Management of patient flow is a complex issue that has been known to cause headaches for hospital executives. In health organizations across the country, complaints are being registered about the valuable time that is wasted as staff members try to figure out what is causing bottlenecks, whether a certain room is available or a patient is ready, and which rooms need to be cleaned.
Some CIOs, however, have found a way to crack the code by deploying patient flow and bed management systems that link with other systems to provide clinicians with a complete, up-to-date view of the status of every room in the facility, organized by floor, department or unit. By looking up at a large screen or logging onto a computer, clinicians can find out what rooms are available and which patients are ready to be discharged, and can learn other vital pieces of information about patients.
It's precisely what Bill Colbert, vice president and CIO at University Health Care System in Augusta, Ga., had in mind when he paid a site visit to a hospital in Alabama a few years ago. When he walked in and saw an electronic board that featured a graphical display of the hospital unit with data on the status of each room, he says he was sold.
“That was exactly what we were looking for,” Colbert says. “It was our goal to be able to present a complete patient picture to a doctor or nurse who could see it and understand what was going on with a patient at a certain point in time. We wanted a system that would give us a complete view of what was going on in the hospital.”
In July of 2008, University Health went live with the Horizon Enterprise Visibility, a system developed by Awarix, which was acquired by Alpharetta, Ga.-based McKesson in 2007. So far, the solution has exceeded his expectations, with the organization realizing — and in some cases, surpassing — all six of the goals it established prior to rolling it out. According to Colbert, University Health set out to achieve a 10 percent reduction in inpatient transfer time, total discharge process time, emergency department (ED) transfer time, diversion hours, and ED length of stay. Within a few months, the organization achieved the following:
Inpatient transfer time decreased from 85 minutes to 50.89 minutes
Total discharge process time decreased from 210 minutes to 187 minutes
ED transfer time went from 87 minutes to 58.31 minutes
Hours spent on diversion status (deciding whether to accept ambulance patients) went from 30 hours per month to 17 hours
ED length of stay decreased from 276 minutes to 149 minutes
Another objective — increasing the number of discharges before noon by four percent — was also realized. Four months after the system went live, University Health saw the figure increase from 30 percent to 32 percent. “Those were all good statistics, and we were able to incorporate them into our presentation to the board when we asked for more money,” says Colbert, who hopes to deploy the system at the new cardiology tower expected to go live in January at University Health. “Our team has done an excellent job with this.”
University Health certainly isn't alone in its success; several other organizations have yielded positive results after implementing enterprise-wide patient flow systems. After deploying the BedTracking system from Pittsburgh-based TeleTracking Technologies, Lehigh Valley Hospital and Health Network in Allentown, Pa., saw bed turnaround time decrease from 240 minutes to 60 minutes at the Cedar Crest site, to 45 minutes at the 17th and Chew Street location and 37 minutes at the hospital's Bethlehem campus, according to the company.
Organizations that utilize systems like those offered by TeleTracking and Statcom (Alpharetta, Ga.) are leveraging real-time technologies and intuitive dashboards to create a centralized source for patient flow information and help link together different information systems. One of the key components of these systems, says Fran Turisco, is the ability to speak with other technologies. According to Turisco, principal researcher in the Lexington, Mass.-based Emerging Practices division of the CSC Corporation (Falls Church, Va.), most patient flow systems can interface or, in some cases, integrate with admissions-discharge-transfer, laboratory, and information systems.
“It just makes life a lot better for the nurses and for bed management,” says Turisco. “It seems like it has a lot of benefits, but it's not like it does anything new or wonderful — all it does is connect the dots. You don't have to place a call to ask a question or go digging in the clinical information system to find out of the lab result came back, because it's right there.”
Once the interfaces have been built, little involvement is required by the IT department. “Once you figure out what roles are going to be involved — who gets to view the information and who gets to go into the system and update it — it doesn't take long to roll out. We're talking 3-6 months as opposed to two years,” says Turisco. “It's really a project that's led by nursing and the bed management crew. So other than the interfaces, there's not a lot of IT involved.”
At University Health, the Visibility system integrates with McKesson's Horizon Clinicals to provide pertinent information about patient stay and track patients if they move rooms or departments. According to Colbert, color-coded icons are used to display data such as a room's status, the type of patient, whether a room is clean or dirty or in progress, and whether a room is on hold. All clinicians have to do, he says, is look up at a screen.
Says Turisco: “It allows clinicians to have a single look at what is going on in their unit and what needs to be done.” And in doing so, it helps them prioritize their work and turn beds over more quickly. “It takes the information, summarizes it, and puts it in a view that you can take one look and understand 10 things that you need to know.”
Another advantage in using enterprise-wide flow management systems is the potential to facilitate more effective communication between different departments, such as environmental services and nursing. For example, in some organizations, when a patient has been discharged, a light above the door is switched on to signal that the room is ready to be cleaned. However, if the housekeeping staff is not in close vicinity of the room, they may not notice that the light is on, and the room can remain vacant for a prolonged period of time, Turisco says.
With patient flow systems, staff workers can go online to see which rooms are empty or soon will be empty, enabling both nursing and environmental services to more efficiently plan and carry out their assignments. “That's a huge time-saver,” she says. “It eliminates the nurse from having to log into the system to check items individually.”
Dollars and sense
For Frank Clark, Ph.D., CIO at Medical University of South Carolina (MUSC, Charleston, S.C.), it was also a goal to provide clinicians with better visibility. But the key driver in deploying the bed management system from the Farmington, Conn.-based Premise Patient Flow Platform was to improve throughput in the four-hospital, 596-bed academic health system.
“We were turning patients away,” Clark says. “We didn't have beds available, so there was a conscientious effort across the hospitals to see how we could increase throughput and increase collections through the entire revenue cycle management process.”
With many hospitals feeling the crunch brought on by the current economic situation, having a system that can better manage the flow of patients who are waiting to be admitted into rooms at a quicker rate can make a significant difference, he says. Since the Premise system went live early in 2008, Clark says he has noticed improvements in bed turnover and staff efficiency.
“It's proven to be a good tool for tracking patients and beds as well as communicating what needs to be done,” Clark says. “It's been valuable across the clinical enterprise — not just for medical-surgical beds, but also for critical care and trying to increase throughput in the emergency department to decrease wait times in the emergency room as well as the operating room.”
In order to maximize profits in the OR, which is a significant source of revenue at MUSC, the staff is looking to increase the number of procedures performed in the department, says Clark. However, many surgeons prefer to work during daytime hours, making it all the more critical that patients are moved quickly through the process. This is a situation, he says, is where a system that can aid in flow optimization and throughput must be leveraged.
“With the economy the way it is, things like collecting money on patients, making sure we're not leaving any money on the table, reducing bad debt, reducing AR days, and just improving the entire revenue wherewithal of the hospital are all so critical,” he says.
In fact, Clark says he feels that hospital executives can view the economic downturn as an opportunity to evaluate how they are spending money and determine how to increase efficiency.
“Most hospitals are going through some difficult times, we're seeing layoffs across the country,” he says. “A crisis can be a good time to look at yourself and try to improve and become better at what you're doing. It's easy to get off course when times are good and overstaff or not really look at your medical-surgical supply costs and not buy off your contracts. Sometimes it takes a crisis to solve a crisis.”
Patient flow and bed management systems, he says, are a technology that can offer a valuable service without breaking the bank — or the CIO's back, for that matter. At MUSC, the implementation of the Premise platform was driven by admissions and the nursing, and has proven to be that rare, easy win.
“It brings a lot of salient, pertinent information to management to look at the whole patient flow to see where the bottlenecks are and how to improve it. It just automates the whole process and makes a lot of nice reports available,” Clark says. “And in the scheme of things it's a fairly easy implementation. Any time you can get a quick win and bring closure to a project, you don't turn down that opportunity.”