it even becomes a real issue.”
- James Scheulen, PA, Chief Administrative Officer, Johns Hopkins Department of Emergency Medicine, President of Johns Hopkins Emergency Medical Services, Baltimore. Telephone: (443) 510-5807. Email: firstname.lastname@example.org.
- Jeff Terry, MBA, FACHE, General Manager and Managing Principal, GE Healthcare Partners, Barrington, IL. Telephone: (262) 506-8029. Email: email@example.com.
- Bree Theobald, Vice President and Practice Leader Care Design & Delivery, GE Healthcare Camden Group, Barrington, IL. Telephone: (262) 506-8029. Email: firstname.lastname@example.org