No knew the world would be in the grips of COVID-19 in 2016. That is when Johns Hopkins Hospital unveiled a first-of-its-kind Capacity Command Center (CCC), a high-tech control room designed to apply all the latest analytical tools to bed management, patient transfers, and surge planning.
Built in collaboration with GE Healthcare, CCC leaders have spent the last five years working around the clock to optimize patient flow and anticipate any potential bottlenecks. But there is no question the concept has been put to the test by pandemic conditions. How did it fare?
By March 1, 2021, administrators reported the CCC managed the transfer of 659 patients with COVID-19 to and from hospitals in the Johns Hopkins Health System. Another 877 patients with the virus were transferred internally within Johns Hopkins Hospital. In each case, there were no reported patient-to-staff virus transmissions.
Safe transfers are a key responsibility of the more than two dozen staff members who work the CCC 24 hours a day, but this only represents a slice of what the CCC is all about.
To find out more about how the concept performed in the most harrowing of years, ED Management connected with Anna Ye, MHA, assistant administrator of the office of capacity management, the leadership team of the CCC.
Accelerate the Pace
Not surprisingly, Ye says the hospital was fortunate the CCC had been running for several years before the pandemic hit.
“We maintained normal operations as we worked,” she says. “We didn’t have to alter much about how we were operating to manage the volume, understand the changes that were happening, and how to respond to them.”
However, that does not mean there have not been challenges. For example, Ye notes the pace for decision-making had to accelerate, beginning with the initial patient surge in April 2020.
“The office of capacity management was heavily involved with the leadership team of the hospital to try to anticipate the creation of spaces needed to take care of our patients, especially those with COVID-19,” Ye explains. “Having the [CCC] gave us the ability to use these systems engineering tools that we have at our disposal, tools like predictive modeling and real-time analytics, to help us make those quick strategic decisions.”
During the rapid influx of patients in spring 2020, CCC staff members were devising ways to create new COVID-19 units every week.
“We used epidemiological modeling to try to anticipate what the demand [would be]. Based off of that, we created a surge plan of how many COVID-19 patients we might see in the coming weeks,” Ye shares. “We tried to stay at least two weeks ahead, but we could plan even a little bit further ahead.”
Such plans would include provisions for how the hospital would respond to various levels of demand. As soon as one hospital unit was turned into a strictly COVID-19 unit, CCC staff members were thinking about how they would flip the next unit.
The CCC remained the center of gravity for all clinical operations within the hospital. But Ye notes that with COVID-19, it quickly became clear there was a need for new avenues of communications.
Not only was it vital to keep the hospital’s leadership team connected and involved, it was important to maintain the transparency of decisions made at the executive level. Thus, the CCC began to host daily leadership briefings. “At the beginning of the pandemic, we were actually having [these briefings] twice a day, but now we have gone to a daily cadence, [including] 50 to 100 leaders across the hospital,” Ye explains. “This is where any new therapeutics or new guidance from the CDC can be brought up and discussed at a leadership level, and where quick decisions can be made.”
The briefings have enabled the CCC to act faster and to stay on top of any changing needs or directives. For example, it became clear that long waits for COVID-19 test results for patients presenting to the ED were a significant drag on hospital throughput. CCC leadership seized on the opportunity to bring in the equipment necessary to provide point-of-care testing in the ED, a step several physicians had been pushing administrators to take before the pandemic.
“Once we put in the point-of-care testing and also put in some automatic orders to get the testing done from the nursing perspective, that really helped push our throughput and allowed us to deal with some of the isolation concerns [with respect to patients with suspected COVID-19] a little bit more easily within the ED,” Ye says.
The approach has eliminated the time it used to take for specimens to be transported to the hospital’s central lab for processing. Test results are expedited. “This was a big project. A lot of different people were involved, but it has been a huge success,” Ye adds.
Beyond leadership briefings, the CCC stays in close contact with the ED all day, every day. “We have our bed management staff in the CCC, and a lot of our admissions come through the ED. They are in constant communication about what operations look like in the ED and how they might affect the rest of the hospital,” Ye says.
Typically, when the ED decides a patient needs to be admitted, the bed managers in the CCC will receive an alert to look for a bed for that patient.
“If there is a disagreement with the service line or the level of care, [the bed managers] will communicate with the clinicians in the ED to determine what the best placement for the patient might be,” Ye says. “Often, this goes without a hitch, but if there is any escalation needed, that is when the attendings will come into play.”
Before the pandemic, the CCC was working to ensure patients who present to the ED with mental health concerns or substance use disorders received prompt, appropriate, and safe care, and that approach has continued. However, as a systemwide strategy, added provisions have been put in place for patients in this population who also have COVID-19.
“We created a special [psychiatric] unit at one of our hospitals where we would transfer any patients from across the entire health system if they became COVID-19-positive at any point,” Ye explains. “That eased any isolation concerns while also making sure those patients receive the best care.”
The CCC has a range of procedures and protocols in place for when the hospital hits high occupancy levels, all of which were employed during surges of COVID-19 patients. These included building new ICU-level care units, working with the hospital medicine team to discharge as many patients from the floor as possible to improve throughput, and helping the ED with extra beds and linens.
Ye acknowledges the demand for ICU beds proved particularly challenging. This prompted capacity management leadership to create a new role in the CCC called the Hopkins triage and integration physician, a position designed to help with triage, but especially regarding ICU-level care.
“Since the ICU was such a bottleneck for us, we needed to make sure that appropriate patients were placed in our ICU beds,” Ye explains. “This was definitely a new lesson for us, and something we will continue using going forward. Having a physician in the CCC helping to triage patients has been really beneficial.”
Since the debut of the CCC, other medical centers have jumped into the space, creating command centers of their own, often with the guidance or assistance of the pioneers at Johns Hopkins. “Before the pandemic, we were doing one to two tours [of the CCC] every week,” Ye observes. “We are happy to share everything we have learned ... with anyone who will listen.”
Johns Hopkins is hoping to learn from the new entries into the space, too.
Adds Ye, “We have been able to create an ecosystem of others who share the same mindset and some of the same challenges that we have now.”