Amid an urgent push to use staff and existing beds more efficiently, and capture more incoming patients, hospital and health system executives are continuously looking to improve hospital operations by using real-time data.
As such, Health First is using Lean methods to improve efficiencies in various departments. The integrated delivery network, headquartered in Rockledge, Fla., has 900 beds across four hospitals, a large multi-specialty medical group, outpatient and wellness services, and health insurance plans.
Specifically, the patient care organization uses technology from Pittsburgh, Pa.-based TeleTracking to monitor daily hospital functions in real time and capture performance data on pull time—the length of time it takes for patients to occupy assigned beds—number of transfers, and total length of stay, as well as turnaround time for all ancillary support services, with the goal of eliminating wasted time and resources. Initially, the idea was to find an environmental services solution for bed cleaning, but then Health First operational leaders started looking at the TeleTracking software for bed placement and transport. Then came the ability to do predictive modeling, says Lisa Maples, director of centralized patient logistics at Health First.
As director of centralized patient logistics, Maples is in charge of anything to do with patient flow and throughput. Every patient that comes in to the organization—be it through the emergency room (ER), intensive care unit (ICU), or operating room (OR), for instance—comes via TeleTracking, where Maples’ frontline staff then makes decisions on bed placement at one of the four hospitals, Maples notes. “We are trying to take a look at volumes coming into our ER. We know what’s been happening historically and know what’s going on now, so we are looking at our admission percentages based on physicians working in our department, we looking at our OR schedules and our [catheterization] lab schedules, all so we have a better picture of what we think we will have as far as admissions per day,” Maples says.
Working with the TeleTracking technology, Health First has what it calls “conditional discharges” that its physicians write. Those then go into the TeleTracking system, and that gives Maples’ team a number of pending discharges for the next day or two days, she explains. “We take a look at all of that information and marry those data sets together,” she says. “This is what we have coming in based on history and schedule, and this is what we have going out. So we try to figure out we’re at as far as where we are with our current census, what is coming in and going out, and try to predict on Monday that Wednesday might be a good or bad day [for admissions], for instance. And then we staff accordingly and look at how we can work through scheduling,” Maples says.
Additionally, the software, which Maples notes integrates with Health First’s electronic health record (EHR) via approximately 30 interfaces, will give metrics for every patient step taken within the organization, from the time he or she comes in to the time he or she leaves. This includes, among other things: how long it took a patient to get through the ER, how long a patient stayed on floor, and how long it took to downgrade a patient. That data is then used to get information about how patients are flowing, high length of stay days, and when certain “milestones” are reached before a patient is discharged. Milestones, Maples explains, are fed from the EHR interfaces, and can include when education for patient has been done, or when medication reconciliation has been signed.
This organizational effort to leverage minute-by-minute census data to forecast and anticipate capacity issues before they occur, led by Maples’ team, has resulted in in 33,000 fewer hours of ED wait time, a 12.9 percent reduction in average cost per discharge and 1.5 days (19 percent) reduction in average length of stay—all this despite a 27 percent increase in total annual admissions and no additional inpatient beds, Health First officials note.
“We have lots of data, more than 300 reports, that are written and given out to the appropriate people, and that data drives the work we want to do,” Maples says when asked about the difference now with data transparency compared with before TeleTracking. She adds that the frontline staff loves the visibility with the system. “They used to have to make phone calls to find if patients will get a bed and when it might be ready. There were so many different questions, but now [our staff] has the visibility with the system so if a patient is asking them something, they know the answer for sure. They see the transparency all across the organization, which in turn makes their jobs easier,” Maples says.
She adds that another added benefit of the technology is being able to get deeper views across the entire system as opposed to only for each individual hospital. “That probably made the biggest difference, being able to use this system to its truest potential,” she says. Now, Health First is able to utilize all of its 900 beds as a system, thus letting Maples’ team quickly figure out where a transport patient should be placed, for instance. “It gives us the ability to look across the system and use any of our beds rather than be pigeonholed at a particular hospital. That’s’ been a great benefit,” she says.
Maples says having the data that can be trusted, indeed a new phenomenon in healthcare, is extremely important for any healthcare organization. “Every one of the changes we have made, all our Lean processes and changes, we could not have sustained it without the data,” she says, adding that it’s equally important to keep up the same level of concentration, even after achieving initial success. “Here’s where we are, so now let’s sustain it. You can lose focus easily. We will still send you reports and you’re still responsible to make sure your team is meeting the goals, and the data will help determine if you’re slipping or not,” Maples says.