The struggle to achieve efficient patient flow remains a pervasive one amongst hospitals nationwide, with the majority of providers having devoted considerable resources towards addressing problems such as overcrowding and a lack of available beds.
The challenges of patient flow within a hospital are both systemic and cultural. In January 2005, The Joint Commission introduced a new Leadership Standard, "Managing Patient Flow," in an effort to mitigate internal impediments to patient flow issues by holding hospital leaders accountable for the problem.
In an effort to expedite bed turnover and patient throughput, Scripps Mercy Hospital, Chula Vista, Calif., a 183-bed acute-care facility, implemented Pittsburg-based TeleTracking's Bed Management Suite, which includes bed tracking, pre-admit tracking, and transport tracking modules.
Essentially, the solution is comprised of two parts, explains Donna Hewitt, patient logistics supervisor, Scripps Mercy Hospital. First off, it's a notification system that informs housekeeping when a bed has been vacated and is in need of cleaning, it also reports pending and confirmed discharges, and notifies transport staff to move patients throughout the system. The second element to the solution is the computerized bed board, which is a large screen that displays the status of every bed throughout the hospital.
Although patient data can be automatically transferred from the hospital's ADT (admission discharge and transfer) system to the TeleTracking system, Scripps still uses manual entry to input information such as bed status or pending discharges into the solution.
However, this isn't always a perfect scenario, as manual data entry can be the point of failure for many systems warns Hewitt. "Your system is only as good as the data that is being plugged in."
When Scripps first implemented the system, in January of this year, the inputting of data was not as accurate as it should have been, she says. However, Hewitt contends that making this function part of a nurse's job responsibility and holding them personally accountable for erroneous data went a long went a long way towards combating this problem.
After ironing out some cultural challenges, such as having staff members incorporate TeleTracking into their daily routine, Hewitt says the system is working well, and has significantly reduced the number of phone calls amongst staff looking for beds, while also providing the ability to allocate staff from light workload areas to heave discharge areas. In addition, she says the solution enables the hospital to take in more direct admissions from the community. In other words, physicians wanting to admit patients directly from home don't have to send them through the ED in order to get a bed.
The hospital staff has had a positive experience using the system, and Scripps has increased its patient through-put, says Sandy Freidman, project manager at Scripps. However, Friedman laments there have been numerous technical glitches that have prevailed throughout the implementation and maintenance of the system.
"TeleTracking is a young company that's growing very fast, and what's typical of companies like this that provide niche products are that they grow faster than their infrastructure allows. They start hiring people quickly and not training them well, and then we get gaps of coverage," she says.
One feature of the TeleTracking system is totally controlled by the vendor, and that has caused some problems, he explains. TeleTracking technicians have the capacity to VPN into the hospital's system, and unless they're properly trained, says Freidman, they can inadvertently cause a problem with the facility's server. "This has occurred a number of times — to the point where we considered turning the VPN tunnel off. But this was only going to increase the lead-time it took to fix a problem, so we decided to leave the VPN tunnel switched on," he says.
Although Freidman opines that TeleTracking did a good job configuring the application and training the end users, "When it came to setting up our servers, the first thing they should have done was make sure the technical environment was set up correctly before they started installing the software, and they didn't do that." Because the servers were not installed properly, TeleTracking's application crashed, and had to be re-installed. "This was obviously extremely time-consuming and frustrating, but these types of technical problems are improving," assures Freidman.
Patient time stamps
Some hospitals are combating their patient flow issues by implementing a system beyond basic bed tracking.
In May of this year, Methodist Hospital, Omaha, Neb., a 430-bed acute-care facility, implemented Navicare Patient Flow solution, provided by Hill Rom (Batesville, Ind.), which enables staff to track patients throughout the entire continuum of care.
"We looked at a number of systems, but this was the only one that offered us an enterprise-wide solution, and therefore gave us the ability to track a patient from the point of admission all the way through to discharge," says Ruth Freed, vice president, patient services, Methodist Hospital.