Optimizing patient safety often means knowing what is going on throughout the hospital and responding before an issue gets out of hand. At most hospitals, those in charge are in different places and without all the data they need to intervene quickly.
That was the situation at The Johns Hopkins Hospital in Baltimore, until it created a state-of-the-art, advanced command center that coordinates care throughout the facility. The command center is staffed by representatives from many departments, with access to a wealth of information that allows them to monitor and respond in real time.
The Judy Reitz Capacity Command Center opened in February 2016 and is similar in appearance to those in controlling space flights, albeit on a smaller scale. It 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. Johns Hopkins worked with GE Healthcare Partners (GE) to design and implement the center.
The command center is staffed by about 24 people from different departments, working together in a single room filled with computer displays that show real-time and predictive information. They are empowered to take action 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 of time 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 who worked 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 the 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 what 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 produce 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 top priority. Fortunately, one of the people working on the project with Scheulen was in charge of 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 perform the jobs they already had, Scheulen says. With the command center up and running, Hopkins is beginning more cross-training for the command center staff.
“That interdepartmental support, with people understanding each other’s jobs and being able to pick up the duties of someone in another department when needed, would never have been possible before,” Scheulen says. “But now we’re seeing that come together.”
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.
One tile display in the command center is called Unit Under Pressure. When a particular unit is overloaded or close to it, the display flashes red to alert command control staff.
“We realized that though we wanted to move patients in and process them as quickly as possible, there was a risk with that. If we didn’t pay attention to the workload of the individual unit, we could potentially overload them and put patients at risk,” Scheulen says. “We worked with the units to find the appropriate thresholds for when that might happen. So if a unit has just had three patients discharged, two patients admitted, and they’re dealing with a rapid response, the command center needs to know that so that we don’t send them more patients and can send resources to help them.”
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 receiving treatment, 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.
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 also are 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%.
“We went into this thinking we were building it for a few things — to work on boarding, accepting patients, and the OR flow problem,” Scheulen says. “As we continue with the command center, it becomes clear that the capacity management function has really evolved from primarily easing the intake of patients to becoming the daily operational center of how patients flow through the hospital.”
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.”
Scheulen notes that hospitals can apply some of the lessons from the Hopkins command center even if building a new command center is not feasible.
“What we’re demonstrating here is the ability to implement systems engineering tools into healthcare. These sophisticated tools of modeling, data simulation, and system availability can be pulled into healthcare to manage complex organizations,” he says. “Think about the complexity of your own organization and tailor this kind of approach to your own needs. Not every hospital can afford this and not every hospital needs this, but the general principles behind it apply, whether you’re a 50-bed hospital or a 50,000-bed hospital.”
- 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: Jeffrey.Terry@med.ge.com.