Last month, the leaders of Children’s Mercy Kansas City, the Kansas City, Missouri-based health system anchored around a 386-bed children’s hospital, announced that they had opened an operations center that is using advanced data analytics to optimize patient flow management, and therefore improve patient care delivery.
As the press release announcing the move on April 24 noted, “Children's Mercy Kansas City, a leading independent children's health organization, announced the launch of the Patient Progression Hub – a hospital operations center that uses artificial intelligence (AI), predictive analytics and real-time information to optimize care progression and coordination from the time a patient's admission is requested until discharged. Children's Mercy is the first freestanding pediatric hospital in the nation to collaborate with GE HealthCare to embed this state-of-the-art technology in its operations to improve access, streamline the flow of patients, enhance discharge planning, improve staffing needs, and forecast patient demand.”
"With the activation of the Patient Progression Hub, Children's Mercy will be at the forefront of technology-enabled innovation in patient flow, quality outcomes and safety," Paul Kempinski, president and CEO of Children's Mercy, said in a statement contained in the press release. "By maximizing the use of actionable, real-time, and predictive data, we will improve the experience of our patients, families and team members alike."
The press release went on to note that “The 6,000-square foot hub, inspired by NASA's mission control center, houses a video wall with customized analytic apps, or "tiles" to monitor and manage the flow of patients. The system uses AI algorithms to identify potential issues, enabling care teams to proactively solve problems before they arise.”
"Our goal is to make it easier for Children's Mercy to orchestrate daily patient care, which in the end means it's that much easier to answer the crucial question: can you accept this child," said Jeff Terry, CEO, Command Centers at GE HealthCare, in a statement contained in the press release. "The Patient Progression Hub combines several existing teams into a new center-of-gravity for patient access and supports throughput and quality care delivery. GE HealthCare is proud to provide its "Command Center" software which is used in the Hub and across Children's Mercy."
The press release also noted that “Hub team members are co-located in the space to facilitate greater communication and collaboration, break down bottlenecks and barriers, and increase satisfaction for both patients and employees.”
"Prior to implementation, the organization relied on manual processes and often retrospective data to understand patient census and anticipate discharges," said Jodi Coombs, R.N., executive vice president and COO at Children's Mercy, said in a statement contained in the press release. "Now we have visibility into operations across the entire system to make faster and smarter complex decisions as soon as vital workflows change. The Patient Progression Hub journey enables endless possibilities for using real-time data to drive actions that deliver excellent patient care and supports our team members."
The press release went on to note the following:
“The Patient Progression Hub enables improvements such as:
Managing right bed, right place, on time – Centralizing bed placement allows staff to manage bed assignment workflow, prioritize bed placement, and place external/intra-system transfers in a timely manner.
Avoiding unnecessary delays – Real-time data allows staff to address potential delays, such as reducing time patients wait in the Emergency Department or the Post-Anesthesia Care Unit (PACU) for an inpatient bed to be available.
Improving staffing – AI predicts patient census levels 24 and 48 hours in advance with a high degree of accuracy. By predicting future demand, staffing needs can be filled, assuring patients are cared for by the appropriate care teams.
Streamlining discharge process – Real-time data and predictive analytics track each patient's journey, enabling staff to prioritize tests, procedures and medicines to get the patient discharged in a timely manner and open a bed for another patient who needs it.”
"Most patients and families won't even know the command center exists, but they will significantly feel the impact – less waiting around for a bed and getting discharged quicker so they can go home that much sooner," Robert Lane, M.D., executive vice president and physician-in-chief, said in a statement contained in the press release. "Making better informed decisions leads to better outcomes for our patients, families and our staff,” he added.
Recently, Healthcare Innovation Editor-in-Chief Mark Hagland interviewed Jennifer Watts, M.D., a pediatric emergency medicine physician and the hospital’s chief patient progression medical officer, and Stephanie Meyer, R.N., A.P.N., the hospital’s senior vice president and chief nursing officer, about the opening the hub and its ongoing evolution into the future. Below are excerpts from that interview.
Tell me about the origins of this initiative and the initial vision for it?
Stephanie Meyer, R.N., A.P.N.:
We’ve been working on the concept for about 14 years, but the technology had just not caught up to what we were wanting to do. This technology helps us watch patient flow from admission through discharge. In the future, we’ll have an ambulatory component as well. So once the technology caught up, we started doing the vendor-vetting; we had a soft launch opening in November, and April 24 was our hard launch.
Dr. Watts, what did you want this to be?
Jennifer Watts, M.D.: I wanted it to be an overlay of the enterprise, for transparency around our patients moving through the system, so we have better line of sight, from the time of call from the referring provider, to discharge. I hoped to have better line of sight, better of ability to know what’s happening, in order to improve pediatric outcomes. The other part I wanted to hone in on was the ability to do predictive analytics, to be proactive and to intervene before things start going downhill. If we can intervene before a child gets sick enough to end up in the ICU, so much the better. To intervene to have even better pediatric health outcomes than we have today. We have oversight of children moving through our system now. We are now working on the connection between quality and operations. We will be able to continue to evaluate and refine the quality measures that impact the patients.
I would imagine that the organization of this will help the nursing staff in a time of staffing shortages?
Meyer: It’s extremely helpful, it takes away some of the burden on the nurses of the administrative burden, so they can make sure a scan is happening on time, a lab is happening, if they have special discharge needs, we have visibility.
Watts: Our entire healthcare staff are seeing incredible rates of burnout and stress. We have staffing challenges, people leaving the field, that we’ve never had to deal with before. This adds to job satisfaction; it’s one of the KPIs we’re using to track that. We’ve found that when we opened the hub, people were excited; there was as spike of hope and energy; we’re reinvigorating our team. It’s exciting to see people being engaged again and finding meaning in their work. You have the patient interaction; but to see how you plug into a broader initiative, that’s something people saw for the first time. You’re also seeing ideas spark, new ideas, among people. So the excitement, the energy, are bringing all of our staff to the table to work together to develop new ideas and improve pediatric care as whole.
What kinds of operating differences exist in the pediatric setting versus the adult setting, around patient flow?
Watts: Some of it’s the same, the logistics of moving patients from Point A to Point B. But pediatrics requires—it’s the age-old line, they’re not just little adults. You can’t take what’s true in the adult world and apply it to pediatrics; they have different pathology, different clinical needs. The way we do things is a little bit different; we’re not as protocol-driven, because there are a lot of nuances that may not be at the surface when they come in. And there are a lot of quality issues that are different, too. So linking those pieces together an d being sure we incorporate them into operations, has been a challenge, but has also been exciting; it’s been exciting to see patient flow issues addressed in a pediatric hospital.
Meyer: While there are similarities between adult and pediatric care environments in this area, one of the biggest differences is that care involves the whole family. A kiddo can’t make a medical decision without the parent at the bedside. So care requires more strategy; it requires that everybody be a little more on point in understanding when mom and dad or whoever the caregiver is, might be here. So that’s one of the biggest things that’s different in pediatric flow. They also have different health disparities and challenges with regard to recovery, and with regard to access. We treat from 17 different countries and 39 different states. That require a lot of coordination.
Watts: And during our triple-demic, involving COVID-19, influenza, and the RSV virus, with the viral surge involved, we faced a lack of pediatric expertise available in multiple areas, and a decrease in available pediatric beds in outlying hospitals. We don’t have as much pediatric healthcare in some of those areas as we do for adults.
Also, inpatient pediatric care delivery involves a higher level of clinician staff intensity, and more clinicians per patient, correct?
Meyer: Yes, typically, it does. And we have 386 beds in our inpatient hospital.
That’s pretty large for a pediatric hospital, correct?
Meyer: Yes, it’s a full-sized system and hospital.
What have you learned since November, when you had your soft launch? Have you made any significant changes since then?
Meyer: We’ve learned quite a bit. One has been how to interact in a way that allows us to take real-time predictive analytics and use them in the moment. Normally, we’re waiting for data to come in or somebody to collate it. This allows us to move faster, particularly the discharge expediter.
Watts: We’ve also learned the amount of education that needs to happen to get our staff to interact with the tiles. It takes a lot of education, but also then going in and prioritizing what needs to be done next. Once somebody touches the system, that unleashes energy; the challenge is to prioritize things. We want to boil the ocean and do everything, but we have to prioritize it and do things in a methodical fashion. The other big challenge is to not add too much change at once to the organization. We’re at a time of high stress and burnout since COVID, and adding change can be very stressful on people.
Meyer: With the hard launch, we’re seeing this excitement, this rejuvenation of the clinical staff, coming back. We’re identifying successes and opportunities, and seeing some areas where we need to improve; but some areas what have knocked it out of the park.
Could you mention a few examples?
Some areas are really good at moving patients through the system, based on the collaboration among their care teams. On a unit where we might have a very proactive care manager, out on the rounds, interacting with physicians and nurses—that may not be replicated, depending on how they’re doing rounds. Their communication might be slightly different. One thing that works well, we can ask, is that something that we replicate in other areas?
What have been the biggest challenges so far?
Watts: One is that we don’t know what we don’t know, until we start uncovering. We’ve uncovered some things we didn’t expect. And getting people to change to new ways of thinking, and to be open to new opportunities, especially when everyone’s stressed and burned out; but those challenges also flip into phenomenal opportunities.
Meyer: The Hub has given us renewed energy. It’s really created an excitement, and a level of dedication, that gives people hope for the future.
One element in the challenge would be dealing with the change management involved, the process aspects, correct?
Watts: Absolutely. And we have a change management-focused team that has helped us a lot.
Have you made use of Lean or Six Sigma in the past?
Meyer: Yes, our main system of choice is Lean, and we incorporate Lean into our processes in the hospital. And we have a performance improvement team grounded in Lean principles.
You have to understand Lean principles to really develop something like this, correct?
Meyer: Agreed. And they’ve helped us understand the tools, and how we interact with the tiles. “Tile” is our term for an app.
Watts: GE takes our multiple technology systems and brings them all onto one platform and creates a user-friendly interface. So there are multiple tiles of what you might e looking at: Capacity Expediter (bed management), Patient Manager; Risk of Harm, per quality. The tile is an organization fashion. We also have Transfer Out—transfers from ICUs to the floors. And we’re also working to develop one around health equity.
You worked closely with your HIT people in developing this entire operations center, correct?
Watts: Absolutely. We had a large team. Stephanie and I lead the nursing-physician dyad. But MDs, nursing, EVS, IT, informatics, everyone—all the stakeholders were involved.
You have a CMIO, CNIO, involved?
Meyer: Yes, intimately involved.
Watts: The CMIO and CNIO have been heavily involved; but it’s not just the technology; it’s how you use it. But we have participation from all disciplines.
What advice might you give to the leaders of other patient care organizations who might follow in your footsteps?
Watts: I think that all of this has been great; it’s been exciting. And I hope to see more children’s hospitals move into this space. We’re opening up new opportunities. And the more additional children’s hospitals who join us on the journey, the more we can improve pediatric care. We have the goal of improving kids’ health.
Meyer: Tactically, I would add, we had frontline staff involvement from the very beginning—nurses, physicians, IT, everyone. Everyone was involved with the platform, with the development of the tiles. You can throw the technology up, but if people don’t use it, there’s no point.
